Immunoprophylaxis Failure of Infants Born to Hepatitis B Carrier Mothers Following Routine Vaccination

Cheung, Ka Wang; Seto, Mimi Tin Yan; Kan, Anita Sik Yau; Wong, Daniel R.; Kou, K.; So, Po Lam; Lau, Wai Lam; Jalal, Khair; Chee, Yuet Yee; Wong, Rosanna Ming Sum; Lee, Chin Peng; Ng, Ernest Hung Yu

doi:10.1016/j.cgh.2017.07.013

Cited by 45 publications

(43 citation statements)

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“…The optimal threshold and timing to start antiviral treatment to prevent immunoprophylaxis failure remains controversial. Our previous work showed the risks of immunoprophylaxis failure with maternal HBV DNA level of <7.2, 7.2‐8.2 or >8.2 log 10 IU/mL were 0%, 8.6% and 3.1%, respectively, in 641 pregnancies . The risk of immunoprophylaxis failure with borderline viral load of 5‐7 log 10 IU/mL has also been reported .…”

Section: Discussionmentioning

confidence: 90%

“…This was a secondary analysis of a prospective study carried out at the antenatal units in five public hospitals in Hong Kong . HBV carriers were identified by positive hepatitis B surface antigen (HBsAg) status examined at booking visit.…”

Section: Methodsmentioning

confidence: 99%

“…Vertical transmission is a major source of HBV infection, as more than 90% of perinatally infected infants will become chronic carriers . Immunization to the infants of HBV carriers can effectively prevent vertical transmission; however, 1%‐4% of infants still suffer from persistent HBV infection after immunization . The risk of immunoprophylaxis failure depends on the maternal HBV viral load during pregnancy and is greatly reduced by antiviral treatment during the third trimester .…”

Section: Introductionmentioning

confidence: 99%

“…3 Immunization to the infants of HBV carriers can effectively prevent vertical transmission; 4 however, 1%-4% of infants still suffer from persistent HBV infection after immunization. [5][6][7][8][9] The risk of immunoprophylaxis failure depends on the maternal HBV viral load during pregnancy and is greatly reduced by antiviral treatment during the third trimester. 10,11 Various authorities have published recommendations on the viral load threshold to initiate antiviral treatment, but the timing of viral load quantification during pregnancy is not well defined.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] HBV DNA level at 28-30 weeks can predict the risk of immunoprophylaxis failure. 9 However, maternal HBV DNA quantification and antiviral treatment in the third trimester raises the theoretical concern of inadequate viral load suppression. In particular, highly viremic carriers are at higher risk of preterm birth.…”

Section: Introductionmentioning

confidence: 99%

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Optimal timing of hepatitis B virus DNA quantification and clinical predictors for higher viral load during pregnancy

Cheung

Seto

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Authorities publish recommendations on the hepatitis B virus (HBV) viral load threshold to initiate antiviral treatment but the timing of quantification during pregnancy is not well defined. HBV DNA levels in pregnancy women at 28‐30 weeks predict the risk of immunoprophylaxis failure. This study compared and evaluated the correlation between HBV DNA levels before 22 and 28‐30 weeks’ gestation. Clinical predictive factors for HBV DNA >6, 7 and 8 log10 IU/mL were studied. Material and methods A retrospective analysis of HBV DNA levels of women <22 and 28‐30 weeks of gestation was carried out in 352 pregnant HBV carriers. HBV DNA was examined using the COBAS TaqMan HBV Monitor Test coupled with the COBAS Ampliprep extraction system (Both Roche Diagnostics, Branchburg, NJ, USA). Results A strong positive correlation was found between the viral loads of women <22 weeks (mean 16.7 weeks) and 28‐30 weeks of gestation, which was independent of the viral load level and gestational age of quantification (r = 0.942, P < 0.001). Univariate analysis showed that positive hepatitis B e antigen (HBeAg), maternal age <35 years old and body mass index ≤21 kg/m2 were associated with a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). These factors were also associated with a higher chance of viral load >6, 7 and 8 log10 IU/mL at 28‐30 weeks (P < 0.05). In multiple regression analysis, only the viral load of <22 weeks and positive HBeAg remained predictive of a higher mean viral load at 28‐30 weeks of gestation (P < 0.05). The receiver operating characteristic curve showed that the HBV DNA of <22 weeks was an excellent predictor for different viral load cut‐offs at 28‐30 weeks. The area under curve was 0.986, 0.998 and 0.994 for viral load 6, 7 and 8 log10 IU/mL, respectively. Conclusions HBV DNA quantification should be performed before 22 weeks of gestation. Viral load cut‐offs similar to those at 28 weeks can be used to determine immunoprophylaxis failure at earlier gestation. Maternal positive HBeAg status was associated with a higher chance of viral load >6, 7 or 8 log10 IU/mL.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%