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Serologic Responses After Hepatitis B Vaccination in Preterm Infants Born to Hepatitis B Surface Antigen–Positive Mothers: Singapore Experience

Tan, Christelle Xian-Ting MB BS, MMed, MRCPCH*; Chan, Si-Min MB BS, MRCPCH, PGDip*†; Lee, Le-Ye MB BS, MMed, MRCPCH*‡; Ong, Christina MB BS, MRCPCH, FRCPCH§; Phua, Kong-Boo MB BS, MMed, FRACP, FAMS§; Aw, Marion Margaret MB BS, MMed, MRCP, FRCPCH*†; Saw, Sharon BSc, MSc, PhD, MAACB; Lee, Guan-Huei MB BS, MRCP, PhD; Wong, Franco MB BS, MMed**; Thoon, Koh-Cheng MB BS, MRCPCH§

Pediatric Infectious Disease Journal: August 2017 - Volume 36 - Issue 8 - p e208–e210
doi: 10.1097/INF.0000000000001578
Vaccine Reports

Background: The Advisory Committee on Immunization Practices (ACIP) recommends a 4-dose vaccination schedule for preterm low birth weight infants (<2 kg) and a 3-dose vaccination schedule for preterm infants (≥2 kg) born to hepatitis B surface antigen (HBsAg)-positive mothers. However, data remain limited for these high-risk infants, and the optimal dosing schedule in Asia is not well established.

Aim: The aim of this study was to evaluate the serologic vaccine responses in preterm infants born to HBsAg-positive mothers using current vaccination guidelines.

Methods: Preterm babies of gestation less than 37 completed weeks born to HBsAg-positive mothers were prospectively recruited during 6 years (June 2009 to December 2015) and retrospectively recruited via convenience sampling in 2 years (June 2013 to April 2015) in 2 tertiary pediatric centers. The preterm infants were given 4 or 3 vaccine doses as per ACIP 2005 guidelines. Vaccine response was defined as achieving hepatitis B surface antibody values of >10 IU/L [Abbott Architect (Abbott Laboratories, Chicago, IL)] at 9 months of chronologic age.

Results: A total of 24 preterm infants were recruited. Four had a birth weight <2 kg. Of 23 surviving infants, all were negative for HBsAg. One baby (4.5%) did not achieve adequate vaccine response. All 4 infants with birth weight <2 kg achieved seroprotective values.

Conclusion: The current ACIP-recommended vaccination schedule results in adequate antibody responses in preterm infants of HBsAg-positive mothers.

From the *Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Neonatology, National University Health System, Singapore; §Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore; Laboratory Medicine, and Department of Gastroenterology and Hepatology, National University Health System, Singapore; and **National Healthcare Group Polyclinics, Singapore.

Accepted for publication October 17, 2016.

This work was supported by Singapore Infectious Disease Initiative and National Healthcare Group Small Innovative Grant.

The authors have no conflicts of interest to disclose.

Address for correspondence: Christelle Xian-Ting Tan, MB BS, MMed, MRCPCH, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, National University Hospital, 1E Kent Ridge Road, Singapore 119228. E-mail:

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