The vertical transmission of hepatitis B virus (HBV) can occur, despite vaccination of the child. This vaccination breakthrough is associated with high maternal viraemia.
In this study, researchers from the Netherlands treated 8 highly viraemic (HBV-DNA≥1.2 x 109 geq/ml) mothers in their last month of pregnancy. They were given 150 mg of lamivudine daily.
The research team measured the babies' HBV-DNA, hepatitis B surface antigen (HBsAg), anti-HBs and anti-HBc levels at birth, and at 3, 6 and 12 months.
The team used 24 children, who were born to untreated HBsAg-positive mothers with HBV-DNA levels ≥1.2 x 109 geq/ml, as historical controls.
All the children received passive-active immunization at birth and the team followed them for 12 months.
The researchers found that 1 child in the lamivudine group was HBsAg and HBV-DNA positive at 12 months.
|Perinatal transmission of HBV:|
- lamivudine group = 13%
- control group = 28%
|Journal of Viral Hepatitis|
However, all the other children seroconverted to anti-HBs, and maintained seroprotection.
In 3 children, HBV-DNA was temporarily detected by PCR.
The researchers found that in the untreated control group, perinatal transmission occurred in 28% of the children.
Dr van Zonneveld's team concluded, "In highly viraemic HBsAg-positive mothers, reduction of viraemia by lamivudine therapy in the last month of pregnancy may be an effective and safe measure to reduce the risk of child vaccination breakthrough".
"This approach should be evaluated in a large controlled trial".