Perinatal
HBV Transmission May Occur Despite Newborn Vaccination and Immune
Globulin
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| SUMMARY:
Babies born to mothers with hepatitis B virus (HBV)
infection may become persistently infected even if
they receive a combination of active and passive immunization
using the HBV vaccine and hepatitis B immune globulin
(HBIG), according to a Dutch study published in the
December
29, 2009 advance online edition of the Journal
of Viral Hepatitis. These findings suggest
that children born to women with hepatitis B should
be monitored for infection beyond 1.5 years. |
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By
Liz Highleyman
In
the Netherlands, as in most developed countries, babies born
to mothers with hepatitis B
are typically immediately given both an injection of antibodies
against HBV (known as passive immunization) and the first of
a series of at least 3 HBV vaccinations (known as active immunization,
because the baby's immune system is stimulated to produce its
own antibodies).
But
this prevention strategy may not be as effective as believed,
based on findings from a study by H.J. Boot from the Dutch Centre
for Infectious Diseases Control and colleagues.
The investigators looked at outcomes among 1743 infants born
to hepatitis B surface antigen (HBsAg) positive women between
January 2003 and July 2007. As newborns, the children received
passive immunization with HBIG and at least 3 active vaccinations.
Serological testing for the presence of HBV markers was offered
after completion of the vaccination series, which typically
occurs by 18 months of age; children were followed for up to
5 years.
Results
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12
of the 1743 babies (0.7%) were found to be HBV infected.
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In
addition, 3 older children were found to have high levels
of hepatitis B core antibodies (anti-HBc), surface antibodies
(anti-HBs), and "e" antibodies (anti-HBe), but
were HBsAg and HBV DNA negative (evidence of resolved or
spontaneously cleared HBV infection). |
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Among
728 older children (1.5 to 5 years of age), about half of
the HBV-infected children (3 of 7) had already cleared infection
by the time samples were collected. |
These
findings led the investigators to conclude, "For a proper
evaluation of the efficacy of a new intervention program to
prevent vertical HBV transmission, it is also important to analyze
the HBV markers in serum collected when the children are older
than 1.5 years."
"In a programmatic setting, all children born to HBV-infected
mothers should be tested not only for the level of anti-HBs
but also for the absence of HBsAg, because 2 of the 12 HBV-infected
children (17%) had a high level of anti-HBs," they advised.
In related news, the Netherlands Society of Gastroenterology
recently issued a recommendation that pregnant women with a
high HBV DNA level during the third trimester should receive
antiviral therapy in an effort to lower their viral load and
thereby reduce the risk of perinatal HBV transmission. U.S.
guidelines, however, do not recommend this approach.
Laboratory
for Infectious Diseases & Perinatal Screening and Epidemiology
& Surveillance Unit, Dutch Centre for Infectious Diseases
Control, National Institute for Public Health and the Environment
(RIVM), Bilthoven, Netherlands; Expertise Centre for Methodology
and Information Services, National Institute for Public Health
and the Environment, Bilthoven (RIVM), Netherlands; Department
of Medical Microbiology, Utrecht University Medical Centre (UMCU),
Utrecht, Netherlands.
2/5/10
Reference
HJ
Boot, S Hahne, J Cremer, and others. Persistent and transient
hepatitis B virus (HBV) infections in children born to HBV-infected
mothers despite active and passive vaccination. Journal of
Viral Hepatitis (Abstract).
December 29, 2009 (Epub ahead of print).
