乙型肝炎病毒母婴传播影响因素探讨

目的：探讨乙型肝炎病毒(HBV)母婴传播的影响因素,寻求降低婴儿HBV感染率的方法。方法：HBV携带及慢性乙型肝炎孕妇共635例,分别比较不同血HBV DNA滴度,不同分娩方式（剖宫产或自然分娩）,以及不同肝功能状态孕妇所生婴儿出生时及3月龄时HBV的感染率。新生儿生后12 h内肌注乙肝免疫球蛋白200 U 及重组酵母乙肝疫苗10 μg;生后即刻显示血清HBV感染存在者,14 d时再肌注乙肝免疫球蛋白200 U。结果：孕妇高滴度组（HBV DNA>105拷贝/mL）所生新生儿出生时（14.4% vs 4.1%,P<0.01）与3月龄时（4.7% vs 0,P<0.01）HBV感染率均高于低滴度组（HBV DNA ≤105拷贝/mL）。两组新生儿3月龄时HBV感染率均低于出生时（P<0.05）。自然分娩的孕妇其婴儿出生时HBV感染率明显高于剖宫产组（P<0.01）,但3月龄时,两组感染率接近。HBV携带孕妇所生婴儿出生时HBV感染率明显高于慢性乙型肝炎孕妇所生婴儿（P<0.01）,但3月龄时两组婴儿HBV感染率亦接近。结论：孕妇血清HBV DNA水平与新生儿HBV宫内感染密切相关,故降低孕妇血清HBV DNA水平可能成为减少新生儿HBV感染的一种有效途径。在乙肝免疫球蛋白及重组酵母乙肝疫苗的双重保护下,孕妇的分娩方式与肝功能状态对HBV母婴传播无影响。     

Effects of Booster HB Vaccine in Preventing Hepatitis B Virus Infection from Mother to Child

Hepatitis B immune serum 200 IU was injected intramuscularly to 127 infants born to hepatitis B e antigen positive mothers immediately after birth and at two months of age, and if necessary at four months. HB adjuvant vaccine 20 μg was injected subcutaneously at three, four, and six months. If antibodies to hepatitis B surface antigen were 2² or less, one to four doses of booster vaccine 20 μg were given. The first booster vaccination was given in 8.7% of cases by the age of one year, in 19.3% by 18 months, in 23.9% by 24 months, and in 36.2% by 30 months; thus 2-to-3-year-old infants were more frequently vaccinated than younger ones. This implies that 80%-90% of infants could be protected from vertical transmission of hepatitis B virus (HBV) up to the age of three years, if a booster vaccine was given to those born to HBeAg positive mothers not later than 24 months. Infants obtained enough antibody to prevent HBV infection by receiving one booster vaccination in 34 cases, by two in nine, by three in five, and by four in two.     

Negative serology for hepatitis A and B viruses in 18 cases of neonatal cholestasis

Serologic evidence of hepatitis A virus (HAV) or hepatitis B virus (HBV) infection was sought in 14 patients with biliary atresia and in four patients with neonatal hepatitis; maternal serum was also analyzed. Specific sensitive radioimmunoassays were used to detect HBV surface antigen (HBsAg) and antibody (anti-HBs); complement fixation was used to detect antibody to HBV core antigen (anti-HBc). Antibody to HAV (anti-HAV) was assayed by radioimmunoassay, as well as by immune adherence hemagglutination. There was no evidence of active or past HBV infection in any infant or mother studied. All three infants with detectable anti-HAV were born to mothers similarly anti-HAV positive; serial testing of sera from two of these infants documented disappearance of detectable anti-HAV by 9 months of age. It is unlikely, therefore, that either HAV or HBV had an etiologic role in neonatal cholestasis in these patients. The role of other (non-A, non-B) hepatitis viruses or nonviral etiologies must be investigated.     

