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Review: protective efficacy of hepatitis B vaccines in neonates
1SmithKline Beecham Biologicals, Rixensart, Belgium.
Insights
High-dose hepatitis B vaccines are effective in preventing chronic infection in at-risk neonates. For lower doses, hepatitis B immune globulin (HBIG) is crucial for optimal protection.
Area of Science:
- Immunology
- Vaccinology
- Public Health
Background:
- Hepatitis B virus (HBV) infection poses a significant global health risk, particularly in neonates born to infected mothers.
- Preventing perinatal HBV transmission is crucial to reduce the incidence of chronic infection and its sequelae, such as liver cancer.
- Hepatitis B vaccines are a cornerstone of prevention, but their efficacy in high-risk neonates requires careful consideration of dosage and adjunct therapies.
Purpose of the Study:
- To review the literature on factors influencing the protective efficacy (PE) of hepatitis B vaccines in neonates born to hepatitis B surface antigen (HBsAg) and e antigen (HBeAg) positive mothers.
- To evaluate the impact of vaccine antigen dose and the use of hepatitis B immune globulin (HBIG) on vaccine effectiveness.
Main Methods:
- A comprehensive literature search was conducted to identify relevant studies.
- Data on vaccine antigen dose, HBIG co-administration, vaccination schedules, and protective efficacy were analyzed.
Main Results:
- Both high and low antigen dose hepatitis B vaccines demonstrate effectiveness in preventing chronic HBV infection in at-risk neonates.
- For lower vaccine doses, concurrent administration of HBIG is more critical for achieving high protective efficacy (PE ≥ 90%) compared to higher doses.
- Lower vaccine doses were associated with less consistent high PE, resulting in a greater number of chronic HBsAg carriers among neonates completing the vaccination course.
- Higher vaccine doses achieved high PE without immediate HBIG, provided the first dose was given at birth and the second within two months.
Conclusions:
- Vaccine antigen dose and the use of HBIG significantly influence the protective efficacy of hepatitis B vaccination in neonates from HBsAg/HBeAg positive mothers.
- Higher vaccine doses offer robust protection, potentially negating the need for immediate HBIG, especially with timely vaccination schedules.
- Careful consideration of vaccination strategies, including dose and HBIG use, is essential for maximizing protection against chronic hepatitis B in high-risk infants.
Abstract:
A literature search was carried out to investigate the factors that influence the protective efficacy (PE) of hepatitis B vaccines when given to neonates of hepatitis B surface antigen and e antigen positive mothers. Hepatitis B vaccines with either high or low antigen doses are very effective in preventing chronic hepatitis B infection in neonates at risk, but there is evidence that with lower dosages simultaneous use of hepatitis B immune globulin (HBIG) administration is more important than with higher dosages to elicit good protection (PE > or = 90%). There is also a tendency for lower dosages to confer high PE less consistently, with noticeably greater numbers of chronic surface antigen carriers in neonates who received a complete vaccination course. Furthermore vaccination courses with higher vaccine dosages give high PEs, without concomitant HBIG administration at birth, provided that the first vaccine dose is given at birth and that the second dose follows within 2 months.