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Background: Although hepatitis B vaccine has been highly effective and passive-active immunoprophylaxis has been used, 20%-30% babies whose mothers are hepatitis B virus (HBV) carriers may fail with vaccination against HBV. Since intrauterine HBV infection is responsible for most failures of immunoprophylaxis, this study was focused on combined antepartum and postpartum immunoprophylaxis for interruption of HBV transmission from mothers with both positive HBsAg and HBeAg to their infants.
Methods: One hundred and four pregnant women were HBsAg carriers with HBeAg positive. They were randomly divided into HBV specific immunoglobulin (HBIG) group and control group after informed consent was obtained and the study design was approved by the institutional ethics committee. The HBIG group received 400 IU HBIG at months 3, 2, 1 before delivery, whereas the control group did not. A total of 105 neonates (including twins) in the two groups were given a dose of 200 IU HBIG at birth and 2 weeks after birth, followed by 3 doses of Hepatitis B vaccine at 1, 2 and 7 months of age. A series of blood specimens obtained from the neonates at birth and 1, 2, and 7 months of age were tested for HBsAg, HBeAg, HBV-DNA, and anti-HBs.
Results: In the HBIG group, 3 of 51 neonates were infected by HBV at birth, which was found to be persistent for one year. The average titers of anti-HBs in 47 neonates at 1 month and 48 neonates at 12 months were 46¡À9.7 and 36¡À15.1, respectively. In the control group, 12 of 54 neonates were infected by HBV at birth. Ten of the 12 HBV infected neonates were found to be persistent for 4 months and 9 for 12 months. The average titers of anti-HBs in 42 neonates at 1 month and 45 neonates at 12 months were 41¡À8.2 and 35¡À12.9, respectively.
Conclusions: The rates of intrauterine HBV infection in the HBIG group and control group were 5.9% and 18.5% respectively (¦Ö2=3.86, P<0.05). The average values of anti-HBs at one month of age in the 2 groups were 46¡À9.7 and 41¡À8.2 (t=2.609, P<0.05). More than 94% high-risk infants at one year of age can be protected by the combined antepartum and postpartum immunoprophylaxis by significantly interrupting the transmission of HBV from mothers with both HBsAg and HBeAg positive to their infants. Key words: hepatitis B virus; antepartum and postpartum; interruption; transmission;
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