乙型肝炎病毒宫内感染对新生儿外周血细胞因子干扰素γ和白介素4的影响

目的 探讨乙型肝炎病毒(HBV)侵犯新生儿外周血单个核细胞(PBMC)后,对新生儿免疫功能的影响,了解其免疫失败发生的机理.方法 聚合酶链反应法(PCR)检测67对乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)阳性孕妇及其新生儿血清和PBMC的HBV DNA.根据新生儿PBMC中HBV DNA分成阴性和阳性组,将新生儿的PBMC分别在植物血凝素(PHA)和纯化HBsAg刺激下进行体外细胞培养,检测培养上清液中干扰素-γ(IFN-γ)、白介素-4(IL-=4)的分泌含量.结果 (1)35例母亲PBMC HBV DNA阳性者其新生儿15例为阳性,母亲与患儿PBMC HBV DNA阳性,差异有显著统计学意义(P＜0.01).(2)新生儿PBMC内HBV DNA阳性组与阴性组比较,纯化HBsAg刺激时,阳性组IFN-γ的分泌量较阴性组低(P＜0.01),IL-4含量显示PBMC HBV DNA阳性组高于阴性组(P＜0.05),PHA刺激时,两组IFN-γ、IL-4含量差异无统计学意义(P＞0.05).结论 PBMC内的HBV DNA可能是HBV母婴垂直传播的一条重要途径;宫内新生儿PBMC感染HBV,IFN-γ特异性反应低下,而IL-4特异性反应增强,细胞调节失衡,可能是新生儿免疫失败和易于免疫耐受的一个重要原因.     

National Project on the Prevention of Mother-to-Infant Infection by Hepatitis B Virus in Japan

In Japan, a nationwide prevention program against mother-to-infant infection by hepatitis B virus (HBV) started in 1985. This program consists of double screenings of pregnant women and prophylactic treatment to the infants born to both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive mothers. These infants are treated with two injections of hepatitis B immune globulin (HBIG) and at least three injections of plasma derived hepatitis B vaccine. We sent questionnaires about the numbers of each procedure or examination during nine months of investigation period to each local government in 1986 and 1987. 93.4% pregnant women had the chance to be examined for HBsAg, and the positive rate was 1.4 to 1.5%. The HBeAg positive rate in HBsAg positive was 23 to 26%. The HBsAg positive rate in neonates and in infants before two months were 3% and 2% respectively. Some problems may arise, because 27 to 30% of infants need the fourth vaccination in some restricted areas.     

新生儿外周血单个核细胞乙型肝炎病毒DNA检测的临床意义

目的探讨HBsAg阳性产妇新生儿外周血单个核细胞(PBMC)乙型肝炎病毒(HBV)感染率、影响因素及检测的临床意义。方法50例HBsAg阳性产妇和其新生儿为研究组,另18例血清乙肝标志物均阴性者为对照组。采用套式聚合酶链反应(n-PCR)法分别检测产妇、新生儿血清及PBMCHBV-DNA。结果HBsAg阳性母亲血清及PBMCHBV-DNA检出率分别为60·0%和40·0%;其新生儿血清及PBMCHBV-DNA阳性率分别为46·0%及30·0%;其中仅血清阳性10例,仅PBMC阳性2例,血清和PBMC均阳性13例。对照组母儿血清及PBMC中未检出HBV-DNA。新生儿PBMCHBV-DNA阳性率在母血清HBeAg、HBV-DNA阳性组高于阴性组(P<0·05,P<0·01);母PBMCHBV-DNA阳性组高于阴性组(P<0·01);母血清和PBMCHBV-DNA均阳性组高于仅血清阳性组(P<0·01);新生儿血清HBV-DNA阳性组高于阴性组(P<0·05)。结论HBsAg阳性母亲新生儿HBV-DNA感染率为30·0%;其感染率与母、儿血清病毒血症水平及孕妇PBMCHBV-DNA状态有关,检测出新生儿PBMCHBV-DNA具有重要临床意义。     

