Determining Hepatitis B Serology After Immune Prophylaxis in Babies of Hepatitis B Surface Antigen Positive Mothers

Öz

Objective: This study aims to evaluate the post-immunization hepatitis B serology of babies born to hepatitis B surface antigen (HBsAg) positive mothers, and to investigate the relationship of antiHBs titer with maternal age, delivery type and baby’s weight, week of gestation, breast milk intake and cigarette exposure. Material and Method: Babies born from HBsAg positive mothers admitted to the Ministry of Health Göztepe Training and Research Hospital Gynecology Clinic were included. Recombinant hepatitis B Immunoglobulin (HBIG) and vaccine were administered intramuscularly to all babies within the first 24 hours. Babies were vaccinated according to the 0, 1, 6 month scheme, and their serum HBsAg and anti-HBs levels were measured when they were 9-12 months old. Maternal age, delivery type, birth weight, gestational week, breast milk intake and smoking exposure were questioned and recorded. Results: Fifty babies were included, 26 (52%) of them were girls and 24 (48%) were boys. HBsAg was found positive in one baby whose mother was also positive for Hepatitis B e antigen (HBeAg). Except for six babies, protective anti-HBs positivity (88%) was detected. Anti-HBs titers were found to be significantly lower in babies with a gestational age of <37 weeks (preterm) (p=0.014). The mean anti-HBs levels were higher in male babies, born by normal vaginal delivery, birth weight> 2500 grams, breastfed less than 6 months, and not exposed to smoking, but this difference was not statistically significant. No relationship was found with maternal age. Conclusion: Hepatitis B serology should be screened in all pregnant women, necessary counseling should be given to those who are positive for HBsAg, babies should be immunized effectively, 4 doses of vaccination should be given to premature babies and the vaccine response should be checked. Vaccination is the most important method of protection against hepatitis B.

Anahtar Kelimeler

• Anti-HBs
• Hepatitis B
• immunoprophylaxis
• perinatal transmission
• vaccine

Hepatit B Yüzey Antijeni Pozitif Annelerin Bebeklerinde Bağışıklama Sonrası Hepatit B Serolojisinin Değerlendirilmesi

Öz

Amaç: Hepatit B yüzey antijeni (HBsAg) pozitif annelerden doğan bebek- lerin bağışıklama sonrası hepatit B serolojilerini değerlendirmek, antiHBs titresinin anne yaşı, doğum şekli, bebeğin kilosu, gestasyon haftası, anne sütü alımı ve sigara maruziyeti ile ilişkisini araştırmaktır. Gereç ve Yöntem: Sağlık Bakanlığı Göztepe Eğitim Araştırma Hastanesi Kadın Doğum Kliniği’ne başvuran HBsAg antijeni pozitif olan annelerden doğan bebekler çalışmaya kabul edildi. Tüm bebeklere ilk 24 saat içinde, rekombinan hepatit B İmmünoglobulin (HBIG) ve rekombinan hepatit B aşısı kas içi yapıldı. Bebekler 0, 1, 6 ay şemasına göre aşılandı, 9-12 aylık olduklarında serum HBsAg ve anti-HBs düzeylerine bakıldı. Anne yaşı, doğum şekli ve kilosu, gestasyon haftası, anne sütü alımı ve sigara maru- ziyeti sorgulanarak hazırlanmış forma kaydedildi. Bulgular: Çalışmaya 50 bebek alındı. Olguların 26’sı (%52) kız, 24’ü (%48) erkek idi. Üç doz aşılamadan sonra bir bebekte HBsAg pozitif bulundu. Bu bebeğin annesinin Hepatit B e antijeni (HBeAg) de pozitifti. Altı bebek haricinde koruyucu düzeyde anti-HBs pozitifliği (%88) saptandı. Gestasyon yaşı <37 hafta olan (preterm) bebeklerde anti-HBs titresi anlamlı olarak düşük bulundu. (p=0,014) .Erkek bebeklerde, normal vajinal yolla doğan- larda, doğum kilosu >2500 gram olanlarda, 6 aydan az anne sütü alanlar- da, sigara maruziyeti olmayanlarda anti-HBs düzeyleri ortalamaları daha yüksekti, ancak bu fark istatistiksel olarak anlamlı değildi. Anne yaşı ile ilişki saptanamadı. Sonuç: Tüm gebelerde Hepatit B serolojisi taranmalı, HBsAg pozitif olan- lara gerekli danışmanlık verilmeli, bebekler etkin bir şekilde bağışıklan- malı, aşı yanıtları yetersiz olduğu için prematürelere 4 doz aşılama yapıl- malı ve aşı yanıtı kontrol edilmelidir. Hepatit B’den korunmada en önemli yöntem aşılamadır.

