Efficacy of Hepatitis B Immunoglobulin and Hepatitis B Vaccine in Prevention of Perinatal Transmission of Hepatitis B
Authors/Creators
- 1. Assistant Professor, Department of Pediatrics, MKCG Medical College and Hospital Berhampur Ganjam Odisha, India - 760004
- 2. Associate Professor, Department of Pediatrics, MKCG Medical College and Hospital Berhampur Ganjam Odisha, India - 760004
- 3. Associate Professor, Department of General Surgery, SCB Medical College and Hospital Cuttack Odisha, India - 753007
- 4. Professor & HOD, Department of Pediatrics, SCB Medical College and Hospital Cuttack Odisha, India - 753007
Description
Introduction: Hepatitis B is a major global health problem and is a most serious type of viral hepatitis, which puts the people at high risk of death from cirrhosis of the liver and liver cancer. Approximately 30% of the world’s population, or about 2 billion persons, have serological evidence of either current or past infection with hepatitis B virus. Most people in China and India become infected with HBV during childhood. India has intermediate endemicity of Hepatitis B, with Hepatitis B surface antigen (HBsAg) prevalence between 2% and 7% among populations studied. It has been estimated that, in India of the 25 million infants born every year, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. Objectives: To evaluate the efficacy of HBIG and HBV vaccine in infants born to HBsAg/HBeAg positive mothers by testing for Anti-HBsAg Anibody titres, 2 months after completing immunization. To find what percentage of infants are HBsAg positive even after completing the vaccination. Methodology: Hospital based prospective cohort study of sample size 77 babies born from HBsAg/HBeAg positive mothers. Infants were given 0.5ml Hepatitis B Immunoglobulin and 10 µg recombinant DNA Hepatitis B vaccination at birth followed by 2nd and 3rd dose of Hepatitis B vaccination at 6 weeks and 6 months of life respectively. At the age of 8 months of life tested for HBsAg and Anti-HBs antibody. Depending on the antibody titres, infants will be classified as either responders (≥10miu/ml) or non-responders (<10 miu/ml). Data were processed using SPSS software version 20.0. Results: In LBW infants comprises 45.4% of total study subjects. Maximum babies (79.22%) were delivered by LSCS method.27.2% infants were delivered from mothers having positive for HBeAg and HBsAg.3.89% of study subjects were found to be non-responders at the end of primary hepatitis B vaccine immunization. At the end of primary immunization, all the infants were found to be negative for HBsAg. All vaccine non-responders were delivered through vaginal route(p<0.0001) which is clinically significant. Out of total three non-responders all of them were LBW babies(p<0.0001) which is clinically significant. There is no correlation between sex of the infants and maternal HBeAg status. Conclusion: This study indicate that hepatitis B vaccine in association with HBIG administered at birth provides immediate and long term protection against HB virus infection in infants born to hepatitis B carrier mothers. Birth weight of infants has co-relation with vaccine response, with low vaccine response in LBW subjects as compared to normal birth weight infants. Mode of delivery also contributed to vaccine response as babies born through vaginal route had low response to vaccine as compared to babies born through LSCS.
