Elsevier

Biologicals

Volume 50, November 2017, Pages 3-19
Biologicals

Review
Eradicating hepatitis B virus: The critical role of preventing perinatal transmission

This review is dedicated to the memory of the late Robert Palmer Beasley for his role as a mentor, scientist, and leader in the global effort to eradicate hepatitis B.
https://doi.org/10.1016/j.biologicals.2017.08.008Get rights and content
Under a Creative Commons license
open access

Abstract

Prevention of hepatitis B virus (HBV) transmission from infected mothers to their newborns is critical to HBV control and eventual eradication. Mother-to-child perinatal transmission causes the highest chronic carrier rate (>85%) with a high rate of subsequent chronic liver disease and hepatocellular carcinoma. This risk is reduced by 90% with HBV vaccine given along with hepatitis B immune globulin (HBIG) starting at birth. New analyses of our data from US trials of HBIG and HBV vaccine in high-risk infants revealed better efficacy with yeast-recombinant vaccine than plasma-derived vaccine, especially in preventing late onset infections, with evidence that vaccine prevented transmission of maternal HBV infection with the glycine to arginine mutation in surface antigen codon 145 (sG145R). Most late infections with sG145R were in vaccine non-responders, suggesting escape from HBIG rather than from vaccine-induced antibody. Our findings also help explain survey results from Taiwan following universal childhood immunization implemented in the mid-1980s. We conclude that current vaccines will remain effective against surface antigen mutants. Anti-viral drugs in high-risk pregnant women, in combination with newborn HBIG and vaccine, show promise for eliminating residual breakthrough neonatal infections, critical to meeting WHO 2030 goals and for eradicating HBV.

Keywords

Chronic HBV infection
Eradication
Escape mutant
Hepatitis B immune globulin
Hepatitis B vaccine
Hepatitis B surface antigen
Mother-to-child transmission
Perinatal HBV infection
Prevention

Abbreviations used

HBV
hepatitis B virus
HBIG
hepatitis B immunoglobulins
HBsAg
hepatitis B surface antigen
HCC
hepatocellular carcinoma
ccc-HBV DNA
covalently closed circular HBV DNA
anti-HBc
hepatitis B core antibodies
HBeAg
hepatitis B e antigen
sG145R
mutation of glycine to arginine at amino acid 145 of HBsAg

Cited by (0)

1

Currently at Ronald Reagan UCLA Medical Center, Los Angeles, CA 90024, United States.

2

Retired.