Hepatitis B virus infection

Hepatitis B virus (HBV) infection is a worldwide health problem and may cause acute, fulminant, chronic hepatitis, liver cirrhosis, or hepatocelullar carcinoma (HCC). Infection with HBV in infancy or early childhood may lead to a high rate of persistent infection (25-90%), while the rates are lower if infection occurs during adulthood (5-10%). In most endemic areas, infection occurs mainly during early childhood and mother-to-infant transmission accounts for approximately 50% of the chronic infection cases. Hepatitis B during pregnancy does not increase maternal mortality or morbidity or the risk of fetal complications. Approximately 90% of the infants of HBsAg carrier mothers with positive hepatitis B e-antigen (HBeAg) will become carriers if no immunoprophylaxis is given. Transplacental HBeAg may induce a specific non-responsiveness of helper T cells and HBcAg. Spontaneous HBeAg seroconversion to anti-HBe may develop with time but liver damage may occur during the process of the immune clearance of HBV and HBeAg. Mother-to-infant transmission of HBV from HBeAg negative but HBsAg positive mothers is the most important cause of acute or fulminant hepatitis B in infancy. Although antiviral agents are available to treat and avoid the complications of chronic hepatitis B, prevention of HBV infection is the best way for control. Screening for maternal HBsAg with/without HBeAg, followed by three to four doses of HBV vaccine in infancy and hepatitis B immunoglobulin (HBIG) within 24h of birth is the most effective way to prevent HBV infection. In areas with a low prevalence of HBV infection or with limited resources, omitting maternal screening but giving three doses of HBV vaccine universally in infancy can also produce good protective efficacy. The first universal HBV immunisation programme in the world was launched in Taiwan 22 years ago. HBV infection rates, chronicity rates, incidence of HCC and incidence of fulminant hepatitis in children have been effectively reduced.     

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

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.     

Prevention of perinatal acquisition of hepatitis B virus carriage using vaccine: preliminary report of a randomized, double-blind placebo-controlled and comparative trial

Hepatitis B is a serious disease of global significance. In developing countries, hepatitis B virus (HBV) infection and its sequelae rank among the public health problems of highest priority. Infants born to mothers who are chronic carriers of HBV are at particularly high risk of acquiring infection and becoming chronic HBV carriers. The efficacy of hepatitis B vaccine alone in preventing the transmission of HBV to infants born to HBV carrier mothers was determined in a double-blind placebo-controlled trial. Infants received plasma-derived vaccine at birth, 1 month, and 6 months of age. Of 180 infants born to hepatitis B surface antigen (HBsAg)-positive mothers, equal numbers received National Institute of Allergy and Infectious Disease (NIAID) vaccine, Beijing Institute of Vaccine and Serum (BIVS) vaccine, and placebo. The cumulative seroconversion to the vaccines at 1 year of age was 95% and 75%, respectively. Vaccine efficacy as measured by the prevention of HBsAg-positive events was 88% for the NIAID vaccine and 51% for the BIVS vaccine. Vaccine efficacy was similar among infants born to hepatitis Be antigen-positive mothers. Because of the low efficacy of the BIVS vaccine, an additional group of 28 infants was given vaccine and hepatitis B immune globulin at birth. The resulting efficacy was 83%. The results of this trial indicate that hepatitis B vaccine alone can substantially reduce perinatally acquired HBV infection and the resulting chronic carrier state.     

Hepatitis B virus infection in pregnant mothers and its transmission to infants

Screening for serological markers of hepatitis B virus infection was done on 500 pregnant mothers. HBsAg, AntiHBs and HBeAg were done. HBsAg was positive in 3.6%, AntiHBs in 17.4% and HBeAg in 0.4% cases. The infants born to the asymptomatic HBsAg carrier mothers were followed upto 6 months to determine the vertical transmission of HBV infection. Rate of transmission of infection from HBsAg positive mothers to infants were 16.66% irrespective of HBeAg status, whereas it was nearly 100% in case of HBeAg positive mothers. All of the HBsAg positive infants developed the antigenemia between 3–6 months of age, supporting the hypothesis that intrapartum transmission is the major mode of vertical transmission.     

