Hepatitis B surface antigenemia at birth: a long-term follow-up study

Area of Science:

• Hepatology
• Immunology
• Pediatrics

Background:

• Hepatitis B virus (HBV) infection poses a significant global health challenge.
• Maternal carriage of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) indicates a high risk of perinatal transmission.
• Current immunoprophylaxis aims to prevent HBV transmission from infected mothers to newborns.

Purpose of the Study:

• To determine the effectiveness of the current immunoprophylaxis program in preventing HBV infection in newborns born to HBeAg-positive HBsAg carrier mothers.
• To investigate the prevalence and long-term outcomes of hepatitis B surface antigenemia in these high-risk newborns.

Main Methods:

• A prospective cohort study involving 665 newborns born to HBeAg-positive HBsAg carrier mothers between 1984 and 1993.
• Newborns were tested for HBsAg shortly after birth, prior to receiving hepatitis B immune globulin and vaccination.
• Seropositive infants were monitored for HBV markers, liver function, and alpha-fetoprotein levels until 1996.

Main Results:

• Sixteen newborns (2.4%) were HBsAg-positive at birth and remained so at 6 months, indicating failure of immunoprophylaxis.
• All 12 infants who received long-term follow-up were confirmed chronic HBV carriers.
• Among the chronic carriers, some exhibited HBeAg seroconversion or alanine aminotransferase flares, while others showed delayed anti-HBc appearance.

Conclusions:

• The current immunoprophylaxis strategy is insufficient to prevent HBV infection in newborns with in utero acquired surface antigenemia.
• Despite immune tolerance, some chronically infected children may mount immune responses against HBV.
• Further strategies are needed to address HBV transmission in high-risk mother-infant pairs.