Content uploaded by Mortada H.F. El-Shabrawi
Author content
All content in this area was uploaded by Mortada H.F. El-Shabrawi on Dec 18, 2014
Content may be subject to copyright.
A preview of the PDF is not available
Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection: Single center study in Egypt
Abstract and Figures
To identify possible maternal risk factors for hepatitis B virus (HBV) acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen (HBsAg) positive mothers.
Screening of 2000 pregnant females was carried out using rapid test and confirmed by enzyme immunoassay. A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBsAg positive female in addition to at least 2 pregnant HBsAg negative females for each positive case. Infants of HBsAg positive women were offered passive and active immunoprophylaxis within the 1(st) 48 h after birth, in addition to 2(nd) and 3(rd) doses of HBV vaccine after 1 and 6 mo respectively. Infants were tested for HBsAg and hepatitis B surface antibodies (HBsAb) at six months of age.
HBsAg was confirmed positive in 1.2% of tested pregnant women. Risk factors significantly associated with HBV positivity were; history of injections (OR = 5.65), history of seeking medical advice in a clinic (OR = 7.02), history of hospitalization (OR = 6.82), history of surgery (OR = 4) and family history of hepatitis (OR = 3.89) (P < 0.05). Dropout rate was 28% for HBsAg women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns. Immunoprophylaxis failure was detected in only one newborn (3.7%) who tested positive for HBsAg at 6 mo of age; and vaccine failure (seronegative to HBsAb after 4 doses of the vaccine) was detected in another one (3.7%). The success rate of the immunoprophylaxis regimen was 92.6%.
This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.
Figures - uploaded by Mortada H.F. El-Shabrawi
Author content
All figure content in this area was uploaded by Mortada H.F. El-Shabrawi
Content may be subject to copyright.
... On the other hand, HBV seroprevalence in our study is higher than that reported in studies conducted in Eritrea [23], and Egypt [24] (3.2% and 5% respectively). These differences may be explained by local/national strategies to prevent [25]. ...
... The higher the viral load, the greater the risk of infants being infected and the more likely the disease becomes chronic. The high viral load increases the risk of maternal-fetal transmission by up to 90% [25]. This result demonstrates the importance of performing HBeAg testing and, if possible, HBV DNA quantification in HBsAg positive mother [13], to assess the risk of HBV MTCT, especially in our country. ...
... This result demonstrates the importance of performing HBeAg testing and, if possible, HBV DNA quantification in HBsAg positive mother [13], to assess the risk of HBV MTCT, especially in our country. Testing for HBeAg and quantifying HBV load during pregnancy not only allows, in case of HBeAg positivity or high viral load to perform birth dose HBV vaccine, but also, if possible, maternal antiviral treatment during the third trimester of pregnancy, when viremia is high (>200 000UI/ ml) [6,25]. ...
Background: Hepatitis B virus (HBV) infection is a major global health problem. It is thus a high priority to develop strategies to reduce HBV transmission, especially mother to child transmission (MTCT), by incorporating birth dose HBV vaccination and if possible additional preventive interventions. However, the prevalence and risk factors of hepatitis B among pregnant women in N'Djamena are not yet documented. The aims of this study were to determine the prevalence of HBV and to identify the risk factors associated with hepatitis B among pregnant women
... On the other hand, HBV seroprevalence in our study is higher than that reported in studies conducted in Eritrea [23], and Egypt [24] (3.2% and 5% respectively). These differences may be explained by local/national strategies to prevent [25]. ...
... The higher the viral load, the greater the risk of infants being infected and the more likely the disease becomes chronic. The high viral load increases the risk of maternal-fetal transmission by up to 90% [25]. This result demonstrates the importance of performing HBeAg testing and, if possible, HBV DNA quantification in HBsAg positive mother [13], to assess the risk of HBV MTCT, especially in our country. ...
... This result demonstrates the importance of performing HBeAg testing and, if possible, HBV DNA quantification in HBsAg positive mother [13], to assess the risk of HBV MTCT, especially in our country. Testing for HBeAg and quantifying HBV load during pregnancy not only allows, in case of HBeAg positivity or high viral load to perform birth dose HBV vaccine, but also, if possible, maternal antiviral treatment during the third trimester of pregnancy, when viremia is high (>200 000UI/ ml) [6,25]. ...
