HEPATITIS-B SURFACE ANTIGENEMIA AT BIRTH - A LONG-TERM FOLLOW-UP-STUDY

Objective: To investigate the prevalence and outcome of hepatitis B su rface antigenemia in newborns of hepatitis B surface antigen (HBeAg)-p ositive hepatitis B surface antigen (HBsAg) carrier mothers under the current immunoprophylaxis program. Study design: From 1984 to 1993, 66 5 high-risk newborns born to HBeAg-positive HBsAg carrier mothers were prospectively recruited. The newborns were tested for HBsAg soon afte r birth, before hepatitis B immune globulin administration. All newbor ns received hepatitis B immune globulin within 24 hours after birth pl us subsequent hepatitis B vaccination. Those who were seropositive for HBsAg at birth were regularly followed up for their hepatitis B virus (HBV) markers, liver function profiles, and alpha-fetoprotein levels from 1984 to 1996. Results: Sixteen (2.4%) of the 665 subjects were fo und to be seropositive for HBsAg at birth, and all remained HBsAg-posi tive at 6 months of age. Twelve of the 16 received long-term follow-up care, and all were confirmed to have chronic HBV infection. Of the 12 , 2 had HBeAg seroconversion, and 1 had alanine aminotransferase flare s without HBeAg seroconversion. Delayed appearance of hepatitis B core antibody (anti-HBc) occurred in 2 without alanine aminotransferase el evation. Conclusions: Current immunoprophylaxis strategy does not prot ect newborns with surface antigenemia, apparently acquired in utero, f rom becoming HBV carriers. Immunologic attempts to eliminate HBV may o ccur in carrier children infected in utero, despite their profound imm une tolerance to HBV.