Predicting Hepatitis B Vaccination Failure in Infants

A brief report (KW Cheung et al. Clin Gastroenterol Hepatol 2018; 16: 144-5) describes a prospective multicenter study (2014-16) in Hong Kong which examined immunoprophylaxis failure (IF) of infants (n=654) born to mothers infected with hepatitis B virus (HBV) infection.  All infants had received HBV vaccine and HBV immunoglobulin (within 12 hours of birth).  Maternal HBV DNA & serology was measured at 28-30 weeks.

Key finding:

  • There were 7 cases of IF (1.1%). All were born to women with positive HBeAg and HBV DNA >8 log10 copies/mL (>17 million IU/mL)
  • The authors note that “although a cutoff of 200,000 IU/mL (~6 log10 copies/mL) has been recommend, the optimal viral load cutoff to initiate HBV antiviral treatment remains debatable.”

My take: HBV prophylaxis with HBV vaccination and HBIG is very effective.  However, HBV DNA levels can be used to target HBV antiviral treatment to further minimize the chance of IF failure.

Related blog posts:

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