Lack of perinatal transmission of hepatitis B virus infection in Senegal, West Africa

Between 1977 and 1980, 1442 pregnant women in Thies, Senegal, were tested for serologic markers of hepatitis B virus (HBV) infection. Of these, 9.8% were HBsAg(+), 59.9% were anti-HBs(+), and 15.6% had anti-HBc alone. Of 116 HBsAg(+) pregnant women, only 19.8% were HBeAg(+), a much lower proportion of infectious carriers than seen in Asian populations. Cord blood from 1353 babies was HBsAg(-), implying that the babies were not infected prior to birth. Four hundred sixty-two babies, including 88 born to HBsAg(+) mothers, were observed for 2 weeks to 38 months after birth. In contrast to observations in Asia, none of the babies became HBsAg(+) before 5 months of age, and only three of the 16 born to HBeAg(+) mothers became HBsAg(+) within the first year of life; all three developed chronic infections (i.e., HBsAg(+) for greater than or equal to 6 months. In the second year of life, six of 34 babies born to HBsAg(+), HBeAg(-)/anti-HBe(-) mothers became infected with HBV, and four of the six developed chronic infections. During the first 3 years of life, infections occurred at a higher rate in infants born to HBsAg(+) (17%) than to HBsAg(-) (4%) women. The latter group of infants included 4.0% of those born to anti-HBs(+) mothers, 4.6% born to anti-HBcAg(+), and 3.2% born to uninfected women. These observations indicate that HBV infections in Senegal usually do not occur perinatally, but do occur at high incidence later in infancy and childhood. Such infections can be prevented by the use of hepatitis B vaccine alone; administration of hepatitis B immune globulin should not be needed.     

Evaluation of screening for hepatitis B surface antigen during pregnancy in a population with a high prevalence of hepatitis B surface antigen-positive/hepatitis B e antigen-negative carriers

BACKGROUND: Universal hepatitis B vaccination in infancy was implemented in Israel in 1992. The program consists of active vaccination at birth and at 1 and 6 months of age, without hepatitis B surface antigen (HBsAg) screening during pregnancy. Infants of HBsAg carrier mothers do not receive specific hepatitis B immunoglobulin in addition to vaccine at birth. The recently arrived Jewish immigrants from Ethiopia are the group with the highest rate of HBsAg carriage (approximately 10%) in Israel. AIM: The objective of this study was to evaluate whether the present policy is effective against perinatal HBV transmission from mothers of Ethiopian origin to their infants. METHODS: The study group included 411 Israeli born children, offspring of mothers of Ethiopian origin. All infants were fully vaccinated starting at birth. Sera were collected from the children at the age of 9 to 36 months and from their mothers. Tests for HBsAg, antibodies to HBsAg (anti-HBs) and antibodies to hepatitis B core antigen (anti-HBc) were performed. RESULTS: Eighty-nine percent of the children had detectable anti-HBs, including 82.2% with protective anti-HBs concentrations (> or =10 mIU/ ml). Although 24 mothers (6.2%) were HBsAg carriers, none of the children was HBsAg-positive. Seven of 394 infants (1.7%) tested positive for anti-HBc. This test became negative in 5 of 6 who were followed for 12 months. The percentage of infants with protective anti-HBs concentrations decreased significantly from 91.4% at 9 to 12 months to 70.1% at 31 to 36 months of age. The mother's infection status was not associated with the infant's response to vaccine. Calculation based on the above data suggests that screening for HBsAg in pregnancy in that group is not cost-effective. CONCLUSIONS: Our results suggest that the Israeli vaccination program against HBV infection is effective, even in a high risk population, and additional measures are not cost-effective.     

Significance of measurement of pre-S2 antigen for the prevention of vertical transmission of hepatitis B virus in infants born to HBsAg carrier mothers

