Abstract
To elucidate the impact of a hepatitis B (HB) vaccination program on the prevalence of HB surface antigen (HBsAg) and HB envelope antigen (HBeAg) as well as the success rate of HBeAg clearance among parturients, we collected data on parturients who gave birth between 2000 and 2010, and recorded the HB status postpartum of those with positive HBeAg before birth. A total of 8696 parturients were enrolled, of whom 113 with prenatal positive HBeAg were invited back. The prevalence of HBsAg decreased over the study period, particularly in the vaccinated cohort, while there was no change in the prevalence of HBeAg. Foreign parturients had a higher HBeAg-positive rate and delayed HBeAg clearance, and those with a higher body mass index (>24 kg/m2) had earlier HBeAg clearance (51.9% vs. 23.9%, p = 0.005). Only 30% of the subjects who were positive for HBeAg before birth became negative 5 years after delivery. In conclusion, the downward trend in HB infection with more significance among vaccinated parturients reflects effective prevention and the impact of universal HB immunization. Nonetheless, aggressive follow-up is necessary for parturients who are persistently positive for HBeAg postpartum, as well as developing different public health policies for foreign parturients from endemic areas.
Highlights
hepatitis B (HB) envelope antigen (HBeAg) seroconversion in the immune clearance phase has been shown to indicate a favorable outcome in the natural course of chronic HBV infection
By stratifying the mothers by birth date into four groups under different coverage strategies of HBV vaccination as before June 1979, July 1979 to June 1984 (5 years before universal immunization to newborns born to HBeAg-positive mothers), July 1984 to June 1986, and after July 1986, the HB surface antigen (HBsAg)-positive rates were 15.9%, 12.4%, 7.8%, and 2.6%, respectively (p = 0.001)
We found that the prevalence of HBsAg had already begun to decrease in the women born as early as 5 years before the introduction of the national HB vaccination program in Taiwan, and there was an even more dramatic decrease in the vaccinated cohort
Summary
HBeAg seroconversion in the immune clearance phase has been shown to indicate a favorable outcome in the natural course of chronic HBV infection. We aimed to investigate the status of HBV infection among Taiwanese pregnant women and those from other Asian countries in order to explore the potential impact of foreign immigration on public health in Taiwan. We conducted this large-scale 10-year retrospective analysis to explore the trends of the prevalence of HBsAg and HBeAg in pregnant women, and a follow-up study for the mothers who were HBeAg-positive to evaluate the rate of postpartum HBeAg seroconversion as well as the associated factors. We hope the results can provide data on the impact of the universal hepatitis B vaccination program in Taiwan, and provide a reference to improve the efficacy of such programs
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