title: Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV.
abstract: OBJECTIVE
  Mother-to-infant transmission is the major cause of hepatitis B virus (HBV) infection among immunized children. There has been much debate about screening pregnant women and administering hepatitis B immunoglobulin (HBIG) to newborns. We analyzed the rate of HBV infection among children born to hepatitis B surface antigen (HBsAg)-positive mothers and whether HBIG administration reduces transmission.
  
  
  METHODS
  We analyzed data from 2356 children born to HBsAg-positive mothers, identified through prenatal maternal screens. In addition to HBV vaccines, HBIG was given to all 583 children with hepatitis B e antigen (HBeAg)-positive mothers and to 723 of 1773 children with HBeAg-negative mothers. Serology tests for HBV were performed from 2007 to 2009, when children were 0.5-10 years old.
  
  
  RESULTS
  A significantly greater percentage of children with HBeAg-positive mothers tested positive for antibodies against the hepatitis B core protein (16.76%) and HBsAg (9.26%) than children with HBeAg-negative mothers (1.58% and 0.29%, respectively; P < .0001 and <.001). Among the HBV-infected children, the rate of chronicity also was higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P = .002). Similar rates of antibodies against the hepatitis B core protein (0.99% and 1.88%; P = .19) and HBsAg (0.14% and 0.29%; P = .65) were noted in children born to HBeAg-negative mothers who were or were not given HBIG. Infantile fulminant hepatitis developed in 1 of 1050 children who did not receive HBIG (.095%).
  
  
  CONCLUSIONS
  Children born to HBeAg-positive mothers are at greatest risk for chronic HBV infection (9.26%), despite immunization. Administration of HBIG to infants born to HBeAg-negative mothers did not appear to reduce the rate of chronic HBV infection, but might prevent infantile fulminant hepatitis. Screening pregnant women for HBsAg and HBeAg might control mother-to-infant transmission of HBV.
authors.affiliation: Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Lung-Huang
authors.initials: LH
authors.lastname: Lin
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Jian-Te
authors.initials: JT
authors.lastname: Lee
authors.forename: Wen-Terng
authors.initials: WT
authors.lastname: Lin
authors.forename: Yao-Jung
authors.initials: YJ
authors.lastname: Yang
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Huang
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Wu
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Wan-Hsin
authors.initials: WH
authors.lastname: Wen
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Chu
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.forename: Pei-Lin
authors.initials: PL
authors.lastname: Tsai
authors.forename: Cheng-Lun
authors.initials: CL
authors.lastname: Chiang
authors.forename: Ming-Kwang
authors.initials: MK
authors.lastname: Shyu
authors.forename: Ping-Ing
authors.initials: PI
authors.lastname: Lee
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
mesh_terms: D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D056724:Immunity, Humoral; D007115:Immunization Schedule; D007136:Immunoglobulins / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D017114:Liver Failure, Acute / Q000517:prevention & control / Q000821:virology; D008403:Mass Screening; D011237:Predictive Value of Tests; D011247:Pregnancy; D011295:Prenatal Care; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D015415:Biomarkers; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin