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Avoidance of perinatal transmission of hepatitis B virus: is passive immunisation always necessary?
Insights
Hepatitis B immunoglobulin (HBIG) passive immunization is not always needed for infants born to mothers positive for Hepatitis B surface antigen (HBsAg). Infants of anti-HBe-positive mothers showed a low risk of perinatal HBV infection.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B virus (HBV) infection poses a significant risk of perinatal transmission.
- Hepatitis B surface antigen (HBsAg) positivity in pregnant women necessitates strategies to prevent infant infection.
Purpose of the Study:
- To evaluate the risk of perinatal HBV infection in infants born to HBsAg-positive mothers in a West European population.
- To assess the efficacy of passive immunization with hepatitis B immunoglobulin (HBIG) in preventing HBV transmission.
Main Methods:
- Screening of pregnant women for HBsAg positivity.
- Follow-up of HBsAg-positive mothers and their infants for 12 months post-delivery.
- Administration of HBIG to a subset of infants based on maternal HBeAg status.
Main Results:
- A low rate (1.2%) of HBsAg positivity was found in pregnant women.
- Infants of anti-HBe-positive mothers ('unprotected' group) showed a low incidence of HBV infection (5%), with some clearing HBsAg without antibody response, suggesting non-viral particle transmission.
- Passive immunization with HBIG provided significant protection for infants born to HBeAg-positive or anti-HBe-negative mothers.
Conclusions:
- The risk of perinatal HBV infection in infants of anti-HBe-positive carrier mothers is low in West European populations.
- Routine passive immunization with HBIG may not be necessary for all infants of HBsAg-positive mothers, particularly those with anti-HBe-positive mothers.
Abstract:
Screening of 8918 pregnant women revealed that 107 (1.2%) were HBsAg-positive. 92 of them (50 of German and 42 of predominantly Asian origin) have already delivered and were followed up for 12 months together with their infants. 14 infants of HBeAg-positive (or anti-HBe-negative) carrier mothers received a single dose of hepatitis B immunoglobulin (HBIG) immediately after birth, while 60 infants of anti-HBe-positive mothers were not immunised. 57 of the 60 "unprotected" children remained seronegative for HBsAg and HBeAg. 3 children showed HBs-antigenaemia immediately after birth; 2 of these lost HBsAg and developed anti-HBs after 6 and 9 months. The third lost HBsAg after 4 months without an antibody response developing. This suggests that the HBsAg particle only was transmitted rather than the whole virus. 12 of the 14 infants born to HBeAg-positive, or anti-HBe-negative carrier mothers were protected with one single high dose of HBIG. 2 had HBs-antigenaemia, 1 had HBeAg as well. These data show that in a West European population the risk of perinatally acquired HBV infection in the infants of anti-HBe-positive carrier mothers is small, and that passive immunisation of this group is not necessarily indicated.