Can anyone help me with vertical transmission and Occult (OBI) questions?

[twinboys1girl4me]

I knew I had HBV when I was pregnant with all of my kids.  All of them were treated with HBIG within 24 hours of birth and full HBV series (from birth to 6 months).  I have been e antigen negative with low viral load as long as I've been monitored.  When my kids were 9 months they all tested HBsAg negative.  Testing for HBsAb was positive for two and the last child did not test higher than 10 IU.  The one that did not get enough antibodies got another series and at 20 months tested negative for HBsAg and positive for anti-HB.

All was good until recently.  I asked their pediatrician if they needed a booster due to my history.  My kids at this time were twins almost 15 and daughter almost 13.  The pediatrician said we could test their titers.  All 3 kids titers were below the 10 IU.  This freaked me out, as she was totally confused on why all of them showed negative for all (HBsAg, HBsAb, and HBcAb).  She ran further testing and all of them showed:

Hepatitis B Core Antibody: Nonreactive
HBsAg: Nonreactive
HBV DNA Non reactive (test guidelines were less than 20 IU/mL Roche TagMan HBV Test)
HBeAg: Nonreactive

She boosted all them and then one month later their Anti-HBs were 252.19 mIU/mL for one of the twins and then the other twin and my daughter were over 1,000 mIU/mL.  The pediatrician felt this was a great response, that their body remembered the immunity.

My question is, do you think that all of my kids are good, or do you think any of them can have an occult infection?  I mainly worry about the one twin, who did not first respond to the 1st set of HBV, and he was the one with the lower (252.19 mIU/mL) memory booster.  

We did see a pediatric gastroenterologist at a highly regarded children's hospital.  She said that they are all good, and do not have HBV.  I have read that OBI can be transmitted and show negative to all testing, and she just said again no, they are all fine and healthy.  

I know many doctors in the US are not all that familiar with HBV and Occult is even more rare, just because of the sneaky way HBV tries to escape traditional testing.  I know I've done everything I could possibly do to protect them, but still worry and hoping anyone has some knowledge of Occult virus.

Thank you again for anyone that can possibly help!

[Ccchuiccc]

My husband got vaccinated and his antibody level was above 1000 (where we live, you don't get an actual number if your antibody is above 1000). He had a physical two years later and it dropped to 122. Our specialist explained to us that your antibody spikes three months after your vaccinations and drops significantly within the first year.  Then the decline is more gradual.

My baby scratched me one time and broke skin and I immediately called my doctor being afraid that my blood may be in her nails and somehow get into her if she scratched herself...my doctor reassured me that if that does happen, since she has antibodies, that if my blood got into her, it would act as a "booster" and her antibodies will fight off the infection and increase her antibody level once that's done.

[Ccchuiccc]

Stephen - just like to thank you for your informative responses. I am a chronic carrier since birth and a lot of your responses are helpful and factual and mirror what my specialist tells me. I am sure a lot of people are grateful you (and a few other top responders) are on this site.

[Scaredpreg]

I totally agree with you twinboys1girlforme. I am totally for vaccinations also. Thankfully none of my family has what I have. All my siblings Got vaccinated. I, on the other hand, feel robbed because I wasnt. I am pro vaccinations too and wouldn't do it any other way.

[Scaredpreg]

Thank you for your response. I'm happy your kids have boosted their titers. I am still new at my research skills and understanding of some articles with regards to this condition.  I'm happy I found this community to help me better understand.  Thabk you for your suggestions.

[twinboys1girl4me]

I obviously am a big proponent for vaccinations, so this article that lays out the cons of vaccination are a mute point for me personally.  Read below in the second to last paragraph the reasons why teens may contract HBsAg.

As for how often we need to boost kids, this is the golden question.  My Hepatologist and the Pediatric Gastro dr that we saw (after the pediatrician had no clue what to do) both said that after a protective titer (10 IU/mL) they are protected for a good 15-20 years-life.  I was told by these two doctors that they only recommend boosters for certain populations, and that as long as my kids once had that protective titer that boosting is not necessary.  Of course, I asked my liver doctor and went to see the Ped Gastro doctor after their pediatrician boosted them, since she didn't know what to do and freaked me out.  A month after the boost, the pediatrician wanted them re-tested and they all did mount a good/great response, so it seems true that that B memory cell immunity is remembered.  

The issue where almost all people fall is say they get a partial series or full HBV series as babies/young children and go on with life.  These people never have had their titers checked, so they have no clue if their body mounted a good enough protected response to the vaccine (10 IU/L).  If they never did get that protective level and then are exposed they do risk being infected.  This is what that article is talking about regarding teens.

So for you, due to your post name, I fully recommend the HBIG, HBV series, and then check titers 3 months after last HBV vaccine.  The vaccines and titer check is key for our kids to make sure they mount a protective antibody level.  Waning antibodies over time is normal but their bodies will remember if an attack is needed (boosting or natural exposure).  

[Scaredpreg]

Thank you for your advice. The article sounds frightening. I understand having to live on our toes not spreading it but I guess peace of mind is a challenge we always go through with this.

[sorte]

That article is some anti-vaccacine propaganda. Most of the hbv infections, at least in my country, was from healthcare and it still happens, there's no something like "risk groups". It's important to vaccacine as early as possible.

[Scaredpreg]

Check out this article I found

http://articles.mercola.com/sites/articles/archive/2013/03/26/hepatitis-b-infection.aspx

How often do we have to vaccinate our kids? Please advise.

[sorte]

stef, is there any rule/stats how fast anibodies go down after vaccination, is it normal that for example person who was vaccinated 15 years ago has HBsAb level over 1000 without exposure to hbv, or its more likely that some exposure happend recently and level of antibodies increased ?

[twinboys1girl4me]

I appreciate your opinion Stephen.  I defiantly know I'm being overly anxious and that it was not helped when the pediatrician was perplexed and made a big deal about all of them losing antibodies.  Thank you again for your help.  At least here I feel somewhat "normal" and not an outcast, like their pediatrician made me feel (we are in the process of now switching pediatricians!).  :)

[StephenCastlecrag]

I think you are being over-anxious and not being helped by your pediatrician who does not seem to be a Hepatitis B specialists. Levels of HBsAb do wane over time, UNLESS, your body is constantly challenged by the virus. So if your kids were never exposed to the virus from you, why would their antibodies levels remain high? As the booster vaccination shows, their immunity memory for HBV remains intact and antibodies were quickly produced once challenged.

Some doctors believe occult is the ultimate immune escape for chronic Hepatitis B. But for someone who is never infected, this is impossible, Also, I believe occult Hepatitis is not only rare, but it is also not medically significant unless the person has to undergo immune-suppressant treatments, such as cancer or transplant.

As usual, these are just my personal opinions.