High Levels of Natural HBsAb in Newborns in India - Protection Against Hepatocellua\lar Carcinoma?

8th Asian Conference of Pediatric Infectious Disease. 8 to 10 November 2016 Queen Sirkitt National Conference Center Bangkok, Thailand

Jacob Puliyel, Pathik Naik, Ashish Puliyel, on behalf of the ICMR Hepatitis B Study Group

High Levels of Natural HBsAb in Newborns in India - Protection against Hepatocellular Carcinoma
*# Jacob Puliyel1, Pathik Naik1, Ashish Puliyel2
1 St Stephens Hospital Delhi India
2 DocuBuzz Computer Solutions 02-12/25, The Franklin, 118223, Singapore,
Introduction 4% of Indians is chronic Hepatitis B carriers. Extrapolating data from Taiwan it was estimated that 250,000 die each year of hepatocellular carcinoma (HCC). However, in India the Cancer Registry shows the incidence of Hepatocellular carcinoma due to hepatitis B infection of 5000 cases a year which is a mere 2% of what is expected. The risk of chronic infection is 90% in children younger than 1 year; the risk is 30% for those 1-5 years and 2% for adults. However in India vaccination against Hepatitis B is given at birth for babies born in hospitals and at 6 weeks for others.
Objective However, this study did not look at protection in babies immunized starting at birth compared to those whose immunization started at 6 weeks of age
Method A case control study was done. Bloods were tested in 2671 children 1 to 5 years who had come for getting other blood tests done. HBsAg HBcAb and HBsAb were tested in babies 1 to 5 years and history of vaccination was obtained. Cases: Children who got infected evidenced by HBsAg or HBcAb . Controls: Those negative for both HBsAg HBcAb. Exposed are those not vaccinated. Unexposed are those fully vaccinated with 3 doses of the vaccine. In one analysis unexposed were those vaccinated completely starting at birth.
Results The HBsAg carrier rate in completely vaccinated starting at birth was 1.59% which was not significantly different from children who did not receive the birth dose but were vaccinated completely starting at 6 weeks (1.59% vs 1.31%, p value 0.6791). Protective antibody HBsAb among the vaccinated was present in about 70% and was not significantly improved by providing the birth dose. (70.27% vs 69.54%, p value 0.8236). completely immunized children with birth dose had HBsAg or anti HBcAg positivity of 2.72% against 3.21% in those who were fully immunized without birth dose which was not statistically significant (p value 0.6515). In the unimmunised too the level of Anti HBsAg was as high as 40 in the first two years of life. The levels gradually reduced with age.
Conclusions Hepatitis B carrier rate is not improved by birth dose. This may be a result of the transfer of passive immunity from mother to child. There is high antibody titre in newborns as a result of passage of antibodies from mother to child. Universal immunization may reduce transfer of passive protection to newborns and has potential of paradoxically increasing chronic hepatitis, cirrhosis and hepatocellular carcinoma in the population.