Placental expression of asialoglycoprotein receptor associated with Hepatitis B virus transmission from mother to child.

BACKGROUND: Asialoglycoprotein receptor expression on hepatocytes has been associated with endocytosis, binding and uptake of hepatitis B virus. The role of asialoglycoprotein receptor in hepatitis B virus vertical transmission and its expression on placenta has not yet been studied. PATIENTS AND METHODS: Thirty-four HBsAg+ve and 13 healthy pregnant mothers along with their newborns were enrolled. The former were categorized into transmitting and non-transmitting mothers based on their newborns being hepatitis B surface antigen and hepatitis B virus DNA positive. Expression of asialoglycoprotein receptor and hepatitis B surface antigen in placenta and isoform of asialoglycoprotein receptor on dendritic cell in peripheral and cord blood dendritic cells were analysed using flowcytometry, immune histochemistry, immune florescence and qRT-PCR. RESULTS: Twelve HBsAg+ve mothers transmitted hepatitis B virus to their newborns whereas the rest (n = 22) did not. Hepatitis B virus-transmitting mothers showed increased expression of asialoglycoprotein receptor in trophoblasts of placenta. Immunofluorescence microscopy revealed colocalization of hepatitis B surface antigen and asialoglycoprotein receptor in placenta as well as in DCs of transmitting mothers. There was no significant difference in the expression of asialoglycoprotein receptor on peripheral blood mononuclear cells or chord blood mononuclear cells between the 2 groups. However, hepatitis B virus-transmitting mothers and their HBsAg+ve newborns showed increased mRNA levels of isoform of asialoglycoprotein receptor on dendritic cell in peripheral blood mononuclear cells. Hepatitis B virus-transmitting mothers and their HBsAg+ve newborns showed an increased expression of isoform of asialoglycoprotein receptor on dendritic cell on circulating dendritic cells compared to hepatitis B virus non-transmitting mothers and their negative newborns. CONCLUSIONS: This study revealed that increased expression of asialoglycoprotein receptor in placenta and colocalization with hepatitis B surface antigen strongly indicates its role in intrauterine transmission of hepatitis B virus. Asialoglycoprotein receptor-blocking strategy can be used for therapeutic intervention of vertical transmission.

Secukinumab for psoriasis in a patient with hepatitis B.

The case reported describes a 48-year-old man with congenital hepatitis B receiving secukinumab for treatment of psoriasis. Some biologic therapies have been associated with an increased risk of reactivation of hepatitis B. In the case of this patient, secukinumab has successfully managed his psoriasis without evidence of hepatitis B virus reactivation.

[Early physical growth and disease analysis among children born delivered by HBsAg-positive mothers].

Objective: To estimate the early physical growth and disease in children born to HBsAg-positive mothers. Methods: This was a retrospective cohort study. Three areas as Xihu in Hangzhou, Lanxi in Jinhua, and Haiyan in Jiaxing in Zhejiang province were selected by cluster sampling. The growth outcomes of children born to HBsAg-positive mothers (exposure group) and matched 1∶1 women uninfected with HBV (control group) in 2014 were investigated and compared at birth, 6, 9, 12, and 18 months, respectively. There were totally 342 children in each group. Results: The incidences of low birth weight (LBW) for children born to exposure and control group were 1.8% (6/342), and 2.6% (9/342), respectively (P=0.433); and, rates of preterm birth were 2.3% (8/342), and 2.0% (7/342), respectively (P=0.794). The mean birth weight of children born to mothers without HBV infection (3.4±0.4) kg was dramatically higher than children in exposure group (3.3±0.4) kg (P=0.019). At 18 months, the average head circumference was significantly greater among children in control group (47.3±1.3) cm than children in exposure group (47.0±2.0) cm (P=0.038). Additional, mean birth weeks, height, weight, increases in height/weight/head circumference each month, weight/height/head circumference for age Z scores, proportion of growth retardation and low weight, disease prevalence were not observed statistically differences between two groups (P>0.05). All children born to HBsAg-positive mothers were received three-dose HBV vaccination. The rate of hepatitis B immunoglobulin for births born to HBsAg-positive was 98.8% (338/342). Mother to children transmission of HBV at 18 months was 1.0% (1/97). Conclusion: No significant differences in growth development and disease prevalence were found among children born to HBsAg-positive women and women without HBV infection.

Hepatitis B Immunoprophylactic Failure and Characteristics of the Hepatitis B Virus Gene in Mother-Infant Pairs in Parts of China.

