Maternal anti‐HBVs suppress the immune response of infants to hepatitis B vaccine

Abstract

It is still controversial whether maternal anti-HBV antibodies (anti-HBVs) affect the infants' immune response to hepatitis B virus (HBV) vaccination. This multicentre study aims to address this question. First, we determined whether the transplacental transfer of maternal anti-HBVs occurs by measuring the titres of 90 anti-HBVs-positive pregnant women and their newborns. The anti-HBVs-positive rates of newborns ranged from 89.7% to 100.0%, depending on the maternal anti-HBVs titres. Secondly, we investigated the effects of maternal anti-HBVs on the immune response of infants to HBV vaccination. A total of 1063 mother-and-infant pairs were enrolled and divided into three groups with maternal anti-HBVs titres of <10 IU/L (negative - 37.9%), 10-499 and ≥500 IU/L. The infants' anti-HBVs-positive rate and titres were negatively correlated with maternal anti-HBVs titres: the anti-HBVs-positive rate of infants were 88.9% (360/405), 84.5% (381/451) and 77.3% (160/207) in mothers with low, intermediate and high antibody titres, respectively, P<.0001. Median titres of anti-HBVs (IU/L) among infants were 169.1, 141.0 and 79.4, respectively, P=.020. One hundred and sixty-two infants were negative for anti-HBVs after the standard vaccination, and 120 of 131 of these infants (91.6%) reached anti-HBVs positivity after the first "booster" dose. The maternal anti-HBVs titres did not significantly affect infant response to this booster. In summary, transplacental transfer of anti-HBVs occurs and high titres of maternal anti-HBVs may suppress the immune response of infants to the standard HBV vaccination. The current schedule of the 0, 1 and 6 month may not be the optimal choice of infants with anti-HBVs-positive mothers.

Antibody response to hepatitis B vaccine in HIV‐exposed infants in Malawi and correlation with HBV infection acquisition

“…There have been suggestions that HBV antigens/antibodies can influence the immune response of infants to hepatitis B vaccine . In our study there were no significant differences in anti‐HBs levels between HBV‐exposed and unexposed infants although at 24 months there was a trend towards a lower level in the HBV‐exposed suggesting that further data are needed to determine if different strategies are needed for these infants.…”

“…This is particularly important for infants born to HIV‐positive mothers in whom a decreased response could be observed and in whom HBV transmission may more frequently occur due to high HBV‐DNA levels in co‐infected mothers . Maternal HBV co‐infection could also be potentially associated with a lower response to HBV vaccine since maternal specific antibody can interfere with the infant's own response to vaccination …”

“…6,7 Maternal HBV co-infection could also be potentially associated with a lower response to HBV vaccine since maternal specific antibody can interfere with the infant's own response to vaccination. 8 We conducted this study in a cohort of HIV-exposed children in Malawi, a country with an HBV seroprevalence of about 8%, 9 where the HBV vaccine has been introduced since more than 10 years with a high vaccine coverage. 10 This study had the following objectives: (i) To determine the proportion of children with protective anti-HBs response at 6, 12, and 24 months of age; (ii) To identify possible factors associated with a low vaccine response; (iii) To correlate the specific antibody response to HBV infection acquisition.…”

Non-specific effects of maternal and offspring rabies vaccination on mortality and antibiotic use in a Danish pig herd: A randomized trial

“…For live measles vaccine, vaccination in the context of passive immunity is known to dampen the specific humoral response to vaccination [31]. Such attenuating effect of maternally-derived antibodies on human infant humoral vaccine responses has also been observed for the non-live viral vaccines inactivated polio vaccine [32] and hepatitis B vaccine [33], and this is corroborated by a series of animal experimental studies [31], including studies in pigs of non-live Haemophilus parasuis immunization [34]. In humans and pigs alike, the development of active cellmediated immunity may not be compromised by the presence of maternal immunity despite blunted humoral responses, as observed for Mycobacterium hyopneumoniae vaccination of piglets from immunized dams [35] or live measles vaccine in humans [31].…”

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

“…A large multicenter study by Chen et al of 1,063 mothers who were HBsAg−/anti‐HBs+ and their infants showed a strong negative correlation between maternal anti‐HBs and infant anti‐HBs titers in vaccinated infants. Further, up to 23% of infants born to mothers with protective anti‐HBs titers >10 IU/L did not respond to the standard vaccination series.…”