... A total of 458 pregnant women were included in the study. Their average age was 25 years (95% CI: [20][21][22][23][24][25][26][27][28][29][30]. 262 participants were aged ≤ 25 years (57.20%). ...
... The seroprevalence we found in pregnant women in N'djamena is higher than that reported in studies conducted in other African countries such as Eritrea [21], Cameroon in another study [22] and Egypt in 2020 [23] ( 3.2%; 4.98% and 5% respectively). Such discrepancies could be due to prevention measures implemented locally or other explanations [24]. ...
Background
Hepatitis B virus (HBV) infection is a major global health problem. In Chad, the prevalence is estimated at 19% in the overall population. Control hepatitis B among pregnant women may help to break the chain of transmission. However, the prevalence and risk factors of hepatitis B among pregnant women in N'Djamena are not documented. The aim of this study was to establish the HBV prevalence and identify the risk factors associated with hepatitis B in pregnant women in N'Djamena.
Methods
We conducted a cross-sectional study in eight health facilities in the city of N'Djamena (Chad) from April 4 to August 2, 2021. HBV surface antigen was determined using the SD Bioline HBsAg WB rapid test. We performed a Chi-squared test and an adjusted logistic regression to identify risk factors associated with hepatitis B infection.
Results
A total of 458 pregnant women were included in the study. The average age of participants was 25 years (95% CI: 20–30). Among risk factors, being older (age > 35 years) and having been tested for HBsAg increase the likelihood of being HBsAg+ (OR = 1.22, 95% CI: 0.33–3.92, p = 0.001, and OR = 4.93, 95% CI: 2.05-12.0, p < 0.001).). Pregnant women whose mothers were AgHBs + were also more likely to be HBsAg+ (OR = 27.8; 95% CI: 4.17–192; P = 0.004).
Conclusion
The prevalence of hepatitis B shows intermediate endemicity in pregnant women in Chad. Age, HBsAg carrier mother, and history of HBsAg screening are associated with HBV infection.). Thus, to avoid mother to child transmission of HBV, here is a need to improve the health education of pregnant women and the access to routine prenatal screening and vaccination of newborns at birth. It is also important to increase the immunization coverage of the population, through children vaccination campaigns.
... There was also no statistically significant and vagrancy (P = 0.02), thus joining us several works in the literature [33][34][35][36]. The family history of hepatitis B was also a major risk factor (P < 0.001), this had joined several studies in the literature [7,19,37]. Family exposure to the HBV virus is frequent, and calls out to us the reality of horizontal intra-family transmission. ...
... In this study, there were still 9 cases of mothers with a history of previous abortion.. This study is in line with El-Karaksy HM, 2014 which states that risk factors associated with HBV transmission or transmission are history of injections / injections, history of medical examinations, history of hospitalization, history of surgery and history of Hepatitis B (El-karaksy et al., 2014). A history of abortion is one of the risks found in pregnant women in several studies that were treated with medical measures, tissue and a history of blood transfusions. ...
Pregnant women were susceptible exposed to Hepatitis B Virus infection due to a decrease activity of Sel T in the immune system. The prevalence of Hepatitis B infection in West borneo (2,53%) was higher than the prevalence in Indonesia (1,9%). HBV infection during pregnancy was caused of vertical transmission from mother to child by uteroplacental circulation with HBsAG and DNA of (HBV) as a medium. The purpose of this research is analyze the determines the risk factors of the incidence Hepatitis B virus infection among pregnancy women in Sungai Durian health center years 2018-2020. The type of research used was case control. The population in this research was 133 as a case, 532 not infected women as a control group was done by simple random sampling. The research instrument uses a check list sheet. Prevalence of Hepatitis B in pregnancy by 2.57%. Related variabels with HBV such as age, parity, size of LILA, anemia and environment with p value < 0,05. Age was dominant variable with Odds Ratio 1.608 caused at risk of becoming infected with HBV through saliva and sperm during sexual intercourse, decreased immunity and medical action which can be an entry point for HBV. Keywords : Hepatitis B, infection, risk factor, pregnancy women
... Also, the duration of this phase may be for many years and acute Hepatitis B is often unrecognized in children younger than five years old. Clinical acute Hepatitis B is more frequent in adults than children and probability of becoming chronic carrier of Hepatitis B is greater in children than adults [8][9][10][11][12]. ...