OBJECTIVE: To determine the hepatitis B immunoprophylactic failure rate in infants born to hepatitis B virus (HBV) infected mothers and to characterize HBV genes. METHODS: HBV-serological testing was conducted for pregnant women and infants. The complete genomes of 30 HBV isolates were sequenced, and genetic characteristics were analyzed using MEGA 5 software. RESULTS: The immunoprophylactic failure rate for infants who had completed the scheduled hepatitis B vaccination program was 5.76% (32/556). High sequence homology (99.8%-100%) was observed in 8 of the 10 mother-infant pairs. We identified 19 subgenotype C2 strains, 9 subgenotype B2 strains, and 2 subgenotype C1 strains. Three serotypes were detected: adr (19/30), adw (9/30), and ayw (2/30). The frequency of amino acid mutation of the 'a' determinant region was 16.67% (5/30), including that of Q129H, F134Y, S136Y, and G145E. We detected 67 amino acid mutations in the basal core promoter, precore, and core regions of the genome. CONCLUSION: The immunoprophylactic failure rate in infants born to HBV-infected mothers is low in the regions of China examined during this study. Moreover, HBV mutation in the 'a' determinant region could not account for immunoprophylactic failure for all infants.

Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen.

AIMS: A placenta with hepatitis B virus (HBV) is one of the main reasons for transplacental transmission during pregnancy. This study aims to explore the factors influencing the presence of hepatitis B surface antigen (HBsAg) in the placenta and the synergistic effect of these factors. METHODS: A total of 155 placentae and blood specimens were collected from HBsAg-positive mothers and their newborns. HBsAg in placenta was detected using the immunohistochemistry method. HBV serum markers were detected using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) methods. RESULTS: The results showed that hepatitis B e antigen (HBeAg) positive, or HBV DNA positive status, is significantly associated with an HBsAg-positive placenta. A synergistic effect was present. The hazard ratio for a HBsAg-positive placenta in mothers with HBeAg and HBV DNA was 1.97 times higher than the sum of the independent relative risk of each separate effect (synergy index, S=1.97). There was a statistically significant association between HBsAg in newborns and HBsAg in placenta, and the risk of newborns with HBsAg was greater (odds ratio values 3.33 and 5.31, respectively) when placental cells close to the fetal side were HBsAg positive. CONCLUSIONS: Being positive for HBeAg and/or HBV DNA are significant risk factors for HBsAg in the placenta. HBsAg can pass through the placenta via cellular transfer, possibly contributing to transplacental transmission.

Development of strategies for screening, predicting, and diagnosing intrauterine HBV infection in infants born to HBsAg positive mothers.

This study aimed at developing strategies for screening, predicting, and diagnosing intrauterine HBV infection in infants born to HBsAg positive mothers. A total of 1,360 infants born to 1,355 HBsAg positive mothers were followed for 1 year. All newborn infants received active and passive immunization within 24 hr after birth. Maternal and infant blood samples were collected and tested for the status of serum HBsAg, HBeAg, and HBV DNA positivity. The accuracy of infant HBsAg positivity, HBV DNA positivity, HBsAg and HBV DNA double positivity, and HBsAg and/or HBV DNA positivity at birth in the diagnosis of intrauterine HBV infection was evaluated by receiver operating characteristic curve analysis. Of 1,360 infants, 145 tested positive for HBsAg and/or HBV DNA at birth. Twenty-one (1.5%) infants, who were diagnosed with intrauterine HBV infection, showed HBsAg positivity from birth to 7 and 12 months of age. Infant HBsAg positivity at birth had the highest sensitivity in predicting intrauterine HBV infection, while neonatal HBsAg and HBV DNA double positivity had the highest specificity. These findings suggest that infants, who were born to HBsAg positive mothers and were positive for both HBsAg and HBV DNA at birth, may be at a higher risk for intrauterine HBV infection. HBsAg positivity at birth may be a good marker for screening intrauterine HBV infection. Infant HBsAg positivity both at birth and 7 months of age may be used as a diagnostic criterion to simplify diagnostic procedures and improve diagnostic efficiency.

Which newborns missed the hepatitis B birth dose vaccination among U.S. children?