Anahtar Kelimeler

• Anti-HBs
• aşı
• hepatit B
• immün bağışıklama
• perinatal geçiş

Teşekkür

Hastalarımıza çalışmaya verdikleri destekten dolayı teşekkür ediyoruz.

Kaynakça

1. 1. World Health Organization; (https://www.who.int/news-room/ fact-sheets/detail/hepatitis-b, erişim 18.11.2020). google scholar
2. 2. Hutin Y, Nasrullah M, Easterbrook P, Nguimfack BD, Burrone E, Averhoff F, et al. Access to treatment for hepatitis B virus infection - worldwide, 2016. MMWR Morb Mortal Wkly Rep 2018;67(28):773-7. DOI: 10.15585/mmwr.mm6728a2. google scholar
3. 3. Dienstag JL.Hepatitis B Virus Infection. N Engl J Med 2008;359(14):1486-500. DOI: 10.1056/NEJMra0801644. google scholar
4. 4. Ganem D, Prince AM. Hepatitis B Virus Infection - Natural History and Clinical Consequences. N Engl J Med 2004;350(11):1118-29. DOI: 10.1056/NEJMra031087. google scholar
5. 5. Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, et al.Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009 4;190(9):489-92. google scholar
6. 6. Şener K. HBsAg(+) Gebelerde Transplasental Geçişin Araştırılması (Uzmanlık Tezi) T.C. Sağlık Bakanlığı Bakırköy Kadın ve Çocuk Hastalıkları Eğitim Hastanesi ve Doğumevi Kadın Hastalıkları ve Doğum Kliniği İstanbul-2005. google scholar
7. 7. Furuncuoglu Y, Bolukbas FF, Bolukbas C, Torun P, Ozturk R. Changes in the prevalence of HBV infection in pregnant women in Turkey between 1995 and 2015: a 20-year evaluation Postgraduate Medical Journal 2016;92(1091):510-3. DOI: 10.1136/ postgradmedj-2015-133876. google scholar
8. 8. Lolekha S, Warachit B, Hirunyachote A, Bowonkiratikachorn P, West DJ, Poerschke G. Protective efficacy of hepatitis B vaccine without HBIG in infants of HBeAg-positive carrier mothers in Thailand Vaccine 2002;20(31-32):3739-43. DOI: 10.1016/s0264-410x(02)00358-4. google scholar

