EASL2012:Outcomes of Combination of Hepatitis B Immunoglobulin and Hepatitis B V

StephenW

Outcomes of Combination of Hepatitis B Immunoglobulin and Hepatitis B Vaccination in High-Risk Newborns Born to HBeAg-positive Mothers
Speaker:Sheng-Nan Lu
Author:
S.-N. Lu*, C.-H. Wu, C.-Y. Ou, T.-Y. Hsu, C.-H. Chen
Affiliation:
Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan R.O.C.. *[email protected]

Background and aims: To evaluate the success rate of universal hepatitis B (HB) vaccination program in Taiwan and elucidate HBV infection and HBsAg carrier rates as well as their associated perinatal factors among children born to HBeAg-positive mothers.
Methods: Children born to 263 HBeAg-positive mothers who delivered in Kaohsiung Chang Gung Memorial Hospital from 2001 to 2010 were invited to inform HB vaccination history and to receive ultrasonography as well as blood sampling for HB seromarkers. Serum HBV DNA levels and quantity of HBsAg and HBeAg were checked for the subjects either with positive HBsAg or with only positive for anti-HBc. Including mothers and children, we further analyzed their HBV genotypes. Perinatal factors, including delivery mode, HB immunoglobulin (HBIG) injection time and healthy condition at birth, were collected from medical records. According to the results of HBsAg, anti- HBs and anti-HBc, subjects were grouped into five as HB naïve (-/-/-), HB vaccine responder (-/+/-), HBsAg carrier (+/-/+), recovery from HBV infection (-/+/+), and anti-HBc-postive alone (-/-/+). Then subjects in groups of HBV naïve and anti-HBc-positive alone with presenting anamnestic response to booster HB vaccine were individually merged to groups of vaccine responder and recovery from infection. Results: Among 196 children received postnatal HBIG and HB vaccination, we identified one HBV naïve (0.5%), 109 vaccine responders (55.6%), 21 carriers (10.7%), and 65 recovered from infection (33.2%). Among 21 carriers, 14 (66.7%), 4 (19%), and 3 (14.3%) presented in immune-tolerance, immune clearance and inactive carrier phase, respectively, while their mean age were 5.1±2.5, 7.0±2.9 and 9.3±3.8 years, respectively (p=0.068). Cesarean section is the only significant perinatal factor between carriers (5.3%) and those recovery from HBV infection (37.7%) (p=0.007). Concerning distribution of HBV genotype B between 115 mothers and 19 children, it showed no difference (75% v.s. 63.2%, p=0.267).
Conclusions: In Taiwan, we still discovered 43.9 % HBV infection rate and 10.7 % HBsAg carrier rate in high-risk children born to HBeAg-positive mothers despite of HBIG and HB vaccine administration. Cesarean section may protect newborns from becoming HBsAg carriers, while HBV genotypes and HBIG injection time gave no contributions to HBV carrier rate.

StephenW

乙肝免疫球蛋白和HBeAg阳性母亲所生的高风险新生儿乙肝疫苗接种相结合的成果
主讲人：卢胜男
作者：
S.-N.卢*，胡忠恒吴，C.-Y.欧，黄敦友许汤振辉陈
单位：
昌高雄长庚医院及长庚大学长庚医学院，高雄，台湾的中华民国。 * [email protected]

背景和目的：评价普遍乙型肝炎（乙肝）疫苗接种计划，在台湾的成功率，并阐明HBV感染和HBsAg携带率以及其相关的HBeAg阳性的母亲所生子女之间的围产期因素。
方法：从2001年至2010年在高雄长庚医院交付的263 HBeAg阳性母亲所生的孩子们请告知乙肝疫苗接种史和接受超声检查，以及血液为乙肝seromarkers采样。检查血清HBV DNA水平和数量HBsAg和HBeAg，HBsAg阳性或只有抗-HBc阳性的受试者。包括母亲和儿童，我们进一步分析其HBV基因型。围产期因素，包括分娩方式，乙肝免疫球蛋白（HBIG）注射时间和出生时的健康状况，收集医疗记录。据HBsAg，抗-HBs和抗-HBc的结果，受试者分为乙肝天真（-/-/-），乙肝疫苗应答五（ -  / + /  - ），HBsAg携带（+ /  -  / + ），恢复从乙肝病毒感染（ -  / + /），和单独抗-HBc的阳性（ -  /  -  /）。然后在HBV的天真和抗-HBc阳性单独提出回忆应答助推器乙肝疫苗组受试者分别合并，以免受感染的疫苗应答和恢复组。结果：在196名儿童接受产后乙肝免疫球蛋白和乙肝疫苗接种，我们确定了一个乙肝病毒天真（0.5％），109（55.6％）的疫苗反应，21个运营商（10.7％），和65感染（33.2％）恢复。 21个运营商，其中14例（66.7％），4（19％），3（14.3％），免疫耐受，免疫清除和无效的载波相位，分别，而他们的平均年龄分别为5.1±2.5 7.0±2.9 9.3±3.8岁，分别为（P = 0.068）。剖腹产是唯一显着的运营商（5.3％）和那些从乙肝病毒感染（37.7％）（P = 0.007）恢复围产期因素。关于HBV B基因型之间115母亲和19名儿童的分布，没有明显差异（75％比63.2％，P = 0.267）。
结论：在台湾，我们仍然发现，尽管43.9％，乙肝病毒的感染率和乙肝表面抗原HBeAg阳性的母亲所生的高风险儿童的带菌率10.7％，乙肝免疫球蛋白和乙肝疫苗管理。剖宫产可能保护成为HBsAg携带者的新生儿，乙肝病毒基因型和乙肝免疫球蛋白的注射时间，而并没有B型肝炎带原率的贡献。

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