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Occult HBV clearance possible for children over time

Immunized children with occult hepatitis B virus infection born to mothers positive for hepatitis B surface antigen may still experience clearance of HBV DNA over time, according to recently published data.

Seyed Mohammad Jazayeri, MD, PhD, of the department of virology, School of Public Health at Yehran University of Medical Sciences in Iran, and colleagues previously observed immunoprophylaxis failure due to occult HBV, regardless of adequate levels of hepatitis B surface antibody (anti-HB), in 21 children from an original cohort 75 children born to mothers who were positive for hepatitis B surface antigen (HBsAg). The goal of the current study was to determine why the failure occurred in some children. Seventeen of the 21 children were comprised the current cohort (mean age: 6.57 ± 2.75 years), and each underwent testing for the presence of various HBV serological markers.

“Several reasons have been proposed for immune failure in high-risk children including: emergence of vaccine escape mutants within or outside of the ‘a’ determinant of the surface protein, low immune response capacity in early childhood and ineffectiveness of vaccine [or hepatitis B immune globulin] due to the exposure of the newborn to HBV particles in the uterus during delivery … this group of children were designated as occult hepatitis B infection … we already showed a high prevalence of [occult HBV] among a group of children who were born to HBsAg-positive mothers … we further aimed to evaluate the persistence of HBV DNA in these children 36 months after the first sampling,” the researchers wrote.

All children did not test positive for HBsAg; however, one child tested positive for HBV DNA and two tested positive for hepatitis B core antibody.

The results of the most recent anti-HBs titration showed that 23.5% had low levels of anti-HBs (n = 4) and 76.5% had adequate levels of anti-HBs (> 10 IU/mL; n = 13). One patient remained positive for occult HBV and carried the G145R mutation when tested in 2009 and again in 2013 in the ‘a’ determinant region of the surface protein, according to the research. This patient had an HBV DNA level of 50 copy/mL. However, after 18 months, this patient was negative for HBV DNA.

The researchers concluded: “In high-risk children, the initial HBV DNA positivity early in the life does not necessarily indicate a prolonged persistence of HBV DNA. Adequate levels of anti-HBs after vaccine and hepatitis B immune globulin immunoprophylaxis following birth could eventually clear the virus as time goes by.” – by Melinda Stevens

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