Protective Effect of Hepatitis B Vaccine Combined with Two-Dose Hepatitis B Immunoglobulin on Infants Born to HBsAg-Positive Mothers

Abstract

BackgroundDespite the use of hepatitis B (HB) vaccine and hepatitis B immunoglobulin (HBIG), a portion of infants are still non- or low-responders, or even immunoprophylaxis failure. We aimed to determine the immune response in the infants from the mothers being positive for hepatitis B surface antigen (HBsAg), by which the infants received three doses of HB vaccine in combination with two-dose 200 IU HBIG injections.MethodsIn this retrospective study, 621 infants from HBsAg-positive mothers in Beijing YouAn Hospital between January 2008 and December 2009 were included. All the infants were given three doses of 10 µg HB vaccine (at 0, 1 and 6 months of age) and two-dose of 200 IU HBIG (at birth and in 2 weeks of age). Serum HBsAg and antibody to HBsAg (anti-HBs) in all the infants were determined at 7 months of age.ResultsOf the 621 infants, 2.9% were immunoprophylaxis failure (positive for HBsAg), 1.4% were non-responders (anti-HBs undetectable), 95.7% were responders. The 594 responders could be categorized into three subsets, 22 were 10 to 99 IU/L for anti-HBs levels, 191 were 100 to 999 IU/L, and 381 were ≥1000 IU/L. The immunoprophylaxis failure rate was at 0% and 5.2% for the infants of HBeAg-negative and HBeAg-positive mothers(P<0.001). Infants from mothers with detectable HBV DNA had higher incidence of immunoprophylaxis failure than those of mothers without detectable HBV DNA (P = 0.002). The factors including gender, birth weight, gestation weeks, the rates of maternal HBeAg-positive, and detectable HBV DNA did not contribute to the no response to HB vaccination.ConclusionsThrough vaccination by three doses of HB and two-dose of HBIG, majority of the infants (95.7%) achieved a protective level of anti-HBs at 7 months of age. Maternal HBeAg-positive and HBV DNA detectable were associated with the immunoprophylaxis failure, but not contribute to the non- or low-response to HB vaccination.

Breastfeeding Is Not a Risk Factor for Mother-to-Child Transmission of Hepatitis B Virus

“…HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; anti-HBc, antibody against hepatitis B core antigen; aOR, adjusted odds ratio; CI, confidence interval.*Including all the factors different (with a P<0.20) between the breastfed and formula-fed children except the mother's age, as which is not associated with the mother-to-child transmission of HBV [16].…”

“…*Including all the factors different (with a P<0.20) between the breastfed and formula-fed children except the mother's age, as which is not associated with the mother-to-child transmission of HBV [16].…”

Seroprevalence of hepatitis B surface antigen and hepatitis B e antigen among childbearing-age women in Mianyang, China

“…HBV infection is not just a risk for childbearing-age women; women with HBV infection can transmit the HBV to their newborns, children or other household members, and sexual partners or spouses by vertical, horizontal, and sexual transmission. Vertical transmission contributes significantly to the persistence of plentiful chronic HBV infections [7] and cannot be totally blocked by immunoprophylaxis for newborns [11]. The Chinese government has formulated some strategies to reduce HBV infections, including screening for HBsAg during pregnancy, immunizing high-risk populations, managing blood products, encouraging condom use, and following standard medical practices [22][23][24].…”

“…For these newborns, postexposure prophylaxis with hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 24 hours of birth have been recommended to tremendously reduce the prevalence of HBV infection [3]. However, the incidence of immunoprophylaxis failure still remains [11]. Both HBsAg-positive and HBeAgpositive mothers more easily transmit the viruses to their newborns than do mothers who are only HBsAg positive [12,13].…”

Economic evaluation on infant hepatitis B vaccination combined with immunoglobulin in China, 2013

“…In 2011, China changed the HepB dosage form to 10mg/0.5ml/dosage to improve vaccine immunogenicity. Joint HBV immune prophylaxis with HepB vaccine and hepatitis B immunoglobulin (HBIG) after birth could generally interrupt HBV MTCT, [3][4][5] and it is recommended by the World Health Organization (WHO), the World Gastroenterology Organization (WGO), and the US Centers for Disease Control and Prevention (CDC). At the end of 2010, China implemented a program for preventing mother-to-child transmission (PMTCT) of HIV, syphilis, and hepatitis B, where all children born to HBsAg positive mothers could receive free 100IU HBIG at birth.…”