OBJECTIVES: Hepatitis B birth dose vaccination is a critical step in preventing perinatal hepatitis B virus infection. This study assesses the prevalence of children who missed the birth dose of hepatitis B vaccination and identifies socio-demographic factors associated with non-receipt of the birth dose among children in the United States. METHODS: A survey observation study was conducted with the national representative sample of 17,053 U.S. children aged 19-35 months obtained from the 2009 National Immunization Survey. Categorical data analysis and multivariable logistic regression in the context of complex sample survey were applied to evaluate the prevalence and determine the independent risk factors. RESULTS: 39.2% of children missed the birth dose of hepatitis B vaccination. Children who reside in states without a universal hepatitis B vaccine supply policy, are not covered by health insurance, and have only 1 vaccination provider are significantly associated with non-receipt of the birth dose hepatitis B vaccination. CONCLUSIONS: Children who reside in states without a universal hepatitis B vaccine supply policy, and who are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination. Future intervention studies could be needed to help control those modifiable risk factors.

Seroprevalence of HIV, hepatitis B, and syphilis among pregnant women at the general hospital, Guatemala City, 2005-2009.

BACKGROUND: sexually transmitted infection (STI) screening in pregnancy provides an excellent opportunity for secondary prevention. OBJECTIVE: to document the epidemiology of HIV, hepatitis B, and syphilis among pregnant women at a Guatemalan national hospital. RESULTS: from 2004 to 2009, 118 (0.76%) of 15 563 of women tested in the prenatal clinic had HIV infection, 29 (0.22%) of 13 028 women tested had hepatitis B virus infection, and 78 (0.60%) of 13 027 had a positive test for syphilis. From August 1, 2007 through December 31, 2009, 29 482 women were tested in the obstetrical emergency room. A total of 63 were HIV positive (0.21%), 48 had hepatitis B (0.16%), and 196 had syphilis (0.66%). Of the 9196 births between August 2007 and July of 2008, 33 (0.36%) were to HIV-infected mothers. CONCLUSION: these 3 STIs were uncommon in our population and did not increase in incidence during the study period. HIV maternal-to-child transmission (MTCT) prevention programs were feasible in our setting.

Relationship between Maternal PBMC HBV cccDNA and HBV Serological Markers and its Effect on HBV Intrauterine Transmission.

OBJECTIVE: To investigate the relationship between maternal peripheral blood mononuclear cells (PBMC) hepatitis B virus (HBV) covalenty closed circular deoxyribonucleic acid (cccDNA) and other HBV serological markers and its effects on HBV intrauterine transmission. METHODS: We enrolled 290 newborns and their hepatitis B surface antigen (HBsAg) positive mothers. HBV cccDNA in PBMC and HBV DNA in serum were detected by a real-time PCR-TaqMan probe while HBV serological markers were detected with an electrochemiluminescence immunoassay. RESULTS: There was a positive correlation between the levels of PBMC HBV cccDNA and serum HBV DNA and HBeAg (r = 0.436 and 0.403, P < 0.001). The detection rate of pattern A ['HBsAg (+), HBeAg (+), and anti-HBc (+)'] was significantly higher in the PBMC HBV cccDNA positive group than in the control group (χ2 = 48.48, P < 0.001). There was a significant association between HBV intrauterine transmission and PBMC HBV cccDNA (χ2 = 9.28, P = 0.002). In the presence of serum HBV DNA, HBeAg, and PBMC HBV cccDNA, the risk of HBV intrauterine transmission was three times higher (OR = 3.69, 95% CI: 1.30-10.42) than that observed in their absence. The risk of HBV intrauterine transmission was the greatest (OR = 5.89, 95% CI: 2.35-14.72) when both PBMC HBV cccDNA and pattern A were present. A Bayesian network model showed that maternal PBMC HBV cccDNA was directly related to HBV intrauterine transmission. CONCLUSION: PBMC HBV cccDNA may be a direct risk factor for HBV intrauterine transmission. Our study suggests that serological markers could be combined with PBMC-related markers in prenatal testing.

Prevention strategy for father-to-child transmission of hepatitis B virus: a systematic review and meta-analysis.

