HBsAg Carrier Mothers Research Articles

Hepatitis B virus infection in pregnant mothers and its transmission to infants.

Screening for serological markers of hepatitis B virus infection was done on 500 pregnant mothers. HBsAg, AntiHBs and HBeAg were done. HBsAg was positive in 3.6%, AntiHBs in 17.4% and HBeAg in 0.4% cases. The infants born to the asymptomatic HBsAg carrier mothers were followed up to 6 months to determine the vertical transmission of HBV infection. Rate of transmission of infection from HBsAg positive mothers to infants were 16.66% irrespective of HBeAg status, whereas it was nearly 100% in case of HBeAg positive mothers. All of the HBsAg positive infants developed the antigenemia between 3-6 months of age, supporting the hypothesis that intrapartum transmission is the major mode of vertical transmission.

Passive and Active Immunization to Prevent Perinatal Vertical Transmission in Infants Born to HBsAg Carrier Mothers

Passive and Active Immunization to Prevent Perinatal Vertical Transmission in Infants Born to HBsAg Carrier Mothers

Prevention of perinatal transmission of hepatitis B Virus (HB V): A comparison of two prophylactic schedules

Perinatal transmission of hepatitis B virus (HBV) from HBsAg carrier mothers who were HBeAg+, antiHBe+, or negative for both HBe markers, was interrupted using either 4 doses of vaccine, or one dose of hepatitis B immunoglobulin (HBIG) at birth, combined with 4 doses of vaccine. In those infants who received HBIG at birth, the antiHBs titre was significantly higher at 1 and 2 months old, but at 6, 9, and 18 months old, there was no significant difference. Among the infants of carrier mothers who did not display HBeAg (i.e., were antiHBe+, or negative for both HBe markers), a transient subclinical infection would have been expected in around 10% had there been no intervention. No evidence of such infection was detected, and no difference in outcome was found between the two treatment groups. Amongst infants born to HBeAg+ carrier mothers, infection occurred in 1 out of 8 who had received HBIG and vaccine, and in 3 of 8 who had received vaccine only. The difference in outcome was not statistically significant, but the numbers analysed were small. The infections which occurred in spite of prophylaxis may be attributable to in utero infection, poor response to vaccine by the infant, or to the mother having a particularly high HBV-DNA level. HBIG given at birth to infants of HBeAg+ carrier mothers may enhance the protection of infants who are destined to be poor responders to vaccine.

HBcAg identification in the placental cytotypes of symptom-free HBsAg-carrier mothers: A study with the immunoperoxidase method

In this study the presence of HBcAg in placental tissue of symptom-free HBsAg-carrier mothers has been determined by the immunoperoxidase technique. The presence of HBcAg in the major placental cytotypes was mostly limited to the trophoblastic lineage. Moreover the activated macrophages with their strong cytoplasmic reaction to the antigen phagocytosis play a remarkable role in the immune response. Because there are continuous channels that link the human amnion through the trophoblastic lineage, including the endovascular trophoblast with maternal decidual vessels, a functional exchange system may be considered valid. This would influence the transmission of infection.

Mother to child transmission of hepatitis B virus in the Philippines.

A follow-up study of mother to infant transmission of hepatitis B virus was conducted in the Philippines between 1981 and 1983. The prevalence of HBsAg among 527 mothers was 8.5%. Overall, seven out of 17 (41.2%) infants born to HBsAg carrier mothers became HBsAg positive within the first 12 months of life. The risk of becoming HBsAg positive was about 20 times higher for infants born to HBsAg positive mothers than for infants born to HBsAg negative mothers (OR = 18.9, 95% Ci = 2.0-86.6). The risk was even higher if the mother was a carrier of both HBsAg und HBeAg (OR = 91.0, 95% Ci = 49.2-164.8). However, the risk of transmission was very low if the mother was an HBsAg carrier and anti-HBe positive. It was estimated that mother to infant transmission accounts for about one third of HBsAg positivity at one year of age. The implications of these findings in the planning of vaccination campaigns to prevent HBV infections are discussed.

