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Role of hepatitis B immunoglobulin in infants born to hepatitis B e antigen-negative carrier mothers in Taiwan

YANG, YAO-JONG MD; LIU, CHING-CHUAN MD, MPH; CHEN, TE-JEN MD; LEE, MENG-FENG MD; CHEN, SHENG-HSIEN MD; SHIH, HSIANG-HUNG MD; CHANG, MEI-HWEI MD

Pediatric Infectious Disease Journal:
Original Studies
Abstract

Background. The efficacy of hepatitis B immunoglobulin (HBIG) in infants of hepatitis B e antigen (HBeAg)-negative hepatitis B surface antigen (HBsAg) carrier mothers in Taiwan is not clear.

Objective. To describe the responses of infants born to HBeAg-negative carrier mothers receiving HBIG combined with hepatitis B vaccine.

Methods. Term babies born to HBeAg-negative carrier mothers were assigned based on chart number to 1 of the 2 treatment groups. Group A infants (n = 94) received 0.5 ml (145 IU) of HBIG within 24 h of birth and 3 subsequent doses of recombinant hepatitis B virus (HBV) vaccine at 3 to 5 days, 1 month and 6 months of age. Group B infants (n = 122) received 3 doses of vaccines only. Infants (n = 19) born to HBeAg-positive carrier mothers were treated like those in Group A and are referred to as Group C. Sera obtained from infants at 2 and 7 months of age were tested for hepatitis B virus (HBV) markers.

Results. There were 2 (1%; one in Group A and one in Group B) subclinical breakthrough hepatitis B infections among studied infants. One (5%) child of Group C had asymptomatic HBV infection at the age of 7 months and became a chronic carrier. The rate of protective anti-hepatitis B surface antibody (anti-HBs) titers achieved (>10 mIU/ml) by 2 months of age was significantly higher in Group A than that in Group B (98% vs. 57%, P < 0.001). However, it was not different by 7 months of age. Infants (Group A) immunized with HBIG and vaccine had a significantly higher geometric mean titer (GMT, milli-International Units/ml) of anti-HBs than those (Group B) with vaccines only at 2 months of age (P < 0.001). Conversely at 7 months of age, the GMT of anti-HBs was significantly higher in infants who received vaccine only (P = 0.001).

Conclusions. A protective level of antibodies was achieved earlier in those infants receiving both passive and active immunizations. However, infants receiving active immunizations alone achieved a higher GMT at 7 months of age. There was no clear benefit of passive-active vs.

active immunization alone for chronic HBV infection in infants of HBsAg-positive, HBeAg-negative mothers.

Author Information

From the Department of Pediatrics, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University and Hospital, Tainan (YJY, CCL); the Departments of Pediatrics (TJC, MFL) and Obstetrics and Gynecology (SHC), Chi-Mei Foundation Medical Center, Tainan; the Department of Pediatrics, Chang Gung Memory Hospital at Chai Yi (HHS); and the Department of Pediatrics, National Taiwan University, College of Medicine, Taipei (MHC), Taiwan.

Accepted for publication March 4, 2003.

Address for reprints: Dr. Hsiang-Hung Shih, Department of Pediatrics, Chang-Gung Memorial Hospital at Chaiyi, (613) 6, Sec. West Chai-Pu Road, Pu-Tz City, Chai Yi Hsien, Taiwan. Fax 886-5-3623002; E-mail hsianghung@adm.cgmh.org.tw.

© 2003 Lippincott Williams & Wilkins, Inc.