OBJECTIVE: Father-to-child transmission (FTCT) occurs in infants born to hepatitis B virus (HBV) infected father. In this study, we aim to summarize the prevention strategy for FTCT of HBV by systematic review and meta-analysis. METHODS: PubMed and China Knowledge Resource Integrated Database were systematically searched. We systematically reviewed the prevention strategy for father, mother, and infant before, during pregnancy and after birth. We also examined trial sequential analysis (TSA) for the required information size (RIS). RESULTS: Fourteen studies with 2825 father-mother-child pairs included in the studies. Two publications assessed father antiretroviral therapy before pregnancy, with the mean FTCT incidence 3.5% in the antiretroviral therapy group and 12.0% in the control group. The summary OR compared between two groups was 0.280 (95% CI 157-0.500; Z = 4.30, p < .00001) by random-effects model. TSA showed further studies were needed. Twelve publications assessed maternal immunoprophylaxis before and during pregnancy, with the mean FTCT incidence 14.9% in the maternal immunoprophylaxis group and 32.8% in the control group. The summary OR compared between two groups was 0.343 (95% CI 252-0.468; Z = 6.77, p < .00001) by random-effects model. TSA showed no further studies were needed. No randomized controlled trials (RCT) and non-RCTs were found assessing neonate and infant immunoprophylaxis for FTCT prevention. CONCLUSION: Father antiretroviral therapy before pregnancy, maternal immunoprophylaxis before and during pregnancy, and neonate and infant immunoprophylaxis are important prevention strategy for FTCT of HBV. However, this conclusion should be confirmed by high quality randomized controlled trials.

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.

Prevention of perinatal hepatitis B through enhanced case management--Connecticut, 1994-95, and the United States, 1994.

Each year, an estimated 20,000 infants are born to women in the United States who are positive for hepatitis B surface antigen (HBsAg). These infants are at high risk for perinatal hepatitis B virus (HBV) infection and for chronic liver disease as adults. To identify newborns who require immunoprophylaxis to prevent perinatal HBV infection, all vaccine advisory groups have recommended routine HBsAg screening of all pregnant women during an early prenatal visit in each pregnancy. Federal funding to support perinatal hepatitis B-prevention programs became available in 1990, and by 1992, programs had been implemented in all 50 states and the District of Columbia. Specific objectives of these programs are to ensure that 1) all pregnant women are tested for HBsAg, and 2) infants born to HBsAg-positive women receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine at birth, with follow-up doses of vaccine at ages 1 and 6 months. This report describes the case-management features of successful hepatitis B-prevention programs in Connecticut during 1994-95 and in the United States during 1994.

Program to prevent perinatal hepatitis B virus transmission in a health-maintenance organization--Northern California, 1990-1995.

Each year, an estimated 20,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women in the United States. These infants are at high risk for perinatal hepatitis B virus (HBV) infection, chronic HBV infection, and associated complications of chronic liver disease, including cirrhosis and hepatocellular carcinoma. All vaccine advisory groups recommend that all pregnant women be routinely tested for HBsAg during an early prenatal visit during each pregnancy to determine whether their newborns will require immunoprophylaxis for the prevention of perinatal HBV infection. Administration of appropriate immunoprophylaxis is approximately 90% effective in preventing HBV infection among children born to HBsAg-positive mothers. In 1995, the Kaiser Permanente Medical Care Program of Northern California (KP)--a health-maintenance organization (HMO) providing care to 2.5 million members and delivering 30,000 infants annually--implemented HBsAg screening of all pregnant women. After initiating the program, KP estimated that at least 25% of the infants born to HBsAg-positive women were not receiving appropriate post-exposure prophylaxis. In response, KP implemented a tracking and follow-up program in 1988. This report describes an assessment of the impact of this program, which indicates that a centralized case-management and tracking system can substantially improve levels of post-exposure prophylaxis.

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.

Perinatal transmission of hepatitis B virus in Senegal, west Africa.

We studied 152 healthy pregnant women and their 156 newborns for markers of hepatitis B virus (HBV) infection in Dakar, Senegal. Of these, 120 mothers (79%) had antibodies to the hepatitis B core antigen (anti-HBc), 21 (13.8%) were hepatitis B surface antigen (HBs Ag) positive, including 2/21 (9.5%) hepatitis B core-associated antigen (HBe Ag) positive and 1/21 (4.7%) HBV DNA positive. At birth, 11 (7%) infants were HBs Ag positive; 9/11 had an HBs Ag positive mother. Ten of these HBs Ag positive-born infants were investigated at 6-7 months: 5 were strongly HBs Ag positive and developed antibodies to HBs Ag, HBc Ag or HBe Ag; these 5 (3.2% of the total) probably became chronic carriers of HBV. The 5 others were HBs Ag negative and 4/5 did not develop antibodies against HBV Ag; HBs Ag positivity at birth was likely due to contamination of the mother's blood. Thirty-one of the 145 HBs Ag negative-born infants were studied at 6-7 months and remained HBs Ag negative. However, 5 (16%) showed evidence of HBV infection occurring between 0 and 6 months, as shown by the development of antibodies to HBs Ag, HBc Ag, and/or HBe Ag. Despite the low prevalence of HBV DNA and HBe Ag in HBs Ag positive African mothers, this study shows the occurrence of perinatal transmission of HBV in West Africa, in contrast with previous studies. Perinatal HBV transmission could explain the HBV vaccination failure recently reported in children in Senegal.