A nationwide vaccination programme in Italy against hepatitis B virus infection in infants of hepatitis B surface antigen-carrier mothers

In order to prevent hepatitis B virus (HBV) infection of infants of hepatitis B surface antigen (HBsAg)-positive mothers, a nation-wide immunization programme was initiated in Italy in January 1984. During the first 3 years (1984-86), 651,667 out of 1726,000 pregnant women (37.8%) were screened for HBsAg; the percentage of mothers screened increased from 32% in 1984 to 51% in 1986 in 15 of the 21 Italian regions, where data by year were available. HBsAg was present in 15,640 mothers (2.4% of those screened); range by region 0.3-6.4%. All newborns of HBsAg-positive women, regardless of the mother's status of hepatitis Be antigen (HBeAg), were given a single dose (0.5 ml Kg-1) of a hepatitis B immune globulin within 24 h after birth and the first dose of plasma-derived hepatitis B vaccine within 7 days after birth. The immunization coverage rate was 80% in the 3-year period. Protective antibodies were found in greater than 97% of a sample of 1071 infants, immunized from different regions. No serious reactions were observed. On the basis of this field experience, it may be concluded that a nation-wide hepatitis B vaccination programme for infants of HBsAg-carrier mothers would be highly immunogenic and safe. Its implementation, however, requires continuous public education and cooperation from physicians.

Chronic hepatitis B in male and female children of HBsAg carrier mothers

We have studied a group of children born to HBsAg+ mothers, resident in the English West Midlands; none of the children had sought medical attention for hepatitis B-related problems. Forty-two out of 48 children born to HBeAg+ mothers were HBsAg+. Among these children, the mean age of the HBeAg+ girls was significantly lower than that of the HBeAg+ boys ( P = 0.05), suggesting that girls eradicate HBeAg at a younger age than boys. Among all children born to HBsAg+ mothers, liver function tests were normal except in 2 HBsAg+ boys who bad elevated serum aminotransferase activities. Excluding these boys, serum alanine aminotransferase activity, while within the normal range, was significantly higher in HBeAg+ and anti-HBe+ children than in their immune (anti-HBs+) and non-infected siblings ( P < 0.01 and P < 0.05). Waning infectivity was observed in many HBsAg+ mothers, giving rise to a typical pattern of infection within a family: older children, born to the still HBeAg+ mother, being HBeAg+ carriers, while younger siblings, born when the mother had become anti-HBe+, had no markers of infection. These younger children are vulnerable to ‘horizontal’ transmission.

HBsAg carrier infants with serum anti-HBc negativity

A total of 128 HBsAg carrier infants born to HBeAg-positive HBsAg carrier mothers were tested for serum HBsAg, HBeAg, hepatitis B virus DNA and anti-HBc. Ninety-three of them had received hepatitis B vaccination. Anti-HBc had been found to be negative in sera of 12 infants who were HBsAg, HBeAg and hepatitis B virus DNA positive during the follow-up period of 3 to 5 years. Liver damage, as measured by serum ALT levels, was found to be normal among the 12 HBsAg carrier infants with serum anti-HBc negativity, whereas 39.7% of the 116 anti-HBc-positive HBsAg carrier infants had abnormal ALT levels during the follow-up period. Anti-HBe and anti-HBs also were not detected in sera of these anti-HBc-negative HBsAg carrier infants. Thus, HBsAg carrier infants with anti-HBc negativity probably result from immune incompetency of the hepatitis B virus antigens.

Long-term immunogenicity and efficacy of hepatitis B vaccine in infants born to HBeAg-positive HBsAg-carrier mothers.

