title: Effects of hepatitis B immunization on prevention of mother-to-infant transmission of hepatitis B virus and on the immune response of infants towards hepatitis B vaccine.
abstract: BACKGROUND
  Combined immunization with hepatitis B immunoglobulin (HBIG) plus hepatitis B vaccine (HB vaccine) can effectively prevent perinatal transmission of hepatitis B virus (HBV). With the universal administration of HB vaccine, anti-HBs conferred by HB vaccine can be found increasingly in pregnant women, and maternal anti-HBs can be passed through the placenta. This study was designed to evaluate the effect of hepatitis B immunization on preventing mother-to-infant transmission of HBV and on the immune response of infants towards HB vaccine.
  
  
  METHODS
  From 2008 to 2013, a prospective study was conducted in 15 centers in China. HBsAg-positive pregnant women and their infants aged 8-12 months who completed immunoprophylaxis were enrolled in the study and tested for HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc). Antepartum administration of HBIG to HBsAg-positive women was based on individual preference. HBsAg-negative pregnant women and their infants of 7-24 months old who received HB vaccines series were enrolled and tests of their HBV markers were performed.
  
  
  RESULTS
  1202 HBsAg-positive mothers and their infants aged 8-12 months were studied and 40 infants were found to be HBsAg positive with the immunoprophylaxis failure rate of 3.3%. Infants with immunoprophylaxis failure were all born to HBeAg-positive mothers of HBV-DNA ≥6 log₁₀copies/ml. Among infants of HBeAg-positive mothers, immunoprophylaxis failure rate in vaccine plus HBIG group, 7.9% (29/367), was significantly lower than the vaccine-only group, 16.9% (11/65), p=0.021; there was no significant difference in the immunoprophylaxis failure rate whether or not antepartum HBIG was given to the pregnant woman, 10.3% (10/97) vs 9.0% (30/335), p=0.685. Anti-HBs positive rate was 56.3% (3883/6899) among HBsAg-negative pregnant women and anti-HBs positive rate was 94.2% in cord blood of anti-HBs-positive mothers. After completing the HB vaccine series, anti-HBs positive rate among infants with maternal anti-HBs titers of <10 IU/L, 10-500 IU/L and ≥500 IU/L was 90.3% (168/186), 90.5% (219/242) and 80.2% (89/111) respectively, p=0.011. Median titers of anti-HBs (IU/L) among infants in the three groups was 344.2, 231.9 and 161.1 respectively, p=0.020.
  
  
  CONCLUSIONS
  HBIG plus HB vaccine can effectively prevent mother-to-infant transmission of HBV, but no HBV breakthrough infection was observed in infants born to HBeAg-negative mothers who received HB vaccine with or without HBIG after birth. Antepartum injection of HBIG has no effect on preventing HBV mother-to-infant transmission. High maternal titer of anti-HBs can transplacentally impair immune response of infants towards HB vaccine.
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, 430071 Wuhan, Hubei Province, China; Department of Infection Control, Qingdao Municipal Hospital, Qingdao, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuchang District, 430071 Wuhan, Hubei Province, China. Electronic address: znact@126.com.
authors.forename: Xi-en
authors.initials: XE
authors.lastname: Gui
authors.affiliation: Department of Medicine, Erie Family Health Center, Chicago, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Teter
authors.affiliation: Mother and Child Hospital, Wuxue , Huanggang, China.
authors.forename: Hairong
authors.initials: H
authors.lastname: Zhong
authors.affiliation: Centers for Disease Control and Prevention, Chongyang County, Xianning, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Pang
authors.affiliation: Centers for Disease Control and Prevention, Xiaonan District, Xiaogan, China.
authors.forename: Lixiong
authors.initials: L
authors.lastname: Ding
authors.affiliation: Mother and Child Hospital, Tongcheng County, Xianning, China.
authors.forename: Fengliang
authors.initials: F
authors.lastname: Li
authors.affiliation: Mother and Child Hospital, Dangyang, Yichang, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Mother and Child Hospital, Huanggang, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
mesh_terms: D002681:China; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006513:Hepatitis B e Antigens / Q000097:blood; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007136:Immunoglobulins / Q000627:therapeutic use*; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D011446:Prospective Studies
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin
keywords: Anti-HBs; HB vaccine; HBIG; HBV; Immune response; Mother-to-infant transmission