Vertical Transmission of Hepatitis B from HBsAg-Negative Mothers
Abstract & Commentary
By Hal B. Jenson, MD, FAAP, Professor of Pediatrics, Tufts University School of Medicine, and Chief Academic Officer, Baystate Medical Center, Springfield, MA, is Associate Editor for Infectious Disease Alert.
Synopsis: Hepatitis B can be vertically transmitted even in the absence of maternal hepatitis B surface antigen (HBsAg), underscoring the importance and benefit of routine hepatitis B immunization of all newborns at birth.
Source: Walz A, et al. Vertical transmission of hepatitis B virus (HBV) from mothers negative for HBV surface antigen and positive for antibody to HBV core antigen. J Infect Dis. 2009;200:1227-1231.
A study of vertical transmission of Hepatitis B virus (HBV) was conducted among 2,365 pregnant women in Germany who were negative for HBV surface antigen (HBsAg). The mothers were screened for antibody to HBV core antigen (anti-HBc) one day before or after delivery. Infants of mothers who were positive for anti-HBc were tested 3-4 months after birth for evidence of hepatitis B infection, as evidenced by HBsAg or HBV DNA using a highly sensitive polymerase chain reaction assay (Taq PCR).
Of the 2,365 mothers, 147 (6.2%) were anti-HBc positive at 3-4 months of age. Follow-up tests were available from 105 infants; seven infants had evidence of hepatitis B infection, five who were positive by HBV DNA and two who were positive for HBsAg. Follow-up assays were performed for five of these children at 5-15 months of age; none of these children developed chronic hepatitis B infection. Children in Germany typically begin HBV vaccination series at 2-3 months of age.
Commentary
Hepatitis B can be transmitted by blood donors and organ donors who are positive for anti-HBc and negative for all other HBV serologic markers. This appears to reflect low-level viremia, even below the limits of detection of HBV DNA by PCR. This study similarly found that HBV can be vertically transmitted even in the absence of maternal HBsAg.
It is reassuring that, at least among this small number, all of these children apparently cleared the vertically acquired infection and none developed chronic HBV infection. A high rate of clearance among these infants would be anticipated, especially with initiation of HBV vaccination at birth. In the United States, it is recommended that all newborns receive their first dose of HBV vaccine (not using a combination vaccine) at birth, prior to discharge from the newborn nursery.
A study of vertical transmission of Hepatitis B virus (HBV) was conducted among 2,365 pregnant women in Germany who were negative for HBV surface antigen (HBsAg).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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