Hepatitis B infection caused by HBV is transmitted through HBV contaminated blood and body fluids, is a major communicable disease of vertical transmission. HBV infection is endemic in Asia pacific regions including Pakistan. The main objective of this study was to determine most common factors affecting and causing Hepatitis B. A cross sectional research study was conducted where blood samples were taken from suspected Hepatitis B individuals for diagnosis and confirmation of HBV. Social and demographical factors were studied with the help of questionnaire. Hepatitis B disease is promoted through sharing of equipment and environment with HBV infected individuals. Smoking either active or passive was significantly positively correlated with Hepatitis B disease whereas education and socioeconomic status were negatively correlated with Hepatitis B. The study conclude that unhygienic practices particularly in dental clinics substantially increase the risk of Hepatitis B. The present study serves as a primary data and will be helpful in future research on Hepatitis B in Balochistan.
... In Nile Delta, more recently, lower prevalences were reported, being 2.3% during 2014 in Menofia and 1.56% during 2017 in Benha [15,16]. In Cairo University Hospitals, the prevalence fluctuated from 1.6% in 2013 to 1.2% in 2014 [17,18]. ...
Introduction
Hepatitis B vaccination of newborns (HBV) and surveillance of pregnant women during antenatal care are complementary to prevent mother to child transmission (MTCT) of HBV infection.
Aim
The aim was to identify the prevalence and pattern of HBV infection in pregnant women born before and after implementing HBV vaccination of newborn in Egypt.
Methods
The study included 600 women attended antenatal clinic of the Suez Canal University Hospital, Ismailia, Egypt. All were inquired about risk factors of HBV infection, vaccination, and screened for hepatitis markers. HBsAg carriers were tested for HBeAg, HBeAb, ALT, and HBV DNA. Participants were divided into group 1 of 285 (47.5%) vaccinated women ≤ 25 years, and 315 (52.5%) non-vaccinated > 25 years.
Results
The prevalence of HBcAg, HBsAg, and HBsAb were 18.3%, 5.0%, and 30.7%. Of the 110 women exposed to infection, 40 (36.4%) cleared infection, 30 (27.2%) were HBsAg carriers, and 40 (36.4%) showed isolated HBcAb. HBsAg carriers were HBeAg negative, HBeAb positive, and HBV-DNA positive and had high ALT. Group 1 had significantly higher frequency of vaccination-related immunity, lower frequency of isolated HBcAb, and susceptibles than group 2 (44.9%, 3.5%, and 38.6% vs. 4.1%, 9.5%, and 75.9% ). The prevalence of HBV exposure and chronic HBsAb carriers in both groups were close (4.9% and 16.5% for group 1 vs. 5.1% and 20% for group 2, p > 0.05).
Conclusion
Although the outcomes of HBV infection were favorable in vaccinated group, chronic HBV represents a potential risk for MTCT that necessitates screening during pregnancy in all public health care settings.
... Postexposure prophylaxis for infants born to HBsAg-positive mothers protects at least 85 % of infants from perinatally acquired HBV infection [20]. In a recent study on Egyptian infants born to HBsAgpositive mothers, who received immunoprophylaxis, the success rate was 92.6 % [21]. ...
Background Occult hepatitis B virus infection (OBI) is a
well-recognized clinical entity characterized by the detection
of HBV DNA in serum and/or liver in the absence of
detectable HBsAg. Diagnosis of OBI requires a sensitive
HBV DNA assay.
Aim We aimed at determining the frequency of OBI in
infants, born to HBsAg-positive mothers, who received
immunoprophylaxis at birth.
Methods Sixty-four infants and children, born to HBsAgpositive
mothers, who received hepatitis B immunoglobulin
and HBV vaccine within 48 h after birth, were tested for
HBV serological profile and HBV DNA by real-time PCR
at least 1 month after last dose of HBV vaccine and not
before 6 months of age.
Results The median age of the studied infants and children
was 8 months, ranging from 6 to 132 months; 54.7 %
were females. HBV DNA was detected in 2 infants. One
case had OBI; she was negative for HBsAg, anti-HBc total,HBeAg and was positive for anti-HBs (titer 267 mIU/mL)
with low level of viremia (HBV DNA 1.13 x 103 IU/mL).
