Milne A

VERY-LOW-DOSE HEPATITIS B VACCINE IN NEWBORN INFANTS: AN ECONOMIC OPTION FOR CONTROL IN ENDEMIC AREAS

Three 1 microgram or 2 micrograms doses of Merck, Sharp and Dohme plasma vaccine were given to 119 infants of mothers negative for antibody to hepatitis B surface antigen (anti-HBs). Anti-HBs antibodies developed in 25/29 (86%) infants given 1 microgram and in 86/90 (96%) given 2 micrograms doses. Levels of anti-HBs achieved by three 2 micrograms doses were similar to those that have been reported for conventional 10 micrograms doses. Similar levels were recorded from infants of anti-HBs-positive mothers, which suggests that maternal antibody does not interfere with the infants immune response to low doses of vaccine. Three 2 micrograms doses of vaccine in infancy produce satisfactory immunogenicity and make possible economic control of hepatitis B in endemic areas.

Liver function of hepatitis B carriers in childhood

This study followed 314 children who were carriers of hepatitis B virus for 2 to 4 years and compared them with noncarriers, matched for age and sex, from the same community. No confirmed carrier lost hepatitis B surface antigen. Hepatitis B e antigen (HBeAg) was lost at a rate of 10.6% per year; the rate of decay was not affected by age or gender. Liver enzymes were higher in HBeAg-positive than in HBeAg-negative carriers and loss of HBeAg was usually followed by return to values in the normal range. There was evidence, however, of persistent mild liver dysfunction in carriers even after development of antibody to HBeAg. Serum alanine aminotransferase concentrations above twice the upper limit of normal were observed in 7% of carriers on at least one occasion but persisted for more than 1 year in less than 1% and clinical manifestations were rare. The hepatitis B carrier state was uncomplicated during the course of this study. However, risks of subsequent serious disease in adult life may be significant and continued surveillance of carriers is important for individual protection and to determine adverse prognostic features.