Obscure clinical implication of occult hepatitis B virus infection by perinatal transmission despite prophylaxis with hepatitis B vaccination and HBIG
Journal
Journal of Hepatology
Journal Volume
57
Journal Issue
6
Pages
1401
Date Issued
2012
Author(s)
Abstract
Dear Editor:We are much interested in the article by Shahmoradi et al. pub-lished in the Journal of Hepatology [1]. In the cross-sectionalreport, the authors investigated the serum samples of 75 childrenborn to hepatitis B surface antigen (HBsAg)-positive mothers.Hepatitis B virus (HBV) DNA could be detected in 21 (28%) outof 75 children previously immunized by a dose of HBIG and threestandard injections of hepatitis B vaccines. All were positive forantibody to hepatitis B surface antigen (anti-HBs), while only 5(24%) were positive for antibody to hepatitis B core antigen(anti-HBc). There are some issues to be addressed.Almost all babies who acquired HBV infection through perina-tal transmission were born to mothers with positive hepatitis B eantigen (HBeAg) [2]. HBeAg can cross the placenta and helpestablish the infectivity [3]. HBeAg, viral load, and metabolicfactors may entangle each other to foster the perinatal transmis-sion [4]. However, this article did not elucidate the associationbetween the risk of occult HBV infection and these three factors.The relatively higherprevalence of occult HBV infection in thisstudy is not consistent with our findings in Taiwan [5], where theprevalence of occult HBV infection was about 0.1% (3/2954)under the 25-year infant universal vaccination program coverage.One possible explanation is that the polymerase chain reactionused in this report was too sensitive to avoid false positive results[1]. Besides, the detection of HBV DNA in this study might be tooearly for anti-HBc levels to be measurable [6]. HBV genotyping isanother concern. Occult HBV infection in Taiwan is mainly geno-type C [5], rather than genotype D as in North of Iran [1]. We alsodo not know how long the positive HBV DNA status would persistin these cases.We agree that mother-to-infant transmission is not com-pletely blocked by immunoprophylaxis [7]. Although the emerg-ing escape mutants caused some concern, less infectivity ofG145R, recombinant vaccine use, and mutant loss with olderage seem to decrease the mutant prevalence in an immunizedpopulation over time [8]. In addition to the risk of transmissionby blood transfusion, individuals with occult HBV infection areat risk of reactivation when they receive chemotherapy or immu-nosuppressive therapy [6]. However, whether the clinical out-come of occult HBV infection is significant or not remainsunclear since most people with occult HBV infection have anormal liver function.In conclusion, a long-term follow-up study is mandatory todefine the clinical significance of occult HBV infection causedby perinatal transmission if any.Conflict of interestThe authors declared that they do not have anything to discloseregarding funding or conflict of interest with respect to thismanuscript.References
SDGs
Other Subjects
hepatitis B antibody; hepatitis B surface antigen; hepatitis B vaccine; virus DNA; disease transmission; hepatitis B; Hepatitis B virus; human; immunoprophylaxis; letter; perinatal infection; priority journal; Female; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Infectious Disease Transmission, Vertical; Male
Type
letter