Another infant showed immunoprophylaxis failure with
positive HBsAg, anti-HBc total, HBeAg, negative anti-HBe
and anti-HBs; HBV viral load was 1.7 × 108 IU/mL. Both
mothers were HBsAg and HBeAg-positive.
Conclusion OBI may occur in infants born to HBsAgpositive
mothers despite the receipt of immunoprophylaxis.
OBI was detected in a low frequency in the present study.
Anti-HBs positivity does not exclude OBI.
Background
The three doses constituting the hepatitis B (HB) vaccine series administered intramuscularly at birth, 1 month, and 6 months induce a protective antibody response (anti-HBs >10 IU/l) in more than 90% of recipients.
Aim
To analyze the long-term immunity and effectiveness of hepatitis B virus (HBV) vaccination and to detect hepatitis B infection situation and its risk factors among an adequate number of the university students in the postcompulsory infant vaccination period.
Patients and methods
A total of 400 university students (aged 17–25 years) were screened for quantitative detection of hepatitis B surface antibody, hepatitis B surface antigen (HBs Ag), and total hepatitis B core antibody (HBc Ab) using commercially available kits. HBV DNA PCR was evaluated in repeatedly positive HBs Ag and/or total HBc Ab.
Results
Nonprotective titer less than 10 IU/l was detected in 218/400 (54.5%), whereas protective titer more than or equal to 10 IU/l was detected in 182/400 (45.5%). Overall, 29/400 (7.3%) were positive for HBs Ag and 50/400 (12.5%) were positive for total HBc Ab, whereas only six (1.5%) were positive for HBV DNA PCR. Moreover, 45/400 (11.4%) students had a history of HBV vaccine booster dose in the protective group.
Conclusions
Marked reduction in HBs Ab titer was observed among university students where nonprotective titer less than 10 IU/l was detected in 54.5%. Chronic HBV inactive carrier was detected in 5.3%, chronic hepatitis B was detected in 1.5%, and resolved HBV infection was detected in 11%.
Background
Hepatitis B infection seriously threatens global public health, especially in developing nations. Despite several investigations on HBV incidence, the national pooled prevalence remains unknown, particularly in populations at-risk at whom interventions should be primarily aimed.
Methods
A comprehensive literature search of the following databases: Medline [PubMed], Scopus, Google Scholar, and Web of Science was conducted following the PRISMA guidelines. I-squared and Cochran's Q were used to measure the heterogeneity between the studies. Publications that matched the following were included: Primary studies published in Egypt from 2000 to 2022 reported HBV prevalence based on HBsAg. We excluded any studies that were not performed on Egyptians or that were performed on patients suspected of acute viral hepatitis or studies focusing on occult hepatitis or vaccination evaluation studies, or national surveys.
Results
The systematic review included 68 eligible studies reporting a total of 82 incidences of HBV infection based on hepatitis B surface antigen with a total sample size of 862,037. The pooled national prevalence among studies was estimated to be 3.67% [95% CI; 3: 4.39]. Children under 20 with a history of HBV vaccination during infancy had the lowest prevalence of 0.69%. The pooled prevalence of HBV infection among pregnant women, blood donors, and healthcare workers was 2.95%, 1.8%, and 1.1%, respectively. While patients with hemolytic anemia and hemodialysis patients, patients with malignancies, HCC patients, and chronic liver disease patients had the highest prevalences at 6.34%, 25.5%, 18.6%, and 34%, respectively. Studies reporting HBV prevalence in urban settings compared to rural settings revealed a similar HBV prevalence of 2.43% and 2.15%, respectively. Studies comparing HBV prevalence in males and females revealed a higher prevalence among males (3.75%) than females (2.2%).
Conclusion
In Egypt, hepatitis B infection is a significant public health issue. The blocking of mother-to-infant hepatitis B transmission, the scaling up of the scope of the existing vaccination program, and implementing new strategies, including screen-and-treat, may reduce the prevalence of the disease.
