Mother-to-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention

• Published in: Journal of hepatology Vol. 59; no. 1; pp. 24 - 30
• Main Authors: Wen, Wan-Hsin, Chang, Mei-Hwei, Zhao, Lu-Lu, Ni, Yen-Hsuan, Hsu, Hong-Yuan, Wu, Jia-Feng, Chen, Pei-Jer, Chen, Ding-Shinn, Chen, Huey-Ling
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2013
• Subjects: Adult; Child, Preschool; Female; Gastroenterology and Hepatology; HBV DNA; Hepatitis B e Antigens - blood; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - transmission; Hepatitis B, Chronic - virology; Humans; Immunization, Passive; Immunoglobulins - therapeutic use; Immunoprophylactic failure; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Male; Perinatal transmission; Pregnancy; Pregnancy Complications, Infectious - virology; Prospective Studies; Risk Factors; Viral Load; Young Adult; FF; n.a; CVS; OR; BF; CI; HBeAg; HCC; HBsAg; ALT; Immunoprophylactic failure; Perinatal transmission; CS; SD; ULN; HBV DNA; HBIG; GA; HBV; PCR; hepatitis B virus; breast feeding; alanine aminotransferase; odds ratio; hepatitis B e antigen; hepatitis B immunoglobulin; not available; gestational age; hepatocellular carcinoma; polymerase chain reaction; Cesarean section; hepatitis B surface antigen; formula feeding; upper limit of normal; chorionic villus sampling; confidence interval; standard deviation
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2013.02.015

Immunoprophylaxis reduces but does not completely eradicate hepatitis B virus (HBV) transmission. This prospective study aims at assessing the rate and risk factors of maternally transmitted HBV infection. We enrolled 303 mother-infant pairs with positive maternal hepatitis B surface antigen (HBsAg) under current immunization program. Maternal viral load was determined by a real-time PCR-based assay. The children were tested for HBsAg at 4–8months and/or 1–3years of age. Rates of HBV infection were estimated using a multivariate logistic regression model. HBeAg-positive mothers (81/303, 26.7%) had higher viral loads than HBeAg-negative mothers (7.4±1.9 vs. 2.7±1.4 log10 copies/ml, p<0.0001). Ten children, born to HBeAg-positive mothers with high viral load (median, 8.4; range, 6.5–9.5log10copies/ml), were chronically infected. After adjustment for maternal age, birth type, factors related to maternal-fetal hemorrhage, gestational age, infant gender, birth weight, timeliness of vaccination, and feeding practice, maternal viral load was significantly associated with risk of infection (adjusted odds ratio for each log10copy/ml increase, 3.49; 95% confidence interval (CI), 1.63–7.48; p=0.001). The predictive rates of infection at maternal viral load levels of 7, 8, and 9log10copies/ml were 6.6% (95% CI, 0.5–12.6%; p=0.033), 14.6% (95% CI, 5.6–23.6%; p=0.001), and 27.7% (95% CI, 13.1–42.4%; p<0.001), respectively. Additional strategies to further reduce transmission should be considered in mothers with a viral load above 7–8log10copies/ml.