Abstract (English)
Introduction: Hepatitis B is a major global health problem and is a most serious type of viral hepatitis, which puts the people at high risk of death from cirrhosis of the liver and liver cancer. Approximately 30% of the world’s population, or about 2 billion persons, have serological evidence of either current or past infection with hepatitis B virus. Most people in China and India become infected with HBV during childhood. India has intermediate endemicity of Hepatitis B, with Hepatitis B surface antigen (HBsAg) prevalence between 2% and 7% among populations studied. It has been estimated that, in India of the 25 million infants born every year, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. Objectives: To evaluate the efficacy of HBIG and HBV vaccine in infants born to HBsAg/HBeAg positive mothers by testing for Anti-HBsAg Anibody titres, 2 months after completing immunization. To find what percentage of infants are HBsAg positive even after completing the vaccination. Methodology: Hospital based prospective cohort study of sample size 77 babies born from HBsAg/HBeAg positive mothers. Infants were given 0.5ml Hepatitis B Immunoglobulin and 10 µg recombinant DNA Hepatitis B vaccination at birth followed by 2nd and 3rd dose of Hepatitis B vaccination at 6 weeks and 6 months of life respectively. At the age of 8 months of life tested for HBsAg and Anti-HBs antibody. Depending on the antibody titres, infants will be classified as either responders (≥10miu/ml) or non-responders (<10 miu/ml). Data were processed using SPSS software version 20.0. Results: In LBW infants comprises 45.4% of total study subjects. Maximum babies (79.22%) were delivered by LSCS method.27.2% infants were delivered from mothers having positive for HBeAg and HBsAg.3.89% of study subjects were found to be non-responders at the end of primary hepatitis B vaccine immunization. At the end of primary immunization, all the infants were found to be negative for HBsAg. All vaccine non-responders were delivered through vaginal route(p<0.0001) which is clinically significant. Out of total three non-responders all of them were LBW babies(p<0.0001) which is clinically significant. There is no correlation between sex of the infants and maternal HBeAg status. Conclusion: This study indicate that hepatitis B vaccine in association with HBIG administered at birth provides immediate and long term protection against HB virus infection in infants born to hepatitis B carrier mothers. Birth weight of infants has co-relation with vaccine response, with low vaccine response in LBW subjects as compared to normal birth weight infants. Mode of delivery also contributed to vaccine response as babies born through vaginal route had low response to vaccine as compared to babies born through LSCS.
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IJPCR,Vol15,Issue11,Article41.pdf
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Additional details
Dates
- Accepted
-
2023-10-30
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue11,Article41.pdf
- Development Status
- Active
References
- 1. Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol 2005; 34:S1-3. 2. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007; 45:507-39. 3. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: Systematic review and metaanalysis. BMJ 2006; 332:328-36. 4. Dwivedi M, Misra SP, Misra V, Pandey A, Pant S, Singh R, et al. Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission. Indian J Gastroenterol. 2011;30:66-71 5. Sarin SK, Singhal AK. Hepatitis B in India: Problems and Prevention, New Delhi, CBS Publications. 1996:5-16. 6. Batayneh N, Bdour S. Risk of perinatal transmission of hepatitis B virus in Jordan. Infect Dis Obstet Gynecol. 2002; 10:127–32. 7. Hollinger FB. Factors influencing the immuno response to hepatitis B vaccine, booster dose guidelines and vaccine protocol recommendations. Am J Med 1989; 87(3A): 365-402. 8. Deng XQ, Xu ZY, Ouyang PY, et al. Relationship between titre of maternal serum hepatitis B surface antigen,e antigen and failure of neonatal hepatitis B immunization. Chinese. J Infect Dis 2000; 18:232-5. 9. Panda SK, Ramesh R, Rao KV, et al. Comparative evaluation of the immunogenicity of yeast-derived (recombinant) and plasmaderived hepatitis B vaccine in infants. J Med Virol. 1991; 35:297–302. 10. Gill HH, Majumdar PD, Dhunjibhoy KR, et al. Prevalence of hepatitis B e antigen in pregnant women and patients with liver disease. J Assoc Physicians India. 1995; 43:247–8. 11. Shenoy S, Baliga S, Parasnath HV. Prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in south Kanara district, Karnataka State, India. Trop Doct. 2004; 34:98–9. 