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Perinatal transmission of hepatitis B virus: an Australian experience

Elke Wiseman, Melissa A Fraser, Sally Holden, Anne Glass, Bronwynne L Kidson, Leon G Heron, Michael W Maley, Anna Ayres, Stephen A Locarnini and Miriam T Levy
Med J Aust 2009; 190 (9): 489-492.

Summary

Objective: To determine the rate of perinatal hepatitis B virus (HBV) transmission in an Australian setting and to identify maternal virological factors associated with highest risk of transmission.

Design, participants and setting: A prospective, observational study of perinatal transmission of HBV. Participants were pregnant women attending Sydney South West Area Health Service antenatal clinics who tested positive for hepatitis B surface antigen (HBsAg), and their babies. All babies were routinely offered hepatitis B immunoglobulin (HBIG) and HBV vaccination. Babies positive for HBsAg at 9-month follow-up underwent further virological testing, including HBV DNA sequencing. The study was conducted between August 2002 and May 2008.

Main outcome measures: HBV DNA levels and demographic characteristics of HBsAg-positive pregnant women; proportion of their infants with active HBV infection at 9-month follow-up; maternal characteristics affecting transmission rate; HBV DNA sequencing of infected infants and their mothers.

Results: Of 313 HBsAg-positive pregnant women, 213 (68%) were HBV DNA-positive and 92 (29%) were positive for hepatitis B “e” antigen (HBeAg); 138 babies born to HBV DNA-positive mothers were tested for HBV infection (HBsAg positivity) at about 9 months of age. Four cases of transmission were identified. All four mothers had very high HBV DNA levels (> 108 copies/mL) and were HBeAg-positive. Three of the four infants were infected with wild-type HBV strains, with identical maternal/infant isolates. The fourth mother–infant pair had an S gene variant, HBV D144E, which has been previously reported in association with vaccine/HBIG escape. (Unfortunately, HBIG was inadvertently omitted from the immunisation schedule of this infant.) Transmission rates were 4/138 (3%) from HBV DNA-positive mothers overall, 4/61 (7%) from HBeAg-positive mothers, and 4/47 (9%) from mothers with very high HBV DNA levels. No transmission was seen in 91 babies of mothers with HBV DNA levels < 108 copies/mL.

Conclusion: In this cohort, HBV perinatal transmission was restricted to HBeAg-positive mothers with very high viral loads.

  • Elke Wiseman1
  • Melissa A Fraser1
  • Sally Holden2
  • Anne Glass1
  • Bronwynne L Kidson1
  • Leon G Heron3
  • Michael W Maley4
  • Anna Ayres5
  • Stephen A Locarnini5
  • Miriam T Levy1

  • 1 Liverpool Hospital, Sydney South West Area Health Service, Sydney, NSW.
  • 2 University of New South Wales, Sydney, NSW.
  • 3 National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead, Sydney, NSW.
  • 4 Sydney South West Pathology Service, Sydney, NSW.
  • 5 Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC.


Acknowledgements: 

Our study was supported by a Sydney South West Area Health Research Foundation grant. We thank Raymond Chan for help with initial virological assessment of one case.

Competing interests:

None identified.

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