Terazawa S, Kondo N, Orii T. Significance of measurement of pre-S2 antigen for the prevention of vertical transmission of hepatitis B virus in infants born to HBsAg carrier mothers. Acta Pædiatr 1994;83:30–4. Stockholm. ISSN 0803–5253
The significance of pre-S2 antigen (pre-S2 Ag) as a marker of hepatitis B virus (HBV) infection, especially in infants born to HBsAg carrier mothers who are HBeAg-negative or HBeAg-positive, was evaluated. Pre-S2 Ag was measured by enzyme immunoassay. HBsAg carrier mothers who were HBeAg-negative and HBeAb-positive were divided into two groups: group A, mothers whose infants were not infected with HBV ( n = 10) and group B, mothers whose infants were infected with HBV ( n = 13). Absorption rates of pre-S2 Ag in group A and B were 0.09 k 0.04 and 1.36 ± 0.95, respectively. The values for pre-S2 Ag in group B were significantly higher than those in group A. Values for pre-S2 Ag among HBsAg carrier mothers who were HBeAg-positive and HBeAb-negative were also measured by reversc passive hemagglutination. In the same way, HBsAg carrier mothers who were HBeAg-positive and HBeAb-negativc were divided into two groups: group C, mothers whose infants did not become HBsAg carriers ( n = 15) and group D, mothers whose infants became HBsAg carriers (n = 11). The titers of pre-S2 Ag (reverse passive hemagglutination) in group C and D were 2^{5.75 ± 1.68} and 2^10.45±^1.69, respectively. The values for pre-S2 Ag in group D were significantly higher than those in group C. The values for pre-S2 Ag as markers of infectivity became higher with increasing amounts of HBV-DNA. Therefore, our results show that measurement of pre-S2 Ag in HBsAg carrier mothers who are HBeAg or HBeAb-positive is useful in the detection of high-risk groups of vertical transmission of HBV.     

Use of hepatitis B vaccine alone or in combination with hepatitis B immunoglobulin for immunoprophylaxis of perinatal hepatitis B infection.

The efficacy of hepatitis B vaccine alone or in combination with immunoglobulin in neonates born to HBsAG positive mothers was investigated. Twenty-four infants were given three doses (at 0, 1, 2 months) of the vaccine alone, while 27 infants were given hepatitis B immunoglobulin (HBIG) and three doses of the vaccine. Fifty-eight infants born to HBsAg positive mothers who did not agree for vaccination or could not come for follow-up constituted the control group. The overall seroprotection rates (anti-HBS levels > or = 10 IU/l) were almost similar in both the groups at 6 months (81 and 76 per cent, respectively). However, the seroprotection rates in babies born to HBeAg positive mothers were better with combination of HBIG and vaccine (71 v. 57 per cent, respectively). It was also observed that seroprotection rates in babies born to anti-HBe positive mothers were even better (100 and 90 per cent in vaccine alone and combination group, respectively). No chronic carrier was detected in babies born to anti-HBe positive mothers.     

孕期应用乙型肝炎免疫球蛋白对预防乙型肝炎病毒垂直传播的预防作用

目的探讨孕期应用乙肝免疫球蛋白(HBIG)对乙肝表面抗原及e抗原双阳性孕妇乙肝母婴垂直传播的预防作用。方法外周血HBsAg阳性孕妇291例,HBsAg、HBeAg双阳性83例,分为HBIG(A组,59例)及非HBIG(B组,24例)组;所有新生儿在出生24 h内,1、6个月分别注射乙肝疫苗并检验乙肝两对半。结果1.HBeAg阳性孕妇的外周血HBV-DNA阳性率为76.56%,显著高于HBeAg阴性孕妇(8.22%),P<0.01;2.孕晚期应用1,2次或3次HBIG的新生儿各月龄HBsAg阳性率及HRsAb阳转率无显著差异;3.A组新生儿出生当天外周血HBsAg阳性率显著低于B组,P<0.05;B组乙肝疫苗免疫后的6个月龄婴儿外周血HBsAb阳转率仅37.5%,显著低于A组(81.4%),P<0.001。结论孕晚期应用HBIG可有效降低乙肝宫内感染率,提高6个月龄婴儿HBsAb阳转率。     