12. Alrowaily MA, Abolfotouh MA, Ferwanah MS. Hepatitis B virus seroprevalence among pregnant females in Saudi Arabia. Saudi J Gastroenterol. 2008;14:70–2 13. Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol 1977; 105: 94-98. 14. Lee CY,Huang LM,Chang MH,Hsu CY, et al.The protective efficacy of recombinant hepatitis B vaccine in newborn infants of hepatitis B e antigen- positive-hepatitis B surface antigen carrier mothers. Pediatr Infect Dis J 1991;10:299-303. 15. Xu ZY, Liu CB, Francis DP. Prevention of perinatal acquisition of hepatitis B virus carriage using vaccine: Prelimnary report of a randomized, double blind placebo controlled and comparative trial. Pediatrics 1985; 76: 713-718. 16. Wong VCW, Ip HMH, Reesink HW, Lelie PN, Reerink-Brongers EE, Yeung CY, Ma HK. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis B vaccine and hepatitis B immunoglobulin: Double blind placebo controlled study. Lancet 1984; i: 921- 926. 17. Li-Zhang Chen, Wen-Qi Zhou, Shu-Shan Zhao, Zhi-Yu Liu and Shi-Wu Wen.A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population. World J Gastroenterol. 2011 August 21; 17(31): 3640-3644. 18. Elke Wiseman, Melissa A Fraser, Sally Holden, Anne Glass, Bronwynne L Kidson, Leon G Heron, Michael W Maley, Anna Ayres, Stephen A Locarnini and Miriam T Levy. Perinatal transmission of hepatitis B virus: an Australian experience.Med J Aust 2009; 190 (9): 489-492. 19. Sharma R, Malik A, Rattan A, Iraqi A, Maheshwari V, Dhawan R. Hepatitis B virus infection in pregnant women and its transmission to infants. J Trop Pediatr. 1996; 42:352–4. 20. N Joshi, A Kumar. Immunoprophylaxis of hepatitis B virus infection. Indian Journal of Medical Microbiology.2001; 19: 172-183 21. Pan C.Q., Zou H.B., Chen Y., Zhang X., Zhang H., Li J., Duan Z. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis b surface antigen-positive women to their infants. 2013. Clinical Gastroenterology and Hepatology, 11, 1349-1355. 22. Poovorawan Y, Sanpavat S, Pongpunlert W, et al. Comparison of a recombinant DNA hepatitis B vaccine alone or in combination with hepatitis B immune globulin for the prevention of perinatal acquisition of hepatitis B carriage. Vaccine 1990 (Suppl8):S56–9. 23. Yazigi Naza, Balisteri f. William: Viral hepatitis. In: Kleigman, Stanton, Behrman eds.Nelson text book of pediatrics, 19thed:1397- 1400. 24. Schleiss R. Mark, Patterson C. Jana: Hepatitis B. In Gleason, Devaskar eds: Avery's Diseases of the new born 9th ed: 498-501. 25. Burchett K. Sandra; Viral infections. In: Cloherty, Eichenwald, Hansen, Stark eds. Manual of neonatal care.7thed.LippincottWilliams and Wilkin; 2012:610-13. 26. WHO: Information sheet: Observed rate of vaccine reactions Hepatitis B vaccine June 2012. 27. Maupas P, Barin F, Chiron J.P, Coursaget P, et al. Efficacy of Hepatitis B vaccine in prevention of early HBs antigen carrier state in children: Controlled trial in an endemic area (Senegal).Lancet 1981, 317:289-92. 28. Mele A, Tancredi F, Romano L,et al. Effectiveness of Hepatitis B Vaccination in babies born to Hepatitis surface antigenpositive mothers in Italy. JID 2001;184:905- 08. 29. Stevens CE,Taylor PE, Tong JM,Nair PV et al. Yeast-recombinant Hepatitis B vaccine efficacy with Hepatitis B immunoglobulin in prevention of perinatal hepatitis B virus transmissions. JAMA.1987;257(19):2612-16. 30. Han K, Shao X, Zheng H et al. Revaccination of non and low responders after a standard three dose hepatitis B vaccine schedule. Human vaccine & immunotherapeutics 2012;8:12,1845-49. 31. Redeker AG, Mosley JW, Gocke DJ, et al. Hepatitis B immunoglobulin as a prophylactic measure for spouses exposed to acute type B hepatitis. N Engl J Med. 1975;293:1055-9. 32. Seeff LB, Wright EC, Zimmerman HJ et al. Type B hepatitis after needle stick exposure: prevention with hepatitis B immune globulin. Final report of the Veterans Administration Cooperative Study. Ann Intern Med 1978; 88:285-93. 33. Jack AD, Hall AJ, Maine N, Mendy M, Whittle HC. What level of hepatitis B antibody is protective? J Infect Dis 1999; 179:489-92. 34. Hoffman F, Kralj N. Criteria for successful hepatitis B vaccination in adults: results of a case study. Infection 2009; 37:266-9. 35. STIKO. Empfeling der standikegen im pfkommission (STIKO) am Robert Kochinstitut/Stand: July 2002 Epid Bull 2002; 28:227-42. 36. Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus: A systematic review. Virol J. 2008; 5:100. 37. Freitas da Motta MS, Mussi-Pinhata MM, Jorge SM, Tachibana Yoshida CF, Sandoval de Souza CB. Immunogenicity of hepatitis B vaccine in pre-term and full term infants vaccinated within the first week of life. Vaccine. 2002; 20:155762.