Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2024; 16(7): 1039-1050
Published online Jul 27, 2024. doi: 10.4254/wjh.v16.i7.1039
Immunoprophylaxis failure and vaccine response in infants born to mothers with chronic hepatitis B infection in Djibouti
Sahal Darar Dirir, Ambroise D Ahouidi, Aboubacry Drame, Warsama Osman Abdi, Guelleh Youssouf Kayad, Mohamed Houmed Aboubakar, Makhtar Camara, Coumba Toure Kane, Halimatou Diop Ndiaye
Sahal Darar Dirir, Laboratoire Medical de la Caisse National de Sécurité Social de Djibouti, Caisse National de Sécurité Social de Djibouti, Djibouti BP 696, Senegal
Ambroise D Ahouidi, Parasitology, Institut de Recherche en santé de Surveillance épidémiologique et de Formation, Dakar 7325, Senegal
Aboubacry Drame, Ecole Doctoral, Université Alioune Diop de Bambey, Dakar 7325, Senegal
Warsama Osman Abdi, Department of Des Soins, Caisse National de Securite Social, Djibouti 696, Senegal
Guelleh Youssouf Kayad, Centre de Soin, Caisse National de Securite Social, Djibouti 696, Senegal
Mohamed Houmed Aboubakar, Laboratoire Medical Mer Rouge, Djibouti 99399, Senegal
Makhtar Camara, Centre Hospitalier Universitaire Aristide le Dantec, Laboratoire Bactériologie-Virologie-Hôpital Aristide le Dantec, Dakar 7325, Senegal
Coumba Toure Kane, Department of Virology, Institut de Recherche en Santé de Surveillance épidémiologique et de Formation, Dakar 7325, Senegal
Halimatou Diop Ndiaye, Bacteriology and Virology Laboratory, Le Dantec University Teaching Hospital, Dakar BP 7325, Senegal
Author contributions: Darar Dirir S, Ahouidi AD, Houmed Aboubakar M, Camara M, Toure Kane C, and Diop-Ndiaye H conceived the research study; Darar Dirir S, Drame A, and Diop-Ndiaye H analyzed the data and wrote the manuscript; Osman Abdi W and Youssouf Kayad G provided reagents and analytical tools; All authors read and approved the final version of the manuscript.
Supported by the Attestation de Financement de These de Doctorat, Dakar le 28/10/2019.
Institutional review board statement: The study was approved by the Scientific Committee of the Ministry of Health of the Republic of Djibouti under N0 149/DG/INSPD/2023.
Clinical trial registration statement: Not applicable, as the study did not involve randomized clinical trials.
Informed consent statement: All study participants provided informed written consent before study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data source will be shared upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Halimatou Diop Ndiaye, BPharm, Professor, Professor Emerita, Bacteriology and Virology Laboratory, Le Dantec University Teaching Hospital, 30 Ave Pasteur, Dakar BP 7325, Senegal. halimatoudiop@yahoo.fr
Received: December 30, 2023
Revised: May 3, 2024
Accepted: June 4, 2024
Published online: July 27, 2024
Processing time: 209 Days and 0.4 Hours
Abstract
BACKGROUND

In endemic areas, vertical transmission of hepatitis B virus (HBV) remains a major source of the global reservoir of infected people. Eliminating mother-to-child transmission (MTCT) of HBV is at the heart of World Health Organization’s goal of reducing the incidence of HBV in children to less than 0.1% by 2030. Universal screening for hepatitis B during pregnancy and neonatal vaccination are the main preventive measures.

AIM

To evaluate the efficacy of HBV vaccination combined with one dose of immunoglobulin in children born to hepatitis B surface antigen (HBsAg)-positive mothers in Djibouti city.

METHODS

We conducted a study in a prospective cohort of HBsAg-positive pregnant women and their infants. The study ran from January 2021 to May 2022, and infants were followed up to 7 mo of age. HBV serological markers and viral load in pregnant women were measured using aVidas microparticle enzyme-linked immunosorbent assay (Biomérieux, Paris, France) and the automated Amplix platform (Biosynex, Strasbourg, France). All infants received hepatitis B immunoglobulin and were vaccinated against HBV at birth. These infants were closely monitored to assess their seroprotective response and for failure of immunoprophylaxis. Simple logistic regression was also used to identify risk factors associated with immunoprophylaxis failure and poor vaccine response. All statistical analyses were performed with version 4.0.1 of the R software.

RESULTS

Of the 50 pregnant women recruited, the median age was 31 years, ranging from 18 years to 41 years. The MTCT rate in this cohort was 4% (2/50) in HBsAg-positive women and 67% (2/3) in hepatitis B e antigen-positive women with a viral load > 200000 IU/mL. Of the 48 infants who did not fail immunoprophylaxis, 8 (16%) became poor responders (anti-HB < 100 mIU/mL) after HBV vaccination and hepatitis B immunoglobulin, while 40 (84%) infants achieved a good level of seroprotection (anti-HB > 100 mIU/mL). Factors associated with this failure of immunoprophylaxis were maternal HBV DNA levels (> 200000 IU/mL) and hepatitis B e antigen-positive status (odds ratio = