Passive-active immunisation of neonates of HBsAg positive carrier mothers: preliminary observations.

Abstract

Screening of pregnant women for hepatitis B surface antigen (HBsAg) in three areas of Holland led to the identification of HBsAg carriers, 20 of whom were subsequently delivered. Within two hours after birth all infants received hepatitis B immune globulin (0-5 ml/kg body weight) and, after randomisation, hepatitis B vaccine (10 ,tg) was given either at 0, 1, and 2 months of age or at 3, 4, and 5 months of age, the latter concomitantly with DPTP vaccination. Eighteen infants complying with the protocol were followed up for at least six months. No side effects were observed after either passive or active immunisation. All infants developed high concentrations of anti-HBs antibodies; no interference of high dose passive immunisation with active immunisation was observed. Concentrations of anti-HBs at three months were significantly lower in infants

Proposal for routine antenatal screening at 14 weeks for hepatitis B surface antigen

“…All blood samples positive for hepatitis B surface antigen were also tested for hepatitis B e antigen and its antibody (Abbott Laboratories). An additional blood sample from the women positive for hepatitis B surface antigen was obtained at delivery to verify the eligibility of their infants for passive-active immunisation 4 5 6. The presence of hepatitis B surface antigen in expectant mothers was checked in the delivery rooms in Rotterdam.…”

“…This study lasted seven years and preliminary results have already been reported 4 5 6. The final results of routine antenatal screening for hepatitis B surface antigen in pregnant women, reported here, led to a proposal for universal screening in the Netherlands; a national programme for such screening was subsequently implemented.…”

Reduced doses of hepatitis B immune globulin in the prevention of perinatal transmission of hepatitis B

“…These infants were still susceptible to HBV, and a substantial portion of them will become HBsAg carriers after HBV infection [Beasley and Hwang, 19831. Because of the transient protection yielded by HBIG alone and the inadequate efficacy of hepatitis B vaccine alone (Lee, Hwang, Beasley, unpublished observations, 1985), many investigators have started the regimen of HBIG plus hepatitis B vaccine in blocking perinatal HBV transmission [Wong et al, 1984;Maze1 et al, 1984;Tada et al, 1982;Chung et al, 1985;Kanai et al, 1985;Piazza et al, 1985;Lo et al, 19851. With HBeAg-positive mothers, our government has adopted the policy of giving 0.5 ml of HBIG to the newborns as soon as possible after birth, followed by four doses of hepatitis B vaccine: at 1 week, 5 weeks, 9 weeks, and 12 months of age [The Hepatitis Control Committee and the Epidemiology Division of the Department of Health, 19851.…”

HBsAg-Serum Protein Complexes Stimulate Immune T Lymphocytes More Efficiently Than Do Pure HBsAg

“…In view of the present studies and our previous findings (24,25) that antigens become more potent immunogens of T cells in uitro when they are linked to antibodies, the minute contaminating HBsAg in these HBIG preparations may have formed immune complexes that became sufficiently immunogenic to induce host's production of anti-HBs. It was shown in another set of studies that the combined administration of HBsAg vaccine and HBIG to newborns of chronic HB carrier (HBeAg+) mothers was far more effective than either the vaccine or HBIG alone in preventing perinatally transmitted HBV infection and the chronic carrier state (53)(54)(55)(56)(57)(58)(59)(60). The effects of HBIG are generally ascribed to its role in passive immunization.…”