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目的 探讨乙型肝炎病毒携带产妇所生新生儿血清乙型肝炎病毒标志物(HBV-M)转归.方法 2001年3月至2006年3月在暨南大学附属第一医院进行产前检查的500例HBsAg阳性产妇所生新生儿,根据母亲HBeAg状态分为HBeAg阳性组144例,HBeAg阴性组356例.两组新生儿在出生12 h内均注射乙型肝炎免疫球蛋白100 IU,并按常规0、1、6方案分别在出生时、1月龄和6月龄注射基因重组乙型肝炎疫苗5μg,注射主被动免疫前分别抽取外周静脉血检测HBV-M.结果 两组新生儿出生时外周血HBsAg、HBeAg均阳性者分别为24例和9例,追踪至6月龄时HBsAg阳性例数分别为10例和5例,HBsAg阴转率差异无统计学意义.两组新生儿出生时HBsAg阳性、HBeAg阴性者分别为4例和21例,追踪至6月龄时,HBsAg阴转率分别为100%和85.7%.出生时HBsAg阴性、HBeAg阳性者,HBeAg阳性组为29例,占20.1%,显著高于HBeAg阴性组比例(P＜0.01),其6月龄HBsAg阳转率为6.9%,明显低于HBeAg阴性组(P＜0.01).在接受全程主被动免疫的情况下,HBeAg阳性组新生儿6月龄HBsAg和HBsAb阳性率分别为9.7%和67.4%,HBeAg阴性组分别为3.1%和78.1%,两组比较差异有统计学意义(P＜0.05).结论 新生儿出生时外周血HBsAg阳性不能作为判断宫内感染的指标,HBeAg阳性新生儿预后与母亲HBeAg状态密切相关,母亲HBeAg阳性会抑制新生儿对乙型肝炎疫苗的反应.     

Should hepatitis B surface antigen positive mothers breast feed?

Breast fed infants may be at greater risk of mother to infant hepatitis B virus infection compared with formula fed infants. We studied 85 infants born to 84 hepatitis B surface antigen positive mothers (only two of whom were hepatitis B e positive), and who had received immunisation against hepatitis B virus. Our results indicate that breast feeding does not increase the risk of developing hepatitis B virus infection in infants born to these mothers if immunisation is carried out.     

Prevention of Perinatal Transmission of Hepatitis B Virus Carrier State

By means of passive and active immunization with hepatitis B immunoglobulin and hepatitis B vaccine, 396 of 407 babies born to hepatitis B antigen-positive carrier mothers, were protected from establishing the hepatitis B virus (HBV) carrier state during a follow-up period of 12 months or longer. Four infants developed the HBV carrier state before the completion of the immunoprophylaxis schedule, and another seven developed the state after the completion of the schedule. Seroconversion of anti-HBc was observed in 26.8% of the successfully protected infants. In Japan a nationwide program to prevent the vertical transmission of HBV with these procedures was established in 1986, and so liver diseases due to HBV are expected to be eliminated in the near future.     

Fulminant hepatitis B in an infant born to a hepatitis Be antibody positive,DNA negative carrier.

A boy was born to a mother who was a chronic hepatitis B virus (HBV) carrier. She was hepatitis Be (HBe) antibody positive and HBe antigen and HBV-DNA negative. The boy had not received hepatitis B vaccine and died from fulminant hepatitis at 3 months of age. This case demonstrates the need to vaccinate babies of HBe antibody positive, HBe antigen negative carriers.     

Combined immunoprophylaxis in the prevention of perinatal transmission of hepatitis B and hepatitis D virus infections in Saudi children.

The efficacy of the combined immunoprophylaxis approach (passive plus active immunization) was evaluated in babies born to 52 HBsAg-carrier Saudi mothers, of whom seven (13.5%) were HBeAg-positive and seven were anti-HDV-positive. Newborns were given 100 IU of hepatitis B immune globulin (HBIG) from the Hepuman Berna-Swiss Serum and Vaccine Institute, Berne, and hepatitis B vaccine (5 micrograms) within 12 hours of birth, and the vaccine was given again at 1 and 6 months of age (5 micrograms/injection). After 18 months of follow-up, all but one baby had protective levels of antibody to HBsAg and none of the babies born to anti-HDV-positive carrier mothers showed evidence of HDV infection. These results show that the combined immunoprophylaxis approach is quite successful in protecting against perinatal transmission of HBV and HDV in the Saudi population. Furthermore, early vaccination against HBV will also protect against HDV infection later in life.