title: Immunoprophylaxis failure against vertical transmission of hepatitis B virus in the Chinese population: a hospital-based study and a meta-analysis.
abstract: BACKGROUND
  Despite effective immunoprophylaxis, vertical transmission of hepatitis B virus (HBV) from infected mothers still occurs. This study aimed to provide an estimate of the prevalence of immunoprophylaxis failure and evaluate associated risk factors.
  
  
  METHODS
  A hospital-based prospective study was conducted from June 1, 2008, to June 30, 2012. In this prospective study, 294 HBsAg-positive mothers were followed up from their first prenatal care visits until their infants completed the proposed vaccination schedule. Further, studies providing prevalence rates of immunoprophylaxis failure in the Chinese population were identified from electronic databases and were collected for a meta-analysis.
  
  
  RESULTS
  In the prospective study, 16 (5.44%) infants developed HBV infection despite passive-active immunoprophylaxis. Twelve of these infants were born to HBeAg-positive mothers with cord blood that was positive for HBV DNA. After adjusting for maternal and infant factors, HBV DNA detectable in cord blood (odds ratio: 22.32, 95% confidence interval: 4.00-124.47) was associated with a significantly greater risk of immunoprophylaxis failure. The prospective study and 23 previous studies were included in the meta-analysis, constituting a total of 7561 Chinese participants. The overall estimated rates of immunoprophylaxis failure for infants with HBsAg-positive and HBeAg-positive mothers were 4.87% and 9.66% respectively.
  
  
  CONCLUSIONS
  Immunoprophylaxis failure is an extensive problem, and further studies should design and assess novel strategies for the prevention of immunoprophylaxis failure, especially for cases involving HBeAg-positive mothers and infants with cord blood that is positive for HBV DNA.
authors.affiliation: From the *Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology; †Wuhan Centers For Disease Prevention & Control; and ‡Wuhan Medical Care Center for Women and Children, Wuhan, China.
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Lin
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.forename: Aifen
authors.initials: A
authors.lastname: Zhou
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Cao
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.forename: Fang
authors.initials: F
authors.lastname: Xiao
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Yukai
authors.initials: Y
authors.lastname: Du
mesh_terms: D002681:China; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006510:Hepatitis B Antibodies / Q000627:therapeutic use; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000635:transmission*; D006761:Hospitals; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens; D007155:Immunologic Factors