The aim of the present study was to determine the intrafamilial spread of HBV in the family members of patients with Hepatitis B in Guilan Province, North of Iran. In a descriptive-comparative study, 156 patients with Hepatitis B, 415 family members of the index cases and 599 age and gender matched people as a control group were enrolled. Blood samples were taken from the participants and were checked for HBs Ag, HBC Ab, HBs Ab, and HBV DNA. Totally 44 (10.6%) of family members and only 1 (0.2%) of control group were HBs Ag positive (P=0.0001, OR=70.92). The overall prevalence in members of the original family was 5.3% (1.2% of the mothers, 2.2% of the brothers, 1.9% of the sisters), in sexual partners it was 1.4%, in offsprings it was 2.4% and in other households it was 1.4%. The mean age of HBs Ag positive family members was 35.3 ± 12.9 years old. Among them 27 (61.4%) were female. Only 8 (18.2%) of all HBsAg-positive reported previous HBV vaccination but just one person had the vaccine titer checked. The present survey indicates that there is a significant difference in the prevalence of Hepatitis B in the general population and family members of Hepatitis B patients and this is an evidence for horizontal transmission of HBV in household contacts.
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.
Thirty-two HBeAg-positive carrier mothers and their 32 babies were investigatedto elucidate the mechanism involved in intrauterine infection with HBV. Five mothers had symptoms and signs of threatened abortion and/or threatened preterm labor. Three mothers gave birth more than 6 weeks after the episodes, and their babies were those infected in utero. The other two gave birth within 1 week after the episodes, and the two babies were treated with HBIG immediately after birth; HBV infection was successfully prevented. Therefore we suggest that transplacental leakage of HBeAg-positive maternal blood, which is induced by uterine contractions during pregnancy and the disruption of placental barriers, is the most likely route to cause HBV intrauterine infection.
To explore the factors influencing failure of an immunization to interrupt perinatal (mother-to-child) transmission of hepatitis B virus (HBV).
Between June 2006 and March 2010, a total of 1355 pregnant women testing positive for the hepatitis B surface antigen (HBsAg), at gestational weeks 20 to 42, and without use of antiviral or immunomodulatory drugs during the pregnancy were prospectively recruited to the study. The mothers were given a choice of receiving hepatitis B immunoglobulin (HBIG; three 200 IU intramuscular injections give at four-week intervals starting from gestation week 28) or not. All neonates (1360, including five sets of twins) received hepatitis B vaccine (10 mug) plus HBIG (200 IU) combined immunization within 24 h of birth, as early as possible. Peripheral venous blood samples were collected from the neonates within 24 h of birth and at 7 and 12 months of age for detection of HBV markers, including hepatitis B e antigen (HBeAg) and HBV DNA. The infants were classified according to HBV perinatal transmission status (infection group and non-infection group) and various factors (maternal-related: age, gravidity, parity; pregnancy/birth-related: threatened premature labor, complications; neonate-related: sex, birth weight, apgar score) were compared between the two groups by using non-conditional logistic regression analysis to determine their potential influence on failure of immunization to inhibit transmission.
After 12 months of follow-up, 1.54% (21/1360) of the neonates had presented with HBV infection. Analysis of the HBV-infected neonates revealed differences in infection rates between neonates born to mothers with HBIG injection (2.22% vs. without HBIG injection: 1.11%, P less than 0.05) and caesarean section (1.35% vs. vaginal delivery: 1.73%) but neither reached statistical significance (P less than 0.05); only the practice of breastfeeding showed a significant difference for infection rate, with neonates fed artificial formula having higher infection rate (3.13%) than the breastfed neonates (0.27%, P less than 0.05). The neonate HBV infection rate was also significantly higher for neonates born to HBeAg-positive mothers (4.44% vs. HBeAg-negative mothers: 0%, P less than 0.05) and HBV DNA-positive mothers (3.13% vs. HBV DNA-negative mothers: 0%, P less than 0.05). When the mothers were stratified by serum level of HBV DNA, there was a significant difference in HBV-infected neonates born to mothers with more than or equal to 1*10(7) IU/ml(6.01% vs. 10(3)-10(6) IU/ml: 0.56% and less than 1*10(3) IU/ml: 0%, both P less than 0.05). Logistic regression analysis indicated that the independent risk factors for HBV perinatal transmission despite immunization were maternal serum HBeAg-positive status (relative risk (RR)=31.74, 95% confidence interval (CI): 3.88-259.38) and maternal HBV DNA of more than or equal to107 copies/mL (RR=22.58, 95% CI: 4.75-107.40).
