Abstract
Background
Chronic hepatitis-B virus (HBV) infection due to mother-to-child transmission (MTCT) during the perinatal period is an important global health concern. Chile is a low-prevalence country with an increasing migratory inflow from Latin- American countries, with intermediate to high endemic rates of HBV infection, and until 2021, there is no universal maternal screening. This study aimed to evaluate infant outcomes using a risk-based strategy of maternal screening to prevent MTCT of hepatitis B virus (HBV) in a low-prevalence country.
Methods
This prospective study included infants born to HBsAg-positive women detected using a local risk-based strategy. The exposed infants received immunoprophylaxis (IP) and follow-up to evaluate their clinical outcomes and immune responses through post-serological vaccine testing (PSVT) after completing the three- dose schedule of the HBV vaccine.
Results
A total of 99 HBsAg-positive mothers were detected. Seventy-six (82%) infants completed the follow-up and had PSVT between 9 and 12 months of age. 55.2% female, the median gestational age was 39 weeks (25–41) and the median birth weight was 3,130g (816–4,400 g). All patients received IP with recombinant HBV vaccine plus hepatitis-B virus immunoglobulin (HBIG) and three doses of the HBV vaccine. There were no cases of HBV infection, and 96% (72) responded to immunization with HBsAg antibodies (anti-HBsAg) >10 UI/ml, with a median level of 799 IU/ml.
Conclusions
A high-risk strategy can be implemented in countries with non-universal screening for VHB. Timely IP plus high-uptake VHB vaccination in infants born to HBsAg-positive mothers was associated with a high immunogenic response and absence of MTCT.
Significance
There is robust evidence that immunoprophylaxis is recommended in all infants born to a HBsAg positive mother like one of different strategies to control VHBtransmission.
AbstractSection What this study adds?In countries with non-universal screening of VHB a risk based strategy could be considered to prevent MTCT. Timely immunoprophylaxis plus high uptake VHB vaccination in infants born to HBsAg positive mothers is associated with a high immunogenic response and no MTCT. PVST should be considered in populations with lower immunogenic response such as infants born with <2,000 g of weight. PVST should be performed 1 or 2 months after the priming vaccine doses, helping to avoid unnecessary revaccination due to expected declining seroprotecting levels through time.
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G.I., R.V., L.C., and E.P. contributed to the design and implementation of the research; G.I., C.I., C.P., P.L., and R.V. analyzed the results and wrote the manuscript. G.I. conceived and supervised the project.
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Copiz, G.I., Ibañez, C., Piñera, C. et al. Outcome of Infants Born to Women with Chronic Hepatitis B: A Local Risk-Based Strategy in a Low Prevalence Country. Matern Child Health J 28, 767–774 (2024). https://doi.org/10.1007/s10995-024-03909-3
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DOI: https://doi.org/10.1007/s10995-024-03909-3