Hepatitis B surface antigenemia at birth: a long-term follow-up study.
OBJECTIVE
To investigate the prevalence and outcome of hepatitis B surface antigenemia in newborns of hepatitis B e antigen (HBeAg)-positive hepatitis B surface antigen (HBsAg) carrier mothers under the current immunoprophylaxis program.


METHODS
From 1984 to 1993, 665 high-risk newborns born to HBeAg-positive HBsAg carrier mothers were prospectively recruited. The newborns were tested for HBsAg soon after birth, before hepatitis B immune globulin administration. All newborns received hepatitis B immune globulin within 24 hours after birth plus subsequent hepatitis B vaccination. Those who were seropositive for HBsAg at birth were regularly followed up for their hepatitis B virus (HBV) markers, liver function profiles, and alpha-fetoprotein levels from 1984 to 1996.


RESULTS
Sixteen (2.4%) of the 665 subjects were found to be seropositive for HBsAg at birth, and all remained HBsAg-positive at 6 months of age. Twelve of the 16 received long-term follow-up care, and all were confirmed to have chronic HBV infection. Of the 12, 2 had HBeAg seroconversion, and 1 had alanine aminotransferase flares without HBeAg seroconversion. Delayed appearance of hepatitis B core antibody (anti-HBc) occurred in 2 without alanine aminotransferase elevation.


CONCLUSIONS
Current immunoprophylaxis strategy does not protect newborns with surface antigenemia, apparently acquired in utero, from becoming HBV carriers. Immunologic attempts to eliminate HBV may occur in carrier children infected in utero, despite their profound immune tolerance to HBV.
Tang
J R
JR
Department of Pediatrics, College of Medicine, National Taiwan University, Taipei.
Hsu
H Y
HY
Lin
H H
HH
Ni
Y H
YH
Chang
M H
MH
D000410:Alanine Transaminase / Q000097:blood; D002353:Carrier State; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000201:enzymology / Q000276:immunology / Q000517:prevention & control / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D007116:Immunization, Passive; D007223:Infant; D007231:Infant, Newborn / Q000097:blood*; D018445:Infectious Disease Transmission, Vertical; D008099:Liver / Q000201:enzymology / Q000503:physiopathology; D008137:Longitudinal Studies; D015995:Prevalence; D011446:Prospective Studies; D014611:Vaccination; D000509:alpha-Fetoproteins / Q000032:analysis
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase