title: Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers.
abstract: In infants born to hepatitis B surface antigen (HBsAg)-positive mothers, failure after passive-active immunization still occurs. The role of maternal hepatitis B DNA level and other risk factors in this setting remains unclear. This study retrospectively evaluated virologic and other risk factors associated with immunoprophylaxis failure in infants born to HBsAg-positive mothers. Between January 2007 and March 2010, we reviewed the clinical and virologic tests in 869 mother-infant pairs. All infants received the identical passive-active immunization schedule after birth. The failure infants (HBsAg positive at 7-12 months of age) were compared to infants who were HBsAg negative when tested during this time period. Among 869 infants, 27 (3.1%) infants were immunoprophylaxis failures and the other 842 (96.9%) infants remained HBsAg negative. When mothers' pre-delivery HBV DNA levels were stratified to <6, 6-6.99, 7-7.99 and ≥ 8 log(10) copies/mL, the corresponding rates of immunoprophylaxis failure were 0%, 3.2% (3/95), 6.7% (19/282) and 7.6% (5/66), respectively (P < 0.001 for the trend). All failure infants were born to hepatitis B e antigen (HBeAg)-positive mothers. Multivariate logistic regression analysis identified maternal HBV DNA levels [odds ratio (OR) = 1.88, 95% confidence interval (CI): 1.07-3.30] and detectable HBV DNA in the cord blood (OR = 39.67, 95% CI: 14.22-110.64) as independent risk factors for immunoprophylaxis failure. All failure infants were born to HBeAg-positive mothers with HBV DNA levels ≥ 6 log(10) copies/mL. The presence of HBV DNA in cord blood predicted failure to passive-active immunization.
authors.affiliation: Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
authors.forename: H
authors.initials: H
authors.lastname: Zou
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: Z
authors.initials: Z
authors.lastname: Duan
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.forename: C
authors.initials: C
authors.lastname: Pan
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000276:immunology* / Q000517:prevention & control* / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D007116:Immunization, Passive; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D012307:Risk Factors; D017211:Treatment Failure; D014611:Vaccination; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens