Increased Protection of Earlier Use of Immunoprophylaxis in Preventing Perinatal Transmission of Hepatitis B Virus.

BACKGROUND: Passive-active immunoprophylaxis against mother-to-child transmission (MTCT) of hepatitis B virus (HBV) recommends administering hepatitis B immunoglobulin (HBIG) and birth-dose hepatitis B vaccine in infants within 12 or 24 hours after birth. With this protocol, MTCT of HBV still occurs in 5-10% infants of HBV-infected mothers with positive hepatitis B e antigen (HBeAg). The present study aimed to investigate whether earlier administration of HBIG and hepatitis B vaccine after birth can further increase protection efficacy. METHODS: We conducted a prospective, multi-center observational study in infants born to mothers with HBV infection, in whom neonatal HBIG and birth dose hepatitis B vaccine were administered within one hour after birth. The infants were followed up for HBV markers at 7-14 months of age. RESULTS: A total of 1140 pregnant women with HBV were enrolled, and 982 infants (9 twins) of 973 mothers were followed up at 9.6 ± 1.9 months of age. HBIG and birth-dose vaccine were administered in newborn infants within a median of 0.17 (0.02-1.0) hours after birth. The overall rate of MTCT was 0.9% (9/982), with none (0%) of the 607 infants of HBeAg-negative mothers and 9 (2.4%) of 375 infants of HBeAg-positive mothers acquiring HBV. All 9 HBV-infected infants were born to mothers with HBV DNA >2.75 × 106 IU/mL. Maternal HBV DNA levels >2 × 106 IU/mL were an independent risk factor (odds ratio, 10.627; 95% confidence interval, 2.135-∞) for immunoprophylaxis failure. CONCLUSIONS: Earlier use (within 1 hour after birth) of HBIG and hepatitis B vaccine can provide better protection efficacy against MTCT of HBV.

Impact of timing on protection of combined immunoprophylaxis in preventing mother-to-child transmission of hepatitis B virus: a retrospective study.

Objective: To evaluate the impact of timing combined immunoprophylaxis on mother-to-child transmission (MTCT) of the hepatitis B virus (HBV) in pregnant women living with hepatitis B. Methods: A retrospective cohort study was included HBsAg-positive pregnant women who delivered full-term at Tianjin Third Central Hospital from January 2019 to December 2021. The objective of this study is to determine whether early administration of hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccination after birth can further improve protection. Result: A total of 694 pregnant women living with hepatitis B were included; 93 infants from these mothers were lost to follow-up [including moving (n = 21), emigrating (n = 26), changing contact information (n = 27), and other reasons (n = 19)], leaving 601 infants for analysis. The incidence in babies born to mothers with hepatitis B was 1.50% (9/601). Based on the different timing of combined immunoprophylaxis administration after birth, 601 infants were divided into two groups (within 2 h and within 2-12 h). The incidence in babies born to mothers with hepatitis B were 0.32% (1/308) and 2.73% (8/293) for infants who received combined immunoprophylaxis within 2 h and between 2 and 12 h of birth, respectively (p = 0.037). The infection incidence of infants born to HBeAg-positive mothers and HBeAg-positive mothers who did not receive antiviral treatment during pregnancy was lower in the 2-h group compared to the 2-12 h group (0.72% vs. 5.84%, p = 0.04 and 1.20% vs. 9.46%, p = 0.047). Conclusion: Using combined immunoprophylaxis as soon as possible (within two hours of birth) may protect against MTCT of HBV more.