In an attempt to evaluate the long-term immunogenicity and efficacy of plasma-derived hepatitis B vaccine in preventing hepatitis B virus infection, 199 infants born to hepatitis B e antigen-positive hepatitis B surface antigen-carrier mothers were found to be antibody to HBsAg-positive (greater than or equal to 10 mIU per ml) 2 months after the first booster of hepatitis B vaccination at age 1, and their serum HBsAg and anti-HBs were rechecked annually to ages 3 to 5. Of the nine infants whose initial anti-HBs were low (10 to 100 mIU per ml) in concentration, four (44%) were found to be anti-HBs seronegative at age 3, while none of the 127 vaccine responders with high anti-HBs levels (greater than 1,000 mIU per ml) lost their anti-HBs during the 4-year follow-up period. Also, in 63 infants whose initial anti-HBs titers were around 101 to 1,000 mIU per ml, only two lost their anti-HBs at age 4, and another two at age 5, respectively. Whether the vaccine responders lost their anti-HBs or not, no hepatitis B virus infection occurred in these vaccinees during the follow-up period. Thus, in the first 5 years of life, the protective efficacy in the high-risk infants who responded to plasma-derived hepatitis B vaccine was 100%. Because of the diversity of anti-HBs response in individuals, we suggest testing anti-HBs titer in all vaccinated infants after the first booster vaccination in order to calculate the time of next booster before the minimal protective level is reached.

Immunocytochemical HBsAg evidence in placentas of asymptomatic carrier mothers

We report three chronic asymptomatic HBsAg carrier mothers. We studied their placentas via application of the immunohistochemical method to identify HBsAg by peroxidase-antiperoxidase techniques. All three placental specimens showed a positive HBsAg reaction. Due to the strong cytoplasmatic reactivity of the cytotypes, we deduced their active participation in the infection, proving that virosis occurs via transplacental circulation.

Lack of evidence for transplacental transmission of HBV infection by HBsAg-carrier mothers

The possibility of transplacental transmission of HBV infection was investigated in 54 HBsAg-carrier Saudi mothers and their newborns. Controls were 60 Saudi mothers with previous exposure to HBV, and their newborns. Thirteen cord blood samples were HBsAg-positive by ELISA, including three from mothers with previous exposure to HBV, compared with one sample which was HBsAg- and HBeAg-positive and three samples which were only HBeAg-positive. Eight of the 13 cord blood samples which were HBsAg-positive by ELISA were haemolysed sera and were found to be HBsAg-negative by RIA and RPHA. None of the infants' sera, taken within 1-4 days of delivery, was positive for HBsAg or IgM anti-HBc. These results indicate that HBV markers in cord blood are either false-positive or due to contamination by maternal blood rather than an indication of in utero infection.

HBsAg carriers among pregnant women in Italy: Results from the screening during a vaccination campaign against hepatitis B

Hepatitis B virus (HBV) is endemic in Italy. Approximately 400,000 infections (a rate of 700/100,000) occur each year. Chronic liver disease is one of the leading causes of death occurring at a rate of 33.6/100,000 and HBV infection is responsible for at least 60% of chronic active hepatitis (CAH) and 30% of non alcoholic liver cirrhosis. The prevalence of asymptomatic HBsAg carriers, studied in males, has been found > 3% in the general population. We report results of a study on a national scale aimed at providing information about the HBsAg prevalence among females; it refers to the years 1984–86. Over 650,000 pregnant women have been screened for HBsAg during the ongoing vaccination campaign against hepatitis B. The overall HBsAg prevalence has been 2.4% with wide regional differences; in some northern and central areas (Trento, Bolzano, Umbria) the prevalence of HBsAg carriers was below 0.5%, whereas in some southern regions (Campania, Puglia, Sardegna) it was higher than 5%. In some southern provinces we have found an HBsAg prevalence higher than 7% and in some towns higher than 10%. This high carrier rate is a consequence of infections aquired very early in life as suggested by the young age of 1154 biopsy proven HBsAg-positive chronic active hepatitis patients. As the proportion of HBeAg positive among HBsAg carrier mothers is only 5% both in northern and in southern Italy, perinatal transmission does not play a major role in the spread of infection. We regard as more important the impact of a later horizontal transmission; the fact that 30% of children with acute hepatitis B belong to a ‘household with a chronic HBsAg carrier’, while only 4% of children with acute hepatitis A present such exposure, confirms this hypothesis. In this scenario, immunization of all babies, irrespective of HBsAg status of the mother appears to be, in selected endemic areas in Italy, a strategy which deserves serious consideration.

