, Volume 37, Issue 4, pp 340–343 | Cite as

Impact of Hepatitis B Vaccination in Children Born to HBsAg-Positive Mothers: a 20-year Retrospective Study

  • L. Bracciale
  • M. Fabbiani
  • A. Sansoni
  • L. Luzzi
  • L. Bernini
  • G. ZanelliEmail author
Clinical and Epidemiological Study



Preventive measures remain the best approach to control the spread of hepatitis B virus (HBV) infection.

Patients and Methods:

To evaluate the effectiveness of vaccination against HBV, we conducted a 20-year retrospective study on 100 subjects, born to hepatitis B surface antigen (HBsAg)-positive mothers, who had received postexposure prophylaxis at the Clinic of Infectious Diseases (Siena University, Italy) during 1984–2004. All patients were tested for the presence of HBsAg, anti-HBs and anti-HB core antigen (anti-HBc).


Two subjects (2%) acquired the infection as shown by the presence of anti-HBc. Of the 98 patients who did not acquire the infection, 62 of these (63.3%) had an anti-HBs concentration considered protective (‡ 10 mIU/ml). The percentage of protected subjects decreased in relation to time from vaccination with a significant reduction (p = 0.009) of anti-HBs geometric mean titre (GMT) after 5 years, which reached the level of 10 mIU/ml after about 15 years. No patients without protective concentration have acquired the infection as of today. Only 12% of the HBsAgpositive mothers were followed in specialized structures after pregnancy, reflecting the scarce knowledge of the problem in the general population.


Our data, while confirming the effectiveness of anti hepatitis B vaccination, highlight the need for postvaccination follow-up, particularly in high-risk categories, to prolong protection, through booster doses if necessary. We show, moreover, the importance of maintaining active surveillance in the territory to improve follow-up to chronic carriers and to sensitize families.


Acute Hepatitis Booster Dose Postexposure Prophylaxis Vaccination Cycle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alter MJ: Epidemiology of hepatitis B in Europe and worldwide. J Hepatol 2003; 39: S64–S69.PubMedCrossRefGoogle Scholar
  2. 2.
    Ranger-Rogez S, Denis F: Hepatitis B mother-to-child transmission. Expert Rev Anti Infect Ther 2004; 2: 133–145.PubMedCrossRefGoogle Scholar
  3. 3.
    Stroffolini T, Bianco E, Szklo A, Bernacchia R, Bove C, Colucci M, Coppola RC, D’Argenio P, Lopalco P, Parlato A, Ragni P, Simonetti A, Zotti C, Mele A: Factors affecting the compliance of the antenatal hepatitis B screening programme in Italy. Vaccine 2003; 21: 1246–1249.PubMedCrossRefGoogle Scholar
  4. 4.
    Ganem D, Prince AM: Hepatitis B virus infection - natural history and clinical consequences. N Engl J Med 2004; 350: 1118–1129.PubMedCrossRefGoogle Scholar
  5. 5.
    Mele A, Tosti ME, Mariano A, Pizzuti R, Ferro A, Borrini B, Zotti C, Lopalco P, Curtale F, Balocchini E, Spada E: National surveillance system for acute viral hepatitis (SEIEVA) Collaborating group: acute hepatitis B 14 years after the implementation of universal vaccination in Italy: areas of improvement and emerging challenges. Clin Infect Dis 2008; 46: 868–875.PubMedCrossRefGoogle Scholar
  6. 6.
    Poland GA, Jacobson RM: Prevention of Hepatitis B with the Hepatitis B vaccine. N Engl J Med 2004; 351: 2832–2838.PubMedCrossRefGoogle Scholar
  7. 7.
    Shouval D: Hepatitis B vaccines. J Hepatol 2003; 39: S70–S76.PubMedCrossRefGoogle Scholar
  8. 8.
    Stroffolini T, Mele A, Tosti ME, Gallo G, Balocchini E, Sangalli M, Ragni P, Santonastasi F, Marzolini A, Ciccozzi M, Mioraghi A: The impact of the Hepatitis B mass immunisation campaign on the incidence and risk factors of acute hepatitis B in Italy. J Hepatol 2000; 33: 980–985.PubMedCrossRefGoogle Scholar
  9. 9.
    Mele A, Tancredi F, Romanò L, Giuseppone A, Colucci M, Sangiuolo A, Lecce R, Adamo B, Tosti ME, Taliani G, Zanetti AR: Effectiveness of hepatitis B vaccination in babies born to hepatitis B surface antigen-positive mothers in Italy. J Infect Dis 2001; 184: 905–908.PubMedCrossRefGoogle Scholar
  10. 10.
    West DJ, Calandra GB: Vaccine induced immunologic memory for hepatitis B surface antigen: implications for policy on booster vaccination. Vaccine 1996; 14: 1019–1027.PubMedCrossRefGoogle Scholar
  11. 11.
    Van Damme P, Hepatitis B: Vaccination programmes in Europe - an update. Vaccine 2001; 19: 2375–2379.PubMedCrossRefGoogle Scholar
  12. 12.
    Zanetti AR, Mariano A, Romanò L, D’Amelio R, Chironna M, Coppola RC, Cuccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zamparo E, Zotti C, Stroffolini T, Mele A: Study group Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005; 366: 1379–1384.PubMedCrossRefGoogle Scholar
  13. 13.
    Yuen MF, Lim WL, Chan AO, Wong DK, Sum SS, Lai CL: 18 year follow-up study of a prospective randomized trial of hepatitis B vaccinations without booster doses in children. Clin Gastroenterol Hepatol 2004; 2: 941–945.PubMedCrossRefGoogle Scholar
  14. 14.
    Sarrecchia C, Cappelli A, Aiello P: HBV reactivation with fatal fulminating hepatitis during rituximab treatment in a subject negative for HBsAg and positive for HBsAb and HBcAb. J Infect Chemother 2005; 11: 189–191.PubMedCrossRefGoogle Scholar
  15. 15.
    Kao JH, Chen DS: Hepatitis B vaccination: to boost or not to boost? Lancet 2005; 366: 1337–1338.PubMedCrossRefGoogle Scholar
  16. 16.
    Lu CY, Chiang BL, Chi WK, Chang MH, Ni YH, Hsu HM, Twu SJ, Su IJ, Huang LM, Lee CY: Waning immunity to plasma-derived hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination. Hepatology 2004; 40: 1415–1420.PubMedCrossRefGoogle Scholar
  17. 17.
    Marzano A, Angelucci E, Andreone P, Brunetto M, Bruno R, Burra P, Caraceni P, Daniele B, Di Marco V, Fabrizi F, Fagiuoli S, Grossi P, Lampertico P, Meliconi R, Mangia A, Puoti M, Raimondo G, Smedile A: Italian association for the study of the liver: prophylaxis and treatment of hepatitis B in immunocompromised patients. Dig Liver Dis 2007; 39: 397–408.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • L. Bracciale
    • 1
  • M. Fabbiani
    • 1
  • A. Sansoni
    • 1
  • L. Luzzi
    • 1
  • L. Bernini
    • 1
  • G. Zanelli
    • 1
    Email author
  1. 1.Infectious Diseases ClinicDept. of Molecular Biology, Siena UniversitySienaItaly

Personalised recommendations