title: Antibody response to postexposure prophylaxis in infants born to hepatitis B surface antigen-positive women.
abstract: BACKGROUND
  Annually 20,000 infants are born to hepatitis B surface antigen (HBsAg)-positive US women. Without prophylaxis 30% risk chronic hepatitis B virus infection, and 25% of those risk dying from resulting liver cirrhosis or liver cancer as adults.
  
  
  METHODS
  We attempted to interview each HBsAg-positive pregnant woman reported to the health department between 1992 and 1997, to provide their infants with immunoprophylaxis at birth and in the clinic or home and to serotest at 9 to 15 months of age.
  
  
  RESULTS
  Of 879 women reported, 92% enrolled; 787 delivered 796 live infants; 91% of infants received hepatitis B immunoglobulin; 98, 95 and 89% received hepatitis B vaccine (HepB) Doses 1, 2 and 3, respectively; and 80% were serotested. Of these 2.2% were HBsAg-positive and 97% had antibody to HBsAg (anti-HBs) of > or =10 mIU/ml. Anti-HBs concentrations measured in 504 infants were 10 to 99 mIU/ml (25%), 100 to 999 mIU/ml (43%) and > or =1000 mIU/ml (29%). Serotesting was less likely among infants of mothers <20 years of age [odds ratio (OR) 2.5]; white, non-Hispanic (OR 2.8); or with a household income of <$15,000/year (OR 2.0). Lower antibody titers were found when serotesting at 4 to 12 months than at <4 months after HepB-3 (OR 1.8 to 4.4), with HepB-3 receipt <6 months after HepB-2 (OR 2.5) and when household income was <$15,000/year (OR 2.1).
  
  
  CONCLUSIONS
  Centralized case management with home visits resulted in high rates of complete immunoprophylaxis and postvaccination testing among infants born to HBsAg-positive women. Perinatal immunoprophylaxis was immunogenic under routine public health use, with higher anti-HBs titers occurring in infants tested <4 months postvaccination. Because infants in households with low income had higher rates of nonprotective antibody responses, they may benefit from extra efforts to ensure that serotesting is conducted postvaccination.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. geuler@cdc.gov
authors.forename: Gary L
authors.initials: GL
authors.lastname: Euler
authors.forename: John R
authors.initials: JR
authors.lastname: Copeland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rangel
authors.forename: Walter W
authors.initials: WW
authors.lastname: Williams
mesh_terms: D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000032:analysis / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008431:Maternal-Fetal Exchange; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011322:Primary Prevention / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000379:methods
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines