Occult HBV infection may still occur after passive and active immunisation in newborns
Pande et al.
Hepatitis B vaccination with or without hepatitis B immunoglobulin at birth to babies born of HBsAg-positive mothers prevents overt HBV transmission but may not prevent occult HBV infection in babies: a randomized controlled trial. J Viral Hepatitis 2013; 20(11): 801–10. [Impact Factor = 3.08]
The authors randomised neonates immediately after delivery to receive either hepatitis B immunoglobulin (HBIG) or placebo in addition to HBV vaccination (at 0, 6, 10 and 14 weeks). 259 neonates were included in the trial with 222 completing 18 weeks of follow-up. Only 62 (28%) reached the primary endpoint of freedom from infection and the development of an adequate immune response to the vaccine. Six had developed overt HBV infection, 64% had developed occult HBV infection and 5% had no infection but had poor immune responses. All of the six overt infections occurred in the placebo group while occult infections were more common in the HBIG group. By 24 months of age 4% had overt infection, 42% had occult infection, 8% had no infection but a poor immune response and 28% were free from infection with a good immune response. Women who were anti-HBe positive were a low-risk group. HBeAg positivity and anti-HBe negativity were associated with infection while high levels of HBV DNA and treatment with vaccine alone were associated with acquisition of overt infection.
A little background, I am a carrier, did not have treatment during pregnancy, HBV DNA was 6 log, both anti HBe and HbeAg were positve. My new born received 1 dose of HBIG within 2 hours after birth, 1st dose of vaccine, followed by 2nd dose of vaccine at 1 month, 3rd dose at 2 months, 4th dose at 6th month and 5th dose at 12th month.
I took him for blood test and the result came back hbsag negative, hbsab over 1000 iu/ml.
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