title: Limited benefit of hepatitis B immunoglobulin prophylaxis in children of hepatitis B e antigen-negative mothers.
abstract: BACKGROUND
  In 2006, Singapore adopted the universal hepatitis B immunoglobulin (HBIg) policy. Since then, all infants of hepatitis B surface antigen (HBsAg)-positive mothers receive HBIg, irrespective of maternal hepatitis B e antigen (HBeAg) status. However, the benefits of HBIg for infants of HBeAg-negative mothers are unclear. We compared the vertical transmission rates among children of HBeAg-negative mothers who were given HBIg versus a retrospective cohort who were not given HBIg, to determine its protective effect.
  
  
  METHODS
  This observational study involved pregnant HBsAg-positive women seen at National University Hospital, Singapore, between June 2009 and December 2013. If the infants of these mothers completed the recommended vaccination schedule, they were recruited into the study, along with their older siblings. Serological testing for the children was performed three months after completion of the last dose of vaccine, and hepatitis B virus (HBV) surface gene sequencing was carried out if HBV DNA was detected.
  
  
  RESULTS
  A total of 111 infants and 47 siblings were recruited. 2 (1.5%) children were found to have vertical transmission despite receiving HBIg, while no incidences of vertical transmission were found among the historical controls who did not receive HBIg (p = 1.00).
  
  
  CONCLUSIONS
  The overall effectiveness of the hepatitis B vaccination programme for children of HBsAg-positive mothers was high, regardless of HBIg administration. The addition of HBIg did not appear to confer additional benefits, in terms of vertical transmission rate, among infants born to HBeAg-negative mothers.
authors.affiliation: Department of Neonatology, National University Hospital, Singapore.|Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Le Ye
authors.initials: LY
authors.lastname: Lee
authors.affiliation: Department of Neonatology, National University Hospital, Singapore.|Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Marion M
authors.initials: MM
authors.lastname: Aw
authors.affiliation: Department of Laboratory Medicine, National University Hospital, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Saw
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Mary
authors.initials: M
authors.lastname: Rauff
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
authors.forename: Pearl Ys
authors.initials: PY
authors.lastname: Tong
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.|Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore.
authors.forename: Guan Huei
authors.initials: GH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000276:immunology* / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology*; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D009154:Mutation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D012189:Retrospective Studies; D035781:Siblings
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin
keywords: hepatitis B chronic carrier mothers; hepatitis B surface gene mutations; vertical transmission