Source Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Primary Care Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.

BACKGROUND & AIMS: Mother-to-infant transmission is the major cause of hepatitis B virus (HBV) infection among immunized children. There has been much debate about screening pregnant women and administering hepatitis B immunoglobulin (HBIG) to newborns. We analyzed the rate of HBV infection among children born to hepatitis B surface antigen (HBsAg)-positive mothers and whether HBIG administration reduces transmission.

METHODS: We analyzed data from 2356 children born to HBsAg-positive mothers, identified through prenatal maternal screens. In addition to HBV vaccines, HBIG was given to all 583 children with hepatitis B e antigen (HBeAg)-positive mothers and to 723/1773 children with HBeAg-negative mothers. Serology tests for HBV were performed from 2007 to 2009, when children were 0.5-10 years old.

RESULTS: A significantly greater percentage of children with HBeAg-positive mothers tested positive for antibodies against the hepatitis B core protein (anti-HBc, 16.76%) and HBsAg (9.26%) than children with HBeAg-negative mothers (1.58% and 0.29%, respectively; P<.0001 and <.001). Among the HBV infected children, the rate of chronicity was also higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P=.002). Similar rates of anti-HBc (0.99% and 1.88%; P=.19) and HBsAg (0.14% and 0.29%; P=.65) were noted in children born to HBeAg-negative mothers that were or were not given HBIG. Infantile fulminant hepatitis developed in 1/1050 children who did not receive HBIG (.095%).

CONCLUSIONS: Children born to HBeAg-positive mothers are at greatest risk for chronic HBV infection (9.26%), despite immunization. Administration of HBIG to infants born to HBeAg-negative mothers did not appear to reduce the rate of chronic HBV infection, but might prevent infantile fulminant hepatitis. Screening pregnant women for HBsAg and HBeAg might control mother-to-infant transmission of HBV.