Failed Postnatal Immunoprophylaxis for Hepatitis B: Characteristics of Maternal Hepatitis B Virus as Risk Factors

Ngui, Siew Lin; Andrews, Nicholas; Underhill, G S; Heptonstall, J; Teo, Chong Gee

doi:10.1086/514610

Cited by 112 publications

(66 citation statements)

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“…The latter can be exactly reflected through HBV DNA quantitation by FQ-PCR test clinically [8,9] . With the prominent sensitivity and specificity of the FQ-PCR test, our study indicated that the intrauterine infection rate had significant correlation with the level of HBV DNA in the maternal serum before delivery, which showed an ascendant trend; the intrauterine infection rate significantly increased at the level of HBV DNA 10 8 copies/mL, which was consistent with the findings by Ngui et al [10] . Those findings suggest that the threshold of HBV DNA 10 8 copies/mL is a potent index of HBV intrauterine infection.…”

Section: Discussionsupporting

confidence: 91%

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Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection

Shi²,

Yang³

et al. 2004

WJG

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AIM:To evaluate the efficacy of hepatitis B immunoglobulin (HBIG) in interrupting hepatitis B virus (HBV) intrauterine infection during late pregnancy. METHODS:We allocated 112 HBsAg positive pregnant women into 2 groups randomly. Fifty seven cases in the HBIG group received 200 IU (unit) HBIG intramuscularly every 4 wk from the 28 wk of gestation to the time of delivery, while 55 cases in the control group received no special treatment. HBsAg, HBeAg, HBcAb, HBeAb, HBsAb and HBV DNA levels were tested in the peripheral blood specimens from all of the mothers at 28 wk of gestation, just before delivery, and in blood from their newborns within 24 h before administration of immune prophylaxis. RESULTS:The intrauterine infection rate in HBIG group and control group were 10.5% and 27.3%, respectively, with significant difference (P<0.05). It showed ascendant trend as HBV DNA levels in the peripheral blood increased before delivery. CONCLUSION:HBIG is potent to cut down HBV intrauterine infection rate significantly when administered to pregnant women regularly during late pregnancy. The possibility of HBV intrauterine infection increases if maternal blood HBV DNA 10 8 copies/mL.

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Section: Discussionsupporting

confidence: 91%

“…The quantity of HBV DNA was transformed to the form of log 10 and then expressed as mean±SD. All data were analyzed as χ 2 (chi-square) test for positive difference and t test for comparisons of means between the 2 groups using SPSS 10.0 for windows.…”

Section: Statisticsmentioning

confidence: 99%

Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection

Shi²,

Yang³

et al. 2004

WJG

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“…The protection rate for postnatal vaccines in our study was 95%, which is similar to the finding of 93.1% in a previous report (14). However, this rate may fluctuate with maternal HBeAg status.…”

Section: Discussionsupporting

confidence: 91%

Does Hepatitis B Virus Prenatal Transmission Result in Postnatal Immunoprophylaxis Failure?

Zhu¹,

Mao²,

Wei-ling³

et al. 2010

Clin Vaccine Immunol

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The objective of this work was to evaluate whether postnatal hepatitis B immunization failure in children is caused by prenatal infections. A prospective study was conducted from October 2006 to September 2008. Fetal samples from HBsAg-positive mothers were retrieved by either amniocentesis or cordocentesis (percutaneous umbilical blood sampling [PUBS]). Hepatitis B virus (HBV) serologic markers (HBVM) and quantitative HBV DNA assays were performed to assess prenatal infection. All neonates were given combined HBV immunoprophylaxis after delivery. The newborns were followed up with HBV serologic testing at 1 year old. For the 252 pregnant women recruited, 16 fetuses were found to be HBV DNA positive, with all HBV DNA levels under 10 4 copies/ml. HBsAg and HBV DNA detected in the uterus were uncommon and were expressed at low levels. In contract to the case with prenatal statuses, neonatal serologies were more similar to their mothers'. The response rate of vaccination was 95%. Six children for whom immunoprophylaxis failed were born to HBeAgpositive mothers with high HBV DNA levels (>10 8 copies/ml), but only one of them was found to be positive for intrauterine HBV DNA (8.5 ؋ 10 2 copies/ml). The presence of intrauterine hepatitis B antigen and DNA does not indicate postnatal HBV infection and vaccination failure.

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“…Additionally, infection risk has been related to the presence of DNA in the placenta (61) and to maternal viremia (4,38), supporting an association between the state of maternal HBV during pregnancy and the risk of transmission to the baby. It is unclear whether HBV can traverse intact epithelial barriers to infect the fetus during gestation.…”

mentioning

confidence: 92%

Hepatitis B Virus Translocates across a Trophoblastic Barrier

Bhat

Anderson

2007

J Virol

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Mother-infant transmission of hepatitis B virus (HBV) accounts for up to 30% of worldwide chronic infections. The mechanism and high-risk period of HBV transmission from mother to infant are unknown. Although largely prevented by neonatal vaccination, significant transmission continues to occur in high-risk populations. It is unclear whether HBV can traverse an intact epithelial barrier to infect a new host. Transplacental transmission of a number of viruses relies on transcytotic pathways across placental cells. We wished to determine whether infectious HBV can traverse a polarized trophoblast monolayer. We used a human placenta-derived cell line, BeWo, cultured on membranes as polarized monolayers, to model the maternal-fetal barrier. We assessed the effects of placental maturity and maternal immunoglobulin on viral transport. Intracellular viral trafficking pathways were investigated by confocal microscopy. Free HBV (and infectious duck hepatitis B virus) transcytosed across trophoblastic cells at a rate of 5% in 30 min. Viral transport occurred in microtubule-dependent endosomal vesicles. Additionally, confocal microscopy showed that the internalized virus traverses a monensin-sensitive endosomal compartment. Differentiation of the cytotrophoblasts to syncytiotrophoblasts resulted in a 25% reduction in viral transcytosis, suggesting that placental maturity may protect the fetus. Virus translocation was also reduced in the presence of HBV immunoglobulin. We show for the first time that transcytosis of infectious hepadnavirus can occur across a trophoblastic barrier early in gestation, with the risk of transmission being reduced by placental maturity and specific maternal antibody. This study suggests a mechanism by which mother-infant transmission may occur.

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Failed Postnatal Immunoprophylaxis for Hepatitis B: Characteristics of Maternal Hepatitis B Virus as Risk Factors

Cited by 112 publications

References 1 publication

Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection

Effect of hepatitis B immunoglobulin on interruption of HBV intrauterine infection

Does Hepatitis B Virus Prenatal Transmission Result in Postnatal Immunoprophylaxis Failure?

Hepatitis B Virus Translocates across a Trophoblastic Barrier

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