Fulminant hepatitis in infants in Taiwan: Strong association with hepatitis B e antigen‐negative but antibody‐positive maternal hepatitis B surface antigen carriage

AbstractThis study examined the virologic profiles and pathologic features in 10 infants with fulminant hepatitis and aged 2–7 months. Nine male infants were related to hepatitis B virus infection: as evidenced by positive anti‐HBc IgM (4 cases); positive serum HBsAg, and/or liver HBcAg (4 cases); or born to an HBsAg carrier mother (1 case). Only one female infant had presumed non‐A non‐B fulminant hepatitis, but none had hepatitis A. The mothers of eight infants with HBV‐ralated fulminant hepatitis were all positive for serum HBsAg, and most (5/6) were negative for HBeAg but positive for anti‐HBe. These findings suggest that infants born to HBsAg carrier mothers, particularly those who are negative for HBeAg, may contract fulminant hepatitis B in infancy in Taiwan. Six infants studied had massive hepatic necrosis and all died, whereas four had submassive or bridging hepatic necrosis and all survived, suggesting a close correlation between the extent of liver necrosis and the patient's outcome. None of the infants had hepatocyte HBsAg, although four had cytoplasmic HBcAg. Anti‐HBc IgM was commonly detected (4/6), in sharp contrast to the constant negativity in infants who had contracted an asymptomatic HBV infection. These findings suggest that cytoplasmic HBcAg and anti‐HBc IgM may be related to the occurrence of severe liver disease.

The maternal-infant center in the control of hepatitis B.

A seroepidemiologic survey of HBV infection was carried out in four population groups served by the Maternity Hospital of Majorca, an island in the Mediterranean. The prevalence of HBV markers (HBsAg, anti-HBs, anti-HBc), determined by enzyme-immunoassay, reached 17.2% among 864 parturients, 17.2% in 783 hospital personnel, 2.7% and 19.2% among the 186 children and 73 husbands of parturients with no HBV markers, 22.8% and 43.8%, respectively, among the 44 children and 48 husbands of HBsAg chronic carrier parturients. The prevalences of HBsAg in the same groups reached 0.9%, 1.5%, 0% and 0%, 11.4% and 2.1%, respectively. The carrier state represents 50% of all infection cases among children and 4.8% among husbands of carrier women. The prevalence of markers, which was especially high among personnel working in maintenance services (39.1%), on surgical wards (35.3%), among midwives (27.6%) and in cleaning and laundry services (27.1%), and laboratories (21.4%), is used as an indicator in defining priorities for the vaccination of people at risk. Sixty-seven newborn babies of HBsAg carrier mothers were administered one dose of HBIG and three doses of hepatitis B vaccine; at 12 months of age, the seroconversion rate was 98.5%, whereas 1 child (1.5%) became a chronic carrier. Maternity hospitals represent the ideal centers in which to carry out the detection of HBsAg in pregnant women prior to parturition, to ensure that all newborns of chronic carrier women receive passive-active immunization, and to screen their family contacts and vaccinate those who are found susceptible to the infection.

A Study of Serum HBV Markers in Term Pregnant Women and Their Neonates

To evealuate the status of hepatitis B virus infection in the mothers and neonates and to determine the maternal-neonatal transmission of hepatitis B virus, 2,276 term pregnant women were screened for the presence of serum HBsAg, at the Department of Obstetrics and Gynecology, Yeungnam University Hospital, during the period of 18 months from Jan. 1986 to Jun. 1987, and the sera of sixty-six HBsAg carrier mothers and their neonates were tested for HBV markers and liver enzymes. The results were as follows : 1. The prevalence rate of asymptomatic HBsAg carrier in the term pregnant women was 4.7%(53/1,279). 2. Positive rates of HBsAg and anti-HBs 10 the sera of sixty-six neonates born to asymptomatic HBsAg carrier mothers were 12.1% and 9.1%, respectively. Transient elevation of SGOT(three to four times of upper normal limit) was detected in one of eight HBsAg-positive neonates and one of six anti-HBs positive neonates. 3. Positive rates of anti-HBc, HBeAg and anti-HBe to the sera of sixty-six asymptomatic HBsAg carrier term pregant women were 93.9%, 45.5% and 50%, respectively. The rates of transmission of maternal anti-HBc, HBeAg and anti-HBe to the neonates were 85.5%(53/62), 90%(27/30) and 87.9%(29/33). respectively. 4. Serum HBsAg was detected in four of thirty neonates born to HBeAg positive HBsAg carrier mother, three of thirty-three neonates born to anti-HBe positive HBsAg carrier mothers, and one of three neonates born to both HBeAg and anti-HBe negative HBsAg carrier mothers.

