Factors associated with vaccine failure & vertical transmission of HBV among

liver411

a cohort of Canadian mothers and infants

Journal of Viral Hepatitis
Early View (Articles online in advance of print)
Published Online: 11 Jun 2010
© 2010 Blackwell Publishing Ltd


Factors associated with vaccine failure and vertical transmission of hepatitis
B among a cohort of Canadian mothers and infants

A. E. Singh 1 , S. S. Plitt 2 , C. Osiowy 3 , K. Surynicz 3 , E. Kouadjo 2 ,
J. Preiksaitis 1 and B. Lee 4

1 Department of Medicine, University of Alberta, Edmonton, AB ;   2 Centre
for Communicable Diseases and Infection Control, Public Health Agency of
Canada, Ottawa, ON ;   3 National Microbiology Laboratory, Winnipeg, MB ; and
4 Provincial Laboratory for Public Health, Edmonton, AB, Canada
Correspondence to Ameeta E. Singh, BMBS, MSc, FRCPC, c/o Alberta Health
Services - Edmonton STD Centre, 3B20-11111 Jasper Ave, Edmonton, AB T5K 0L4,
Canada. E-mail: [email protected] support: Stollery Children's
Hospital Foundation.
Copyright © 2010 Blackwell Publishing Ltd

ABSTRACT
Summary. Mother-to-child transmission of hepatitis B virus (HBV) continues to
occur despite immunoprophylaxis. We examined maternal factors contributing to
transmission in infants receiving adequate immunoprophylaxis in Alberta,
Canada. Prenatal specimens from HBsAg-positive women whose babies developed
HBV infection despite immunoprophylaxis (cases) and HBsAg-positive mothers
whose babies did not (controls) were tested for HBsAg, HBeAg and HBV DNA.
Specimens with detectable DNA underwent HBV genotyping. Routinely collected
surveillance data and laboratory test results were compared between cases and
controls. Twelve cases and 52 controls were selected from a provincial
registry from 2000 to 2005. At the time of prenatal screening, median maternal
age was 31 years [interquartile range (IQR): 27.5–34.5], and median
gestational age was 12 weeks (IQR 10.0–15.5). Cases were more likely than
controls to test positive for HBeAg (77.8%vs 23.1%; P < 0.05). Of all mothers
with detectable viral load (n = 51), cases had a significantly higher median
viral load than did controls (5.6 × 108 IU/mL vs 1750 IU/mL, P < 0.0001). Of
the two cases who were HBeAg negative, one had an undetectable viral load 8
months prior to delivery and a sP120T mutation. The viral load in the other
case was 14 000 IU/mL. The majority of isolates were genotype B (31.3%) and C
(31.3%) with no significant differences in genotype between cases or controls.
In this case–control study, transmission of HBV to infants was more likely
to occur in mothers positive for HBeAg and with high HBV DNA.

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Received January 2010; accepted for publication March 2010
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1365-2893.2010.01333



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