| AIM: To observe the sequel of hepatitis B virus (HBV) intrauterine infection by follow-up study. To further estimate the reliability of previous criteria to diagnose HBV intrauterine infection, and to evaluate the blocking effect on HBV mother to infant transmission through injecting HBsAg positive mothers during the third trimester of pregnancy with hepatitis B immunoglobulin (HBIG) and combined injecting infants with HBIG and HB vaccine.METHODS: A group of 402 children of HBsAg positive mothers were recruited into our study from 1993 to 1997 in Maternal and Children Health Hospital of Shaanxi Province. The mothers were not injected with HBIG and were defined as the historical control group. They served as long-term follow-up cohort, and were followed up to observe the sequel of HBV infection. Another group of 108 infants of HBsAg-positive mothers were recruited into our study from 2002 to 2004 in the same Hospital. They served as short-term follow-up cohort. The mothers were injected with HBIG during the third trimester ofpregnancy and were defined as the HBIG group. The infants received HBIG immediately after birth and HB vaccine at 0, 1, 6 month of age. All of infants of HBIG group were followed up at 1, 3, 6 and 12 month of age to study the efficacy of HBIG for interruption of HBV mother-infant transmission. HBV markers including HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc in sera of all subjects were detected by enzyme-linked immunosorbent assay (ELISA). In the blood samples of followed-up children and their mothers, sera alanine transaminase (ALT) levels were assayed by autoanalyzer. The data were analyzed by t-test, x 2 test and Fisher probabilities with SPSS software. RESULTS:(1) In long-term follow-up cohort, the intrauterine infection rate of HBV among 402 children was 3.7%. Among 402, 205 infants were followed up and 106 of them were followed up actually. Within 205 infants, 11 infants were positive for HBsAg at birth. Among the 11 infants, 9 infants were HBsAg positive persistently, 2 infants became negative for HBsAg. Another 5 infants became positive for HBsAg and lasted for 6.3 months on average. During short-term follow-up cohort, the intrauterine infection rate of HBV was 6. 8%( 14/205), the chronic infection rate of HBV was 87.5%(14/16). Of the infants followed up, anti-HBs in sera of 81 infants were tested, out of which, 11 infants were anti-HBs negative, and the rate of non-respondent to HB vaccine was(2) Among the long-term follow-up cohort, 59 pairs of children and their mothers were followed up. The intrauterine infection rate of HBV was 8.5%( 5/59) at birth, and 5.1%(3/59) in long-term follow-up. The chronic infection rate of HBV was 60%(3/5). The non-respondent rate to HB vaccine was 13.6%(8/59). Obvious differences were found inmothers' sera HBV markers before and after delivery. Among the 59 mothers, 13 mothers were HBeAg positive before delivery but 84.6%(11/13) mothers became HBeAg negative after delivery.(3) Among the short-term follow-up cohort, 6 infants were HBsAg positive at birth, the intrauterine infection rate of HBV was 5.5%(6/108). Among the 108 infants, 85 were followed up at 1, 3, 6 and 12 month of age, respectively. Among the 85 infants, 4 were HBsAg positive at birth. One of the 4 infants became persistently positive for HBsAg, the rest 3 became negative during follow-up. The chronic infection rate of HBV was 25%(l/4) during follow-up. The responsive rate to HB vaccine was 98.8%(84/85). HBeAg, anti-HBe, anti-HBc in sera of neonates could be testable. At the first month of age, HBeAg entirely disappeared in sera of infants. Anti-HBe began to fade away at sixth month of age and entirely disappear at twelfth month of age. Anti-HBc lasted longer and began to fade away at seventh month of age, 38% of them were still positive at twelfth month of age.(4) When mothers take no prevention measures during pregnancy, the intrauterine infection rate of HBV was 3.7% at birth, 6.8% during short-term follow up and 5.1% during long-term follow-...
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