台湾隐匿性 HBV 感染的免疫母亲所生婴儿无慢性病

StephenW

台湾隐匿性 HBV 感染的免疫母亲所生婴儿无慢性病

    赖明伟
    张耀龙
    郑宝仁
    和颜觉
    张顺智
    叶秋婷

发布时间：2022年2月13日DOI：https://doi.org/10.1016/j.jhep.2022.01.030

强调

    •
    在过去 35 年内出生的台湾人口中，HBsAg 携带率已降至 2% 以下。
    •
    大约 5% 的接种疫苗者患有隐匿性 HBV 感染 (OBI)。
    •
    <1% 的接种疫苗的孕妇是 HBsAg 携带者，而在本研究中约有 6% 患有 OBI。
    •
    患有 OBI 的母亲有可能将 HBV 传染给婴儿。
    •
    完成乙型肝炎疫苗接种系列 1 年后，病毒血症被清除。

背景与目标
在全民疫苗接种时代出生的台湾人群中，HBsAg 携带率已降至 2% 以下，而约 5% 的人发展为隐匿性乙型肝炎感染 (OBI)。然而，尚未充分研究从患有 OBI 的母亲向其婴儿传播的可能性。我们旨在调查患有 OBI 的母亲是否会将 HBV 传染给婴儿。
方法
从台湾北部的一家三级医院招募了 253 名 1986 年 7 月以后出生并在婴儿期完全接种过乙肝疫苗的孕妇。测定HBV血清学和DNA水平。对患有 OBI 的母亲所生的婴儿进行随访直至 1 岁。对表面基因进行测序。
结果
在 18 名接种疫苗的母亲中记录了 HBV 感染，其中 2 名是 HBsAg 反应性（0.79 %）。 17 例 HBV DNA 阳性，其中 16 例（6.32%）出现 OBI，中位 DNA 水平为 145 IU/ml（四分位距：37.8-657.3 IU/ml）。招募了 10 名患有 OBI 的母亲所生的 11 名婴儿。 3 名婴儿出现 HBsAg 反应，2 名婴儿 HBV DNA 阳性（17.0 和 212.0 IU/ml）。七名患有 OBI 的母亲携带多种表面基因变异。两名暂时感染的婴儿携带来自其母亲的 HBV 准物种的变异体。所有婴儿都接种了完整的乙型肝炎疫苗。在 12 个月大时，没有一个婴儿的 HBsAg 或 HBV DNA 呈阳性。
结论
患有 OBI 的母亲有可能将 HBV 传播给她们的婴儿，因此婴儿的表面基因变异来源于其母亲的次要变异。完成乙型肝炎疫苗接种系列 1 年后，病毒血症被清除。
总结
自台湾启动乙型肝炎疫苗接种计划以来，携带 HBV 表面抗原的年轻个体（即 1986 年之后出生）的比率已降至 2% 以下，尽管约有 5% 的接种疫苗个体发生隐匿性 HBV 感染。在这里，我们表明患有隐匿性 HBV 感染的孕妇可以将 HBV 传播给她们的后代。然而，在完成完整的 HBV 疫苗接种系列后，没有婴儿在 1 岁时持续感染。

StephenW

Absence of chronicity in infants born to immunized mothers with occult HBV infection in Taiwan

    Ming-Wei Lai
    Yao-Lung Chang
    Po-Jen Cheng
    Ho-Yen Chueh
    Shun-Chih Chang
    Chau-Ting Yeh

Published:February 13, 2022DOI:https://doi.org/10.1016/j.jhep.2022.01.030

Highlights

    •
    HBsAg carrier rates have fallen below 2% in the Taiwanese population born within the last 35 years.
    •
    Approximately 5% of vaccinated individuals had occult HBV infection (OBI).
    •
    <1% of vaccinated pregnant mothers were HBsAg carriers, whereas around 6% had OBI in the present study.
    •
    It was possible for mothers with OBI to transmit HBV to their babies.
    •
    Viremia was cleared 1 year after completing the hepatitis B vaccination series.

Background & Aims
In the Taiwanese population born in the universal vaccination era, HBsAg carrier rates have fallen below 2%, while approximately 5% develop occult hepatitis B infection (OBI). However, the potential for transmission from mothers with OBI to their infants has not been well studied. We aimed to investigate whether mothers with OBI could transmit HBV to their babies.
Methods
A total of 253 pregnant women who were born after July 1986 and had been fully vaccinated against HBV during infancy were recruited from a tertiary hospital in Northern Taiwan. HBV serology and DNA levels were determined. Babies born to mothers with OBI were followed-up until 1 year of age. The surface genes were sequenced.
Results
HBV infection was documented in 18 vaccinated mothers, 2 of whom were HBsAg-reactive (0.79 %). Seventeen were positive for HBV DNA, among whom 16 (6.32%) presented with OBI with a median DNA level of 145 IU/ml (interquartile range: 37.8–657.3 IU/ml). Eleven babies born to 10 mothers with OBI were recruited. Three babies were HBsAg-reactive, and 2 were positive for HBV DNA (17.0 and 212.0 IU/ml). Seven mothers with OBI carried multiple surface gene variants. Two transiently infected babies harbored variants originating from their mother’s HBV quasi-species. All infants received complete hepatitis B vaccines. At 12 months of age, none of the babies were positive for HBsAg or HBV DNA.
Conclusions
It was possible for mothers with OBI to transmit HBV to their babies, who consequently harbored surface gene variants originating from their mothers’ minor variants. Viremia was cleared 1 year after completing the hepatitis B vaccination series.
Lay summary
Since initiating the hepatitis B vaccination program in Taiwan, the rate of young individuals (i.e. born after 1986) carrying the HBV surface antigen has fallen below 2%, although around 5% of vaccinated individuals develop occult HBV infections. Herein, we show that pregnant mothers with occult HBV infections can transmit HBV to their offspring. However, no infant had sustained infection at 1 year of age having completed a full HBV vaccination series.