Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth

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doi:10.1542/peds.2017-1870

Cited by 56 publications

(17 citation statements)

References 19 publications

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“…Our findings are consistent with WHO recommendation that infants should receive HBvacc-BD as soon as possible from the time of and within 24 h of birth. The American Academy of Pediatrics endorses the recommendation to administer both HBvacc and HBIG within 12 h of birth, regardless of any maternal antenatal treatment with antiviral medication [20]. Our results provide additional evidence to verify the importance of timely HBvacc-BD and demonstrate a need to update the current national guidelines recommendation to a requirement for vaccination within 12 h of birth [8].…”

Section: Discussionmentioning

confidence: 65%

“…WHO recommends that infants born less than 2000 g should be given HBvacc-BD, but that the dose should not count as part of the primary three-dose HBvacc [31]. The US guidelines recommend that infants of all birth weights born to HBsAg-positive mothers receive both the HBvacc and HBIG within 12 h of birth [20]. In China, the 2016 National EPI guidelines similarly require HBvacc-BD regardless of birth weight for HBV-exposed infants, followed by the three-dose HBvacc series [8].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016–2017

Qiao

Yao³

et al. 2019

Infect Dis Poverty

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Background In addition to providing free hepatitis B vaccine (HBvacc) series to all infants in China since 2005, the national programme on prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) started providing free hepatitis B immunoglobulin for all new-borns born to hepatitis B surface-antigen (HBsAg) positive mothers in 2010. However, few studies have evaluated the effectiveness of the PMTCT programme. Therefore, we aimed to investigate the outcomes of the programme and identify associated factors. Method Using a cross-sectional study design, we collected data on 4112 pairs of HBsAg-positive mothers and their children aged 7–22 months in four representative provinces through interviews and medical record review. We tested HBsAg and hepatitis B surface antibody (anti-HBs) of children by enzyme-linked immunosorbent assay at designated maternal and child hospital laboratories. We used logistic regression to analyse factors associated with child HBsAg and anti-HBs positivity. Results Thirty-five children were HBsAg positive, indicating the mother-to-child transmission (MTCT) rate was 0.9% (0.6–1.1%). The anti-HBs positive rate was 96.8% (96.3-97.4%). Children receiving HBvacc between 12 and 24 h of birth were 2.9 times more likely to be infected than those vaccinated in less than 12 h (adjusted odds ratio [a OR ] = 2.9, 95% confidence interval [ CI ]: 1.4–6.3, P = 0.01). Maternal hepatitis B e-antigen (HBeAg) positivity was associated with higher MTCT rate (a OR = 79.1, 95% CI : 10.8–580.2, P < 0.001) and lower anti-HBs positive rate (a OR = 0.4, 95% CI : 0.3–0.6, P < 0.001). Children with low birth weight (LBW) were 60% less likely to be anti-HBs positive than those with normal birth weight (a OR = 0.4, 95% CI : 0.2–0.8, P = 0.01). Conclusions The MTCT rate was lower than the 2030 WHO elimination goal, which implies the programme is on track to achieve this target. As earlier HBvacc birth dose (HBvcc-BD) was associated with lower MTCT rate, we suggest that the PMTCT programme work with the Expanded Programme on Immunization (EPI) to modify the current recommendation for early HBvcc-BD to a requirement. Our finding that LBW was associated with lower anti-HBs positivity points to the need for further studies to understand factors associated with these risks and opportunities for program strengthening. The programme needs to ensure providing essential test to identify HBeAg-positive mothers and their infants and provide them with appropriate medical care and follow-up. Electronic supplementary material The online version of this article (10.1...

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016–2017

Qiao

Yao³

et al. 2019

Infect Dis Poverty

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“…Hepatitis B vaccine is an alum-adjuvanted vaccine containing hepatitis B surface antigen (HBsAg). The alum-adjuvanted HBV is given within the EPI (Table 1 ) and also in Australia, Europe, and United States, where a birth dose is recommended ( 28 ). With respect to innate immune activation, while the Alum adjuvant present in HBV may engage the inflammasome, HBsAg also interacts with CD14 to activate dendritic cells ( 29 ).…”

