LOW-LEVEL VIRUS-REPLICATION IN INFANTS WITH VERTICALLY TRANSMITTED FULMINANT-HEPATITIS AND THEIR ANTI-HBE POSITIVE MOTHERS

Perinatal transmission of hepatitis B virus (HBV) occurs in about 10%- 20% of anti-HBe seropositive mothers. The babies are at risk of develo ping fulminant hepatitis. In most cases no viral DNA has been detected in the sera of mothers and children by conventional hybridisation tec hniques. Thus, the aim of our investigation was to demonstrate HBV DNA in three children with liver failure and their anti-HBe positive moth ers by more sensitive molecular hybridisation techniques. The babies w ere healthy at birth and did not receive vaccination. At 3 months of a ge they developed acute liver failure and died from liver insufficienc y. Only in one child serum HBV DNA was detected by dot blot hybridisat ion, but polymerase chain reaction (PCR)-detectable HBV DNA was presen t in all sera. The liver specimen was negative for HBV DNA by Southern blot hybridisation, but showed a focal distribution of viral sequence s as determined by in situ hybridisation. This finding was confirmed b y PCR. Our results prove that chronic anti-HBe positive HBsAg carrier mothers and their babies show a low level virus replication. Fulminant hepatitis is due to vertical transmission of very small amounts of vi ral DNA, only detectable by most sensitive techniques like PCR and in situ hybridisation. Our findings underline the necessity to vaccinate all babies of HBsAg positive mothers regardless of HBeAg/anti-HBe stat us.