ＨＢワクチンによる能動免疫を獲得した後にキャリア化した１例

ＨＢワクチンによる能動免疫を獲得した後にキャリア化した１例

Hepatitis B Virus Infection in the Infants Born to HBe Antigen Negative Carrier Mothers: A Preliminary Report

AbstractOne hundred infants born to hepatitis‐Be antigen (HBeAg)‐negative carrier mothers were followed with or without the administration of hepatitis‐B vaccine (HB vaccine) and/or hepatitis‐B hyperimmune globulin (HBIG). Among the infants without treatment, 7.6% of the infants born to the antibody‐to HBeAg (anti‐HBe)‐positive carrier mothers and 14% of those born to the carrier mothers without HBeAg and anti‐HBe developed HBs‐antigenemia, whereas none of the infants treated became positive for HBsAg. The results indicate the necessity for preventive measures for the babies born to HBsAg‐carrier mothers, regardless of their HBeAg state.

Prevention of maternal-infant hepatitis B virus transmission by immunization: the role of serum hepatitis B virus DNA.

Sera from 108 HBsAg carrier mothers at delivery and their respective offspring at birth and at 6 months of age were examined for hepatitis B virus DNA by the dot-blot hybridization technique. Hepatitis B virus DNA was detected in 83% of 88 carrier mothers who were HBeAg positive, and in 10% of 20 carrier mothers who were HBeAg negative. All five infants born to HBeAg-positive carrier mothers with hepatitis B virus DNA levels over 80 pg per 10 microliters of serum were infected by hepatitis B virus, in spite of receiving hepatitis B immunization. All 17 infants without hepatitis B immunization who were born to HBeAg and hepatitis B virus DNA-positive carrier mothers developed hepatitis B virus infection. Of 56 infants born to HBeAg and hepatitis B virus DNA-positive carrier mothers and who had received hepatitis B immunization, a higher hepatitis B virus infection rate was found in a group of infants whose sera hepatitis B virus DNA were positive (15/16, 93.8%) than in infants whose sera were negative (17/40, 42.5%) at birth (p less than 0.0005). These data suggest that the assay for hepatitis B virus DNA in sera of HBsAg carrier mothers at delivery or their infants at birth will predict the efficacy of hepatitis B immunization for prevention of maternal-infant hepatitis B virus transmission.

Screening of Pregnant Women and Hepatitis B Prophylaxis in Newborns

Abstract Prevention of perinatal hepatitis B includes: (1) screening ol pregnant women for hepatitis B surface antigen, and (2) immunoprophylaxis of babies at risk. HBIG treatment seems to be of some efficacy in preventing the HBsAg carrier state while it permits passive active immunization to occur. The disadvantage of HBIG is that it confers only temporary immunity. Therefore, it infection does not occur, babies will still be susceptible to the virus when passively administered anti-HBs will no longerbe circulating. On the other hand, vaccine provides a long term but not immediate protection. Therefore the ideal approach in post-exposure prophylaxis is a combination of passive plus active immunization. The aim is to provide an immediate protection, with the HBIG, and a long term immunity, with the vaccine, to babies born to HBsAg carrier mothers.

A Case of Hepatocellular Carcinoma Complicating Hepatitis B Infection in a Nine-year-old Boy

A 9-year-old boy born of Chinese parents in England, and adopted by English parents at an early age, presented with primary hepatocellular carcinoma in a non-cirrhotic liver. His serum contained hepatitis B surface antigen and 'e' antibody, a probable result of perinatal infection from an HBsAg carrier mother. The management of infants at risk of perinatal hepatitis B virus transmission should now include active and passive immunisation.