Section: Proof Of Concept: Routine Neonatal Vaccinesmentioning

confidence: 99%

Neonatal Immunization: Rationale, Current State, and Future Prospects

2018

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Infections take their greatest toll in early life necessitating robust approaches to protect the very young. Here, we review the rationale, current state, and future research directions for one such approach: neonatal immunization. Challenges to neonatal immunization include natural concern about safety as well as a distinct neonatal immune system that is generally polarized against Th1 responses to many stimuli such that some vaccines that are effective in adults are not in newborns. Nevertheless, neonatal immunization could result in high-population penetration as birth is a reliable point of healthcare contact, and offers an opportunity for early protection of the young, including preterm newborns who are deficient in maternal antibodies. Despite distinct immunity and reduced responses to some vaccines, several vaccines have proven safe and effective at birth. While some vaccines such as polysaccharide vaccines have little effectiveness at birth, hepatitis B vaccine can prime at birth and requires multiple doses to achieve protection, whereas the live-attenuated Bacille Calmette–Guérin (BCG), may offer single shot protection, potentially in part via heterologous (“non-specific”) beneficial effects. Additional vaccines have been studied at birth including those directed against pertussis, pneumococcus, Haemophilus influenza type B and rotavirus providing important lessons. Current areas of research in neonatal vaccinology include characterization of early life immune ontogeny, heterogeneity in and heterologous effects of BCG vaccine formulations, applying systems biology and systems serology, in vitro platforms that model age-specific human immunity and discovery and development of novel age-specific adjuvantation systems. These approaches may inform, de-risk, and accelerate development of novel vaccines for use in early life. Key stakeholders, including the general public, should be engaged in assessing the opportunities and challenges inherent to neonatal immunization.

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“…The risk of infection in preterm (PT) infants increases nine-fold when compared to their full term (FT) counterparts (2)(3)(4)(5) and correlates inversely with gestational age (6); furthermore, PT infants face an increased risk of VPDs emphasizing importance of vaccination (7,8). It is generally recommended that the preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants with the only exception of birth dose of hepatitis B vaccine, to be administered to babies weighing > 2000 g (9,10). In view of premature immunity and introduction of more and more immunogens at/around one time, it is of utmost importance to verify if the preterm babies generate satisfactory immune response to all the vaccine components.…”

Section: Introductionmentioning

confidence: 99%

Immune Response of Indian Preterm Infants to Pentavalent Vaccine Varies With Component Antigens and Gestational Age

et al. 2021

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Childhood vaccination plays critical role in protecting infants from several dreaded diseases. Of the global 15 million preterm (PT) infants with compromised immune system born annually, India contributes to >3.5 million. Generation of adequate vaccine-induced immune response needs to be ensured of their protection. Immune response of Indian PT (n = 113) and full-term (FT, n = 80) infants to pentavalent vaccine administered as per the national recommendation was studied. Antibody titers against component antigens of pentavalent vaccine, immune cells profiling (T and B cells, monocytes and dendritic cells) and plasma cytokines were determined pre- and post-vaccination. Additionally, cell-mediated recall immune responses to pentavalent antigens were evaluated after short time antigenic exposure to infant PBMCs. Irrespective of gestational age (GA), all the infants developed adequate antibody response against tetanus, diphtheria, and protective but lower antibody levels for Haemophilus influenzae type-b and hepatitis B in preterm infants. Lower (~74%) protective antibody response to pertussis was independent of gestational age. PT-infants exhibited lower frequencies of CD4 T cells/dendritic cells/monocytes, increased plasma IL-10 levels and lower proliferation of central and effector memory T cells than in term-infants. Proliferative central memory response of FT-infants without anti-pertussis antibodies suggests protection from subsequent infection. Responder/non-responder PT-infants lacked immunological memory and could be infected with Bordetella. For hepatitis B, the recall response was gestational age-dependent and antibody status-independent. Humoral/cellular immune responses of PT-infants were dependent on the type of the immunogen. Preterm infants born before 32 weeks of gestation may need an extra dose of pentavalent vaccine for long lived robust immune response.

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Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth

Cited by 56 publications

References 19 publications

Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016–2017

Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016–2017

Neonatal Immunization: Rationale, Current State, and Future Prospects

Immune Response of Indian Preterm Infants to Pentavalent Vaccine Varies With Component Antigens and Gestational Age

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