Failure of vaccine plus HBIG to interrupt mother-to-child transmission of HBV is influenced by maternal serum HBeAg-positive status and maternal HBV DNA of more than or equal to107 copies/mL.
Unlabelled:
Hepatitis B virus (HBV) infection is a global health issue. Universal infantile hepatitis B (HB) vaccination is very efficacious. However, HBV infections among those immunized subjects have been reported. The long-term efficacy of postnatal passive-active HB vaccination in high-risk subjects is not well explored. A total of 8,733 senior high school students who were born after July 1987 were assayed for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). The overall HBsAg and anti-HBs-positive rates were 1.9% and 48.3%, respectively. The HBsAg-positive rate was 15% in HB immunoglobulin (HBIG) recipients (adjusted odds ratio [OR]: 15.63; 95% confidence interval [CI]: 10.99-22.22). Among students who did not receive HBIG, there was a significantly negative association between HB vaccination dosage and HBsAg-positive rate (P for trend = 0.011). Adjusted ORs for those who received 4, 3, and 1 to 2 doses were 1.00, 1.52 (95% CI: 0.91-2.53), and 2.85 (95% CI: 1.39-5.81), respectively. Among HBIG recipients, the HBsAg-positive rate was significantly higher in subjects with maternal hepatitis B e antigen (HBeAg) positivity and who received HBIG off-schedule. A booster dose of HB vaccination was administered to 1974 HBsAg- and anti-HBs-negative subjects. Prebooster and a postbooster blood samples were drawn for anti-HBs quantification. The proportions of postbooster anti-HBs titer <10 mIU/mL was 27.9%. Subjects with prebooster anti-HBs titers of 1.0-9.9 mIU/mL had significantly higher postbooster anti-HBs titers than those with prebooster anti-HBs titers of <1.0 mIU/mL (P < 0.0001).
Conclusion:
Having maternal HBeAg positivity is the most important determinant for HBsAg positivity in adolescents who received postnatal passive-active HB vaccination 15 years before. A significant proportion of complete vaccinees may have lost their immunological memories against HBsAg.
EPIDEMIOLOGY Hepatitis B virus (HBV) infection is a global health problem. Its prevalence and patterns of transmission vary greatly throughout the world 1 . Furthermore, the consequences of chronic HBV infection represent a burden to health systems as a large proportion of patients develop cirrhosis and hepatocellular carcinoma (HCC). The prevalence of HBsAg in Egypt is of intermediate endemicity (2–8%) 2 . Nearly 2-3 million Egyptians are chronic carriers of HBV. In Egypt, it appears that HBV transmission is a mixture of perinatal and horizontal transmission. However, the majority of HBV infection is acquired by horizontal transmission 3 . HBV GENOTYPES HBV genotype D is the prevalent genotype in Egypt. The clinical impact of HBV genotype D has been studied less extensively. However, initial studies have found that it may be associated with lower rates of sustained remission and HBsAg clearance and more severe liver disease compared with genotype A 4 . Emerging evidence suggests that patients with genotype D infection may develop fulminant hepatitis with high frequency 5 . A study from India indicated that genotype D is more often associated with HBeAg-negative chronic hepatitis B (CHB), more severe diseases and may predict the occurrence of HCC in young patients 6 . Several recent studies have reported lower response rates to interferon and pegylated interferon-α therapy in patients with genotypes C and D than in those infected with genotypes B and A 7-8 . New evidence suggests that the emergence of lamivudine resistance develop later and less frequent in patients with genotype D infection than in those with genotype A infection 9-11 .
A literature search was carried out to investigate the factors that influence the protective efficacy (PE) of hepatitis B vaccines when given to neonates of hepatitis B surface antigen and e antigen positive mothers. Hepatitis B vaccines with either high or low antigen doses are very effective in preventing chronic hepatitis B infection in neonates at risk, but there is evidence that with lower dosages simultaneous use of hepatitis B immune globulin (HBIG) administration is more important than with higher dosages to elicit good protection (PE ≧ 90%). There is also a tendency for lower dosages to confer high PE less consistently, with noticeably greater numbers of chronic surface antigen carriers in neonates who received a complete vaccination course. Furthermore vaccination courses with higher vaccine dosages give high PEs, without concomitant HBIG administration at birth, provided that the first vaccine dose is given at birth and that the second dose follows within 2 months. © 1994 Wiley-Liss, Inc.