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.

Neonatal hepatitis B infection: clinical and immunologic considerations.

A chronic infection develops in the vast majority of newborn infants infected with the hepatitis B virus, compared with fewer than 10% of infected adults. The reason is probably related to the immaturity of the newborn immune response to infection, resulting in failure to completely eradicate the virus from hepatocytes. Studies of the newborn immune system demonstrate a variety of defects that may predispose infants to chronic hepatitis B infection, including diminished cytokine production, decreased cytotoxic activity, and a generalized suppression of the immune response. In addition, there is evidence that exposure of the fetus to certain maternal hepatitis B antigens and antibodies may adversely modulate the newborn immune response. This article reviews the epidemiologic, virologic, and immunologic aspects of newborn hepatitis B infection, and discusses the reasoning behind the recent recommendations for universal hepatitis B vaccination of newborn infants.

Neonatal hepatobiliary disorders.

Neonatal hepatobiliary disorders are now better understood due primarily to new discoveries in molecular genetics, virology, and immunology. Because they are almost always pathologic and require early intervention, the neonatologist must recognize infants with these hepatocellular and ductal cholestatic problems occurring in the first few weeks of life. This article focuses mainly on new developments regarding neonatal metabolic disorders and their potential for gene therapy; perinatal infections, especially those caused by hepatitis B virus, hepatitis C virus, and human immunodeficiency virus; and recent concepts of neonatal hepatitis and biliary atresia, including a review of predictors that influence outcome for infants undergoing Kasai portoenterostomy and liver transplantation.

[Epidemiology and clinical course of perinatally acquired hepatitis B infection]. / Epidemiologie und klinischer Verlauf der peripartal akquirierten Hepatitis-B-Infektion.

A report is presented on 10 children with perinatally-acquired hepatitis B virus infection. In 9 cases the mother was most probably the source of infection (vertical transmission of hepatitis B), whilst one child was infected via repeated blood transfusion. 7 mothers were of south-eastern European and/or Anatolian origin. Only 2 mothers suffered from clinically apparent liver disease (one had chronic-aggressive hepatitis with positive HBs-antigen and the other had acute hepatitis B). All the others were healthy hepatitis B carriers. Of 7 mothers examined 2 were HBe-antigen positive, and 5 were anti-HBe positive. The clinical course of infection in children varied: 2 children developed subclinical infection, 2 developed acute hepatitis B, which was fulminant with a fatal outcome in one. 6 children showed antigen persistence (HBs-antigen carriers) over the whole period of observation. In one child this antigen persistence is associated with cirrhosis of the liver, 3 children suffer from chronic-persistent hepatitis B, 2 children are healthy carriers; all children are HBe-antigen positive and, thus, seem to be highly infectious. Apart from the risk to the individual, perinatal hepatitis B infection in a certain population. Hence, preventive measures are indicated and should be carried out in form of HBs-antigen screening of pregnant women - at least of high-risk groups - and active-passive immunization of the newborns at risk. The indication for immunization should not depend on the HBe-antigen status of HBs-antigen positive mothers.

Is there evidence for intrauterine HBV infection in newborns of hepatitis B carrier mothers?

It has been proposed that some neonates infected with hepatitis B virus (HBV), acquire their infections in utero as demonstrated by HBV seromarkers in venous blood samples at birth. In this study, paired blood samples from 13 HBsAg-positive, 19 HBsAg- and HBeAg-positive, 2 HBsAg-negative mothers and 34 of their neonates, were drawn 24-72 hours after birth and tested for HBV-DNA in their peripheral blood mononuclear cells (PBMC). The presence of HBV-DNA in PBMC was detected in 69.2% (9/13) of HBsAg-positive mothers, 94.7% (18/19) of HBsAg- and HBeAg-positive mothers, and in none of their neonates. The conclusion from these results is that the evidence for hepatitis B infections occurring in neonates of hepatitis B carrier mothers in utero is uncommon.