Hepatitis B vaccine in the prevention of perinatally transmitted hepatitis B virus infection: Final report on a West Midlands pilot study

Abstract

A four-dose vaccination schedule was used to interrupt perinatal transmission of hepatitis B virus from carrier mothers to their babies. Of 49 babies immunised and successfully followed up, 43 (88%) became immune: 15 out of 21 (71%) of babies born to HBeAg + mothers became immune, the other 6 becoming the only carrier babies in the study. Without immunisation a carrier rate in excess of 70% would have been expected in this high-risk group. Vaccine alone, given in a rapid immunisation schedule, protected the majority of babies at risk. In those babies in whom the carrier state occurred in spite of immunisation, infection may have taken place in utero, or the infant may have failed to produce adequate antibody in response to the vaccine.

Antenatal survey for the seroprevalence of HTLV-1 infections in the West Midlands, England

“…It is, however, similar in size to the prevalence of HBsAg carriers in the healthy blood donor population in the United Kingdom, and the comparatively low HBsAg carrier rate has led to routine screening of all antenatal sera in various parts of the country so that immediate postnatal vaccination against HBV infection can be offered. This has been shown to be a highly successful public health measure [39][40].…”

Licensed recombinant hepatitis B vaccines protect chimpanzees against infection with the prototype surface gene mutant of hepatitis B virus

“…51 The results indicate that transmission of the Gly-145-Arg mutant of HBV would not occur among individuals who possess protective titers of anti-HBs. This study did not attempt to demonstrate postexposure immunoprophylaxis against mutant HBV infection, but because successful postexposure prophylaxis against field strains of HBV by HB vaccines is well documented in chimpanzees 52,53 and in infants born to carrier mothers, [54][55][56] the results suggest that perinatal transmission of the Gly-145-Arg mutant of HBV would also be prevented by immunization programs that were properly administered as currently recommended. 48,49,[57][58][59] Several reasons for reported vaccination failures may exist.…”

Congenital and perinatal infections

“…O uso combinado de imunoglobulina humana hiperimune contra o VHB (IGHB) e da vacina confere eficácia protetora de 85% a 95%, mesmo quando a mãe é portadora do antígeno HBe e não possui anticorpos anti-HBe 37 . O uso isolado da vacina contra o VHB no período perinatal previne 70% a 85 % dos casos de transmissão vertical, dependendo da freqüência do marcador HBeAg na população 38 .…”

“…A adoção da triagem de gestantes e imunização dos recém-nascidos de mães infectadas pode ser medida aceitável como alternativa à imunização de rotina na infância para regiões onde as taxas de prevalência de infecção pelo VHB sejam inferiores a 1% a 2%. Entretanto, para regiões de taxas de prevalência superiores a 2%, essa medida deve ser combinada à vacinação de rotina na infância ou, quando houver dificuldades operacionais ou de custo para a identificação de gestantes infectadas, a vacinação deve ser iniciada logo após o nascimento para todas as crianças, quando eventualmente já ocorreu a exposição ao VHB, podendo-se proteger a maioria dos casos de infecção perinatal, mesmo sem a utilização de imunoprofilaxia passiva 38 .…”