[The course of hepatitis B in 9 children who became positive for viral surface antigen HBsAg in spite of vaccination].

OBJECTIVE

To describe the viral, clinical and biochemical course of infants, who, in spite of passive-active hepatitis B immunisation, became infected with hepatitis B.

DESIGN

Prospective cohort study.

SETTING

The Netherlands.

MATERIAL AND METHOD

As part of the research programme of the Dutch study group 'Prevention neonatal hepatitis B', 705 newborns of HBsAg-positive mothers received passive and active immunisation. Despite passive-active immunisation, 9 children became positive for HBsAg. These children were analysed clinically and their HBsAg, anti-HBs, HBeAg, anti-HBc and anti HD were measured.

RESULTS

Median follow up was 5 years (range 3-8 years). Of the 9 HBsAg-positive infants 8 also tested positive for HBeAg. At the end of the follow-up 1 child had lost HBsAg and 2 children had lost HBeAg. Only 1 child experienced a symptomatic hepatitis B infection with raised aminotransferase levels. The other 8 infants with chronic hepatitis B had no clinical symptoms. Aminotransferase levels were normal throughout in 7 infants.

CONCLUSION

Most of the infants who, in spite of passive-active hepatitis B immunisation, became HBsAg positive developed a chronic hepatitis B infection without clinical or biochemical dysfunctions. On the basis of these findings and considering possible therapy, guidelines are given for the follow up of children with chronic hepatitis B.