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Hepatitis B Postexposure Prophylaxis in Preterm and Low-Birth-Weight Infants
Markus Waitz1, Reinhard Hopfner1, Helmut D Hummler1
1Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, University of Ulm, Germany.
Insights
Hepatitis B immunoprophylaxis in very low-birth-weight infants is not standardized. While some infants show low antibody levels, infection rates are low, suggesting further research is needed for optimal infant immunization schedules.
Area of Science:
- Neonatal immunology
- Hepatitis B virology
- Vaccine efficacy
Background:
- Hepatitis B surface antigen (HBsAg)-positive mothers pose a risk of perinatal transmission to infants.
- Current recommendations for immunoprophylaxis in low-birth-weight (LBW) infants are inconsistent.
- This study reviews postexposure immunoprophylaxis outcomes in HBsAg-exposed preterm and LBW infants.
Observation:
- A literature review identified studies on HBsAg-exposed preterm and LBW infants who completed vaccine schedules.
- Antibody response data were analyzed for 31 LBW infants and 49 preterm infants.
- Follow-up data revealed low anti-HBs antibody levels in 29% of LBW infants and low HBsAg positivity rates (10-12%) in preterm and LBW infants.
Findings:
- Heterogeneity in immunization schedules and limited data on transmission rates hinder definitive conclusions.
- A small proportion of LBW and preterm infants exhibited suboptimal antibody responses or remained HBsAg-positive.
- One study reported no infections among 26 very LBW infants exposed to HBsAg.
Implications:
- Optimal postexposure prophylaxis for HBsAg-exposed LBW infants requires further investigation.
- A proposed immunization schedule includes active and passive immunization at birth, followed by three active doses (0-1-2-12 month schedule).
- Prospective studies are essential to establish evidence-based guidelines for preventing Hepatitis B transmission in vulnerable infant populations.
Abstract:
Objective Recommendations for immunoprophylaxis in low-birth-weight (LBW) infants born to hepatitis B surface antigen (HBsAg)-positive mothers vary. We successfully immunized an HBsAg-exposed infant (birth weight: 400 g) and performed a literature review on the outcome of postexposure immunoprophylaxis in HBsAg-exposed preterm and LBW infants. Methods By use of PubMed we identified articles relevant to the topic. Studies were included if the intended vaccine schedule was completed and follow-up data were reported. Results Antibody response was reported in 31 LBW infants (birth weight < 2,500 g) and 49 infants with gestational age of < 38 weeks. Low anti-HBs antibody levels (< 100 IU/L) were found in 9 (29%) of the 31 LBW infants. Overall, 2 of 20 (10%) preterm infants and 2 of 17 (12%) LBW were HBsAg-positive on follow-up. In one study, none of the 26 exposed very LBW infants became infected. Conclusion Due to heterogeneity in immunization schedules, lack of information on transmission rates, and the small number of included subjects, no firm conclusions can be drawn regarding the optimal postexposure prophylaxis in LBW infants. We propose that active and passive immunization at birth should be completed by three further active doses (0-1-2-12 month schedule) until further prospective studies are available.
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