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Passive immunoprophylaxis of hepatitis B virus infections in newborn infants
Insights
Newborns of mothers carrying hepatitis B virus (HBV) were studied. Treatment with hepatitis B immunoglobulin (HBIg) significantly reduced chronic HBV infection in infants born to HBsAg and HBeAg positive mothers.
Area of Science:
- Hepatology
- Immunology
- Pediatrics
Background:
- Hepatitis B virus (HBV) infection poses a significant global health risk.
- Chronic carriers of hepatitis Bs antigen (HBsAg) can transmit HBV to their newborns.
- Hepatitis Be antigen (HBeAg) positivity in mothers indicates a higher risk of vertical transmission.
Purpose of the Study:
- To evaluate the efficacy of hyperimmune hepatitis B immunoglobulin (HBIg) in preventing perinatal HBV transmission.
- To assess the rate of chronic HBsAg carriage in infants born to HBsAg-positive mothers with and without HBeAg.
Main Methods:
- A randomized controlled trial involving newborn infants of HBsAg-positive mothers.
- Infants were allocated to receive HBIg at birth and six weeks, or no treatment.
- Follow-up included sequential blood tests for HBsAg up to one year of age.
Main Results:
- 90% of untreated infants born to HBsAg and HBeAg positive mothers became chronic HBsAg carriers.
- Only 9% of infants treated with HBIg became HBsAg positive.
- Mothers who were HBsAg positive but HBeAg negative rarely infected their infants (6% HBsAg positive at one year).
- Infections were predominantly observed in Pacific Islanders, Maoris, and Asians.
Conclusions:
- HBIg prophylaxis is highly effective in preventing chronic HBV infection in infants born to HBsAg and HBeAg positive mothers.
- Antenatal screening for HBsAg and HBeAg is recommended for high-risk populations.
- Passive immunoprophylaxis with HBIg should be administered to infants of HBsAg, HBeAg positive mothers to prevent HBV spread.
Abstract:
Newborn infants of mothers who were chronic carriers of hepatitis Bs antigen (HBsAg) were randomly allocated to be treated or not treated with hyperimmune hepatitis B immunoglobulin (HBIg) at birth and six weeks and were then followed up to one year with sequential blood tests. Ninety percent of all untreated infants born of mothers positive for both HBsAg and hepatitis Be antigen became chronic carriers of HBsAg at one year. In contrast only 9% of infants treated with HBIg became HBsAg positive. Mothers who were HBsAg positive but hepatitis Be antigen negative only uncommonly infected their infants, with 6% being HBsAg positive at one year. Nearly all infections were in Pacific Islanders, Maoris or Asians. It is recommended that antenatal testing of these groups most at risk for hepatitis B virus spread, be initiated, followed by passive immunoprophylaxis with HBIg of infants born of HBsAg, HBeAg positive mothers.