Virologic factors associated with failure to passive–active immunoprophylaxis in infants born to HBsAg‐positive mothers

Abstract

In infants born to hepatitis B surface antigen (HBsAg)-positive mothers, failure after passive-active immunization still occurs. The role of maternal hepatitis B DNA level and other risk factors in this setting remains unclear. This study retrospectively evaluated virologic and other risk factors associated with immunoprophylaxis failure in infants born to HBsAg-positive mothers. Between January 2007 and March 2010, we reviewed the clinical and virologic tests in 869 mother-infant pairs. All infants received the identical passive-active immunization schedule after birth. The failure infants (HBsAg positive at 7-12 months of age) were compared to infants who were HBsAg negative when tested during this time period. Among 869 infants, 27 (3.1%) infants were immunoprophylaxis failures and the other 842 (96.9%) infants remained HBsAg negative. When mothers' pre-delivery HBV DNA levels were stratified to <6, 6-6.99, 7-7.99 and ≥ 8 log(10) copies/mL, the corresponding rates of immunoprophylaxis failure were 0%, 3.2% (3/95), 6.7% (19/282) and 7.6% (5/66), respectively (P < 0.001 for the trend). All failure infants were born to hepatitis B e antigen (HBeAg)-positive mothers. Multivariate logistic regression analysis identified maternal HBV DNA levels [odds ratio (OR) = 1.88, 95% confidence interval (CI): 1.07-3.30] and detectable HBV DNA in the cord blood (OR = 39.67, 95% CI: 14.22-110.64) as independent risk factors for immunoprophylaxis failure. All failure infants were born to HBeAg-positive mothers with HBV DNA levels ≥ 6 log(10) copies/mL. The presence of HBV DNA in cord blood predicted failure to passive-active immunization.

PROPORTION OF HBsAg AND HBeAg POSITIVE IN MATERNAL PATIENTS AND THEIR HBsAg POSITIVES BABIES WITH IMMUNOPROPHYLAXIS OF HBV IMMUNIZATION IN Dr. SOETOMO GENERAL HOSPITAL, SURABAYA

“…The existence of HBV DNA in cord blood also reflects the failure to respond passive and active immunization. 20 From the result in this study, there was no tendency of transmission of HBV through certain delivery technique, same as in Hu et al (2013) study which stated that if hepatitis B vaccine and HBIG were given immediately after birth, the choice of labor procedure didn't determine the tendency of HBV transmission.…”

Chronic Hepatitis B Virus Infection and Pregnancy

“…31 Although, maternal HBeAg positivity has been suggested as an independent risk factor for mother to infant transmission, 32 this finding has not been confirmed by other studies. 33,34 In a study from China, in 54 mother-infant pairs (33 mothers were HBeAg positive, and 21 HBeAg negative; all babies received passive-active immunoprophylaxis with hepatitis B immune globulin and hepatitis B vaccine), 70% (23/33) of neonates from HBeAg-positive mothers were HBeAg positive at birth compared with 0% (0/21) of neonates from HBeAg-negative mothers. HBeAg was present at higher titer in the birth sera of the babies with HBV breakthrough than in babies without breakthrough.…”

Risks of Viral Hepatitis B Transmission in Mother-to-Infant of Pregnant Women Carriers of Chronic Viral Hepatitis B in Cote d’Ivoire

“…Some authors consider that the vertical transmission risk is high when the DNA VHB > 2.105 UI/ml [33]. This transmission risk reaches 28% to 50% for a viral load > 2.108 UI/ml [1] [6]. Other authors in an Asian study, evaluated the significant transmission risk from a DNA of VHB about 7 -8 Log UI/ml [34].…”

“…Several more recent studies [6] have shown that the predictive factors of transmission risk of VHB in mother-to-baby were: the high viral load in the mother during child labour, the carrying of Bhe Ag in mother, the long time during delivery. The objective is to list the risk factors of the mother-to-child transmission of VHB in Hbs Ag positive pregnant women in Cote d'Ivoire.…”

“…In Cote d'Ivoire, this one goes from 8% to 10% [4] [5]. The infection through the VHB often occurs very early in childhood with a chronic carrying risk of the virus in about 90% of cases [6]. Vertical motherto-infant transmission is the cause of one third of the chronic infection B [7].…”