Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2011.01492.x/abstract

Virologic factors associated with failure to passive–active immunoprophylaxis

in infants born to HBsAg-positive mothers

H. Zou1, Y. Chen1, Z. Duan1, H. Zhang2, C. Pan3

Article first published online: 1 AUG 2011

DOI: 10.1111/j.1365-2893.2011.01492.x

© 2011 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Early View (Online Version of Record published before inclusion in an issue)

Summary.  In infants born to hepatitis B surface antigen (HBsAg)–positive

mothers, failure after passive–active immunization still occurs. The role of

maternal hepatitis B DNA level and other risk factors in this setting remains

unclear. This study retrospectively evaluated virologic and other risk factors

associated with immunoprophylaxis failure in infants born to HBsAg-positive

mothers. Between January 2007 and March 2010, we reviewed the clinical and

virologic tests in 869 mother–infant pairs. All infants received the identical

passive–active immunization schedule after birth. The failure infants (HBsAg

positive at 7–12 months of age) were compared to infants who were HBsAg

negative when tested during this time period. Among 869 infants, 27 (3.1%)

infants were immunoprophylaxis failures and the other 842 (96.9%) infants

remained HBsAg negative. When mothers’ pre-delivery HBV DNA levels were

stratified to <6, 6–6.99, 7–7.99 and ≥8 log10 copies/mL, the corresponding

rates of immunoprophylaxis failure were 0%, 3.2% (3/95), 6.7% (19/282) and 7.6%

(5/66), respectively (P < 0.001 for the trend). All failure infants were born to

hepatitis B e antigen (HBeAg)–positive mothers. Multivariate logistic

regression analysis identified maternal HBV DNA levels [odds ratio (OR) = 1.88,

95% confidence interval (CI): 1.07–3.30] and detectable HBV DNA in the cord

blood (OR = 39.67, 95% CI: 14.22–110.64) as independent risk factors for

immunoprophylaxis failure. All failure infants were born to HBeAg-positive

mothers with HBV DNA levels ≥6 log10 copies/mL. The presence of HBV DNA in

cord blood predicted failure to passive–active immunization.