title: Acute self-limiting hepatitis B after immunoprophylaxis failure in an infant.
abstract: The occurrence of acute hepatitis after failure of immunoprophylaxis in cases of mother-to-infant transmission of hepatitis B virus (HBV) is uncommon. Because immunoprophylaxis failure is caused by the emergence of an "a" determinant escape mutant, the infants usually become HBV carriers. To evaluate whether mutations in the S gene coding for the surface protein that contains the "a" determinant are associated with acute hepatitis after immunoprophylaxis failure, HBV DNA of an infant in with acute hepatitis developed with seroconversion to anti-HBs antibodies at 12 months of age despite administration of anti-hepatitis B immunoglobulin and hepatitis B vaccine was analyzed. The S gene from HBV DNA isolated from the serum of the infant at 12, 19, and 27 months of age was cloned and sequenced. Mutations affecting amino acid residues in the first loop within the "a" determinant (codons 124-147) were found at 12 months of age. Moreover, a novel deletion mutant, with a 1-bp deletion at nucleotide 449 of the S gene, was found at 19 and 27 months of age. This deletion resulted in a frame shift and it introduced a stop codon (TAG) at codon 176. Because the open reading frame of the S gene is completely overlapped by the polymerase gene, mutations in the S gene may affect the polymerase gene. Based on this case, this study suggests that the observed frame-shift mutation in the S gene might affect the polymerase protein and induce prompt suppression of viral replication.
authors.affiliation: Department of Pediatrics, National Defense Medical College, Saitama, Japan. grd1303@gr.ndmc.ac.jp
authors.forename: Haruki
authors.initials: H
authors.lastname: Komatsu
authors.forename: Tomoo
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sogo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Isozaki
authors.forename: Ayano
authors.initials: A
authors.lastname: Inui
authors.forename: Isao
authors.initials: I
authors.lastname: Sekine
authors.forename: Makoto
authors.initials: M
authors.lastname: Kobata
authors.forename: Yunosuke
authors.initials: Y
authors.lastname: Ogawa
mesh_terms: D000208:Acute Disease; D000595:Amino Acid Sequence; D001483:Base Sequence; D004279:DNA, Viral / Q000097:blood; D005260:Female; D017353:Gene Deletion; D015483:HIV Antibodies / Q000008:administration & dosage / Q000097:blood* / Q000276:immunology; D006509:Hepatitis B / Q000517:prevention & control* / Q000628:therapy* / Q000635:transmission / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000235:genetics / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000276:immunology; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008969:Molecular Sequence Data; D017422:Sequence Analysis, DNA; D017211:Treatment Failure
chemical_list: D004279:DNA, Viral; D015483:HIV Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins