[Vertical hepatitis B transmission in the Vienna area: epidemiologic and clinical studies]

This paper makes a summary on epidemiological and clinical experiences gained in Vienna since 1974 on the transmission of hepatitis B from mother to child (vertical hepatitis B transmission). 1. Hepatitis B and pregnancy: Whereas acute hepatitis B does not occur often in pregnant women, and HBs-antigen carrier status was found in 23 of 4,500 (0.52%) pregnant women examined prospectively. Three women were HBs-antigen positive, 18 were anti-HBe positive, and in no woman signs for an infection with delta-agent were found. These women are nearly always asymptomatic. About 2/3 have immigrated from the Balkans, Turkey and South-East Asia. While acute hepatitis B in the sense of an unspecific effect of the disease leads to an increased rate of premature births, neither a tendency to premature births nor to intrauterine dystrophia was found in HBs-antigen carriers--not even in infected children. 2. Frequency of vertical hepatitis B transmission: Prospectively, an infection of the children was found in three cases in pregnancies of 16 HBs-antigen carrier mothers. In mothers with positive HBe-antigen the risk was higher than in those with positive anti-HBe. But the latter may not be considered to be non-infectious in general: In an examination carried out retrospectively, 6 of 8 mothers examined were anti-HBe positive. Anti-HBe positive mothers of Westeuropean origin may also infect their children. It is known from American investigations that pregnant women suffering from acute hepatitis B in the third trimester of pregnancy or six weeks after delivery infect their children with hepatitis B in 66 to 100% of cases. 3. Mode of infection: The fact that most children demonstrate serological signs of infection only two to four months after birth justifies the assumption that the majority of children is infected perinatally, i.e. by ingestion or inoculation of infectious secretions of the mother, possibly also by maternofetal transfusions. Postnatal and in particular intrauterine infections are exceptions. The human milk is probably only important as source of infection if it is contaminated by bleeding rhagades. 4. Course of the disease in infected children: The following course of disease was observed prospectively and retrospectively: subclinical infection, acute hepatitis B, fulminant hepatitis B (including two cases in siblings), asymptomatic carrier status, chronic persistent hepatitis B, chronic aggressive hepatitis B. The course of infection in the child seems to be influenced by the HBe-antigen status of the mother: In children of anti-HBe positive mothers HBs-antigen elimination is a frequent occurrence during the course of infection.(ABSTRACT TRUNCATED AT 400 WORDS)