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Hepatitis B infection in infants after neonatal immunization
Insights
This study on preventing hepatitis B infection in newborns found that while some babies have natural protection, hepatitis B vaccine immunization is highly effective. Adding hepatitis B immune globulin (HBIG) further improved protection rates.
Area of Science:
- Hepatology
- Immunology
- Pediatrics
Background:
- Hepatitis B virus (HBV) infection poses a significant risk to newborns born to carrier mothers.
- Effective prevention strategies are crucial to reduce the burden of chronic hepatitis B.
Purpose of the Study:
- To evaluate the efficacy of hepatitis B vaccine, with and without hepatitis B immune globulin (HBIG), in preventing chronic hepatitis B infection in infants born to HBeAg-positive carrier mothers.
- To determine the overall protection rates conferred by natural immunity, vaccination alone, and combined vaccine-HBIG strategies.
Main Methods:
- A double-blind, randomized, placebo-controlled trial involving 235 infants.
- Infants received heat-inactivated hepatitis B vaccine, with Group I receiving multiple HBIG doses, Group II a single HBIG dose, and Group III only the vaccine.
- Follow-up extended to three years to assess chronic infection and other hepatitis events.
Main Results:
- Chronic infection rates were 6.7% (Group I), 4.7% (Group II), and 1.6% (Group III) after three years.
- Natural protection was observed in 30% of infants.
- Vaccine alone protected 46%, single-dose HBIG added 10% protection, and multiple HBIG doses added 5% protection.
- Intrauterine infection occurred in 2%, and 7% failed to respond to immunization.
Conclusions:
- A significant proportion of infants born to hepatitis B carriers possess natural protection.
- Hepatitis B vaccination is a highly effective primary prevention method.
- The addition of HBIG, particularly multiple doses, offers incremental protection, but a notable percentage of infants may not respond to intensive immunization schedules.
Abstract:
A double-blind randomized placebo-controlled study to prevent hepatitis B infection in 235 babies born to chronic hepatitis B, HBeAg carriers was carried out. Babies in three treatment groups all received heat-inactivated hepatitis B vaccine. In addition multiple doses of HBIG and a single dose of HBIG were given in groups I and II respectively. After three years of follow-up, 4/60 (Group I), 3/64 (Group II), and 1/64 (Group III) developed chronic infection. For those who escaped chronic infection, other hepatitis events also occurred. They were transient HBs-antigenaemia, anti-HBc conversion and significant rise in anti-HBs titre without seroconversion for anti-HBc. It was deduced that 30% of babies born to hepatitis carriers are naturally protected from chronic infection. Immunization, with vaccine only, protects another 46%. The addition of single and multiple doses of HBIG protects another 10% and 5%, respectively. 2% acquired intrauterine infection and 7% failed to respond to the most intensive immunization schedule.