9. 9. Yang YJ, Liu CC, Chen TJ, Lee MF, Chen SH, Shih HH, et al. Role of hepatitis B immunoglobulin in infants born to hepatitis B e antigen-negative carrier mothers in Taiwan Pediatr Infect Dis J 2003;22(7):584-8. DOI: 10.1097/01.inf.0000073123.93220.a8. google scholar
10. 10. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Effect of hepatitis B immunisation in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis. BMJ 2006;332(7537):328-36. DOI: 10.1136/bmj.38719.435833.7C. google scholar
11. 11. Machaira M, Papaevangelou V, Vouloumanou EK, Tansarli GS, Falagas ME. Hepatitis B vaccine alone or with hepatitis B immunoglobulin in neonates of HBsAg+/HBeAg- mothers: a systematic review and meta-analysis. J Antimicrob Chemother 2015;70(2):396-404. DOI: 10.1093/jac/dku404. google scholar
12. 12. Zanetti AR, Mariano A, Romano L, D’Amelio R, Chironna M, Coppola RC, et al. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005;366(9494):1379-84. DOI: 10.1016/S0140-6736(05)67568-X. google scholar
13. 13. Duval B, Gîlca V, Boulianne N, De Wals P, Masse R, Trudeau G, et al. Comparative long term immunogenicity of two recombinant hepatitis B vaccines and the effect of a booster dose given after five years in a low endemicity country. Pediatr Infect Dis J 2005;24(3):213-8. DOI: 10.1097/01.inf.0000154329.00361.39. google scholar
14. 14. Bialek SR, Bower WA, Novak R, Helgenberger L, Auerbach SB, Williams IT, et al. Persistence of protection against hepatitis B virus infection among adolescents vaccinated with recombinant hepatitis B vaccine beginning at birth: a 15-year follow-up study. Pediatr Infect Dis J 2008;27(10):881-5. DOI: 10.1097/ INF.0b013e31817702ba. google scholar
15. 15. Gilca V, De Serres G, Boulianne N, De Wals P, Murphy D, Trudeau G, et al. Antibody kinetics among 8-10 years old respondents to hepatitis B vaccination in a low endemic country and the effect of a booster dose given 5 or 10 years later. Vaccine 2009;27(43):6048-53. DOI: 10.1016/j.vaccine.2009.07.100. google scholar
16. 16. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus.Clin Gastroenterol Hepatol 2012;10(5):452-9. DOI: 10.1016/j.cgh.2011.10.041. google scholar
17. 17. Wang F, Zhang G, Zheng H, Miao N, Shen L, Wang F, et al. Post-vaccination serologic testing of infants born to hepatitis B surface antigen positive mothers in 4 provinces of China. Vaccine 2017;35(33):4229-35. DOI: 10.1016/j.vaccine.2017.06.019. google scholar
18. 18. Zhang L, Gui XE, Teter C, Zhong H, Pang Z, Ding L, et al. Effects of hepatitis B immunization on prevention of mother-to-infant transmission of hepatitis B virus and on the immune response of infants towards hepatitis B vaccine. Vaccine 2014;32(46):6091-7. DOI: 10.1016/j.vaccine.2014.08.078. google scholar
19. 19. Tekin Koruk S, Batirel A, Kose S, Akhan SC, Aygen B, Tulek N, et al. Evaluation of hepatitis B virus transmission and antiviral therapy among hepatitis B surface antigen-positive pregnant women. J Obstet Gynaecol Res 2015;41(12):1870-6. DOI: 10.1111/jog.12821. google scholar
20. 20. Bracciale L, Fabbiani M, Sansoni A, Luzzi L, Bernini L, Zanelli G. Impact of hepatitis B vaccination in children born to HBsAg-positive mothers: a 20-year retrospective study. Infection 2009;37(4):340-3. DOI: 10.1007/s15010-008-8252-3. google scholar
21. 21. Chinchai T, Chirathaworn C, Praianantathavorn K, Theamboonlers A, Hutagalung Y, Bock PHL, et al. Long-term humoral and cellular immune response to hepatitis B vaccine in high-risk children 18-20 years after neonatal immunization. Viral Immunol 2009;22(2):125-30. DOI: 10.1089/vim.2008.0087. google scholar
22. 22. Ko SC, Schillie SF, Walker T, Veselsky SL, Nelson NP, Lazaroff J, et al. Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women. Vaccine 2014;32(18):2127-33. DOI: 10.1016/j.vaccine.2014.01.099. google scholar
23. 23. Bhave S, Bhise S, Chavan SC, Naik SS, Pusapati RVLN, Bavdekar A et al Hepatitis B vaccination in premature and low birth weight (LBW) babies. Indian Pediatr 2002;39(7):625-31. google scholar
24. 24. Saari TN. Immunization of preterm and low birth weight infants. American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics 2003;112(1 Pt 1):193-8. google scholar
25. 25. Losonsky GA, Wasserman SS, Stephens I, Mahoney F, Armstrong P, Gumpper K, et al. Hepatitis B vaccination of premature infants: a reassessment of current recommendations for delayed immunization. Pediatrics 1999;103(2):E14. DOI: 10.1542/peds.103.2.e14. google scholar
26. 26. Lian WB, Ho SK, Yeo CL. Hepatitis B vaccination is effective for babies weighing less than 1800 g J Paediatr Child Health 2006;42(5):268-76. DOI: 10.1111/j.1440-1754.2006.00853.x. google scholar
27. 27. Linder N, Vishne TH, Levin E, Handsher R, FinKremer I, Waldman D et al Hepatitis B vaccination: long-term follow-up of the immune response of preterm infants and comparison of two vaccination protocols. Infection 2002;30(3):136-9. DOI: 10.1007/s15010-002-2068-3. google scholar
28. 28. Kirmani KI, Lofthus G, Pichichero ME, Voloshen T, D’Angio CT. Seven year follow-up of vaccine response in extremely premature infants. Pediatrics 2002;109(3):498-504. DOI: 10.1542/peds.109.3.498. google scholar
29. 29. Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002;99(6):1049-52. DOI: 10.1016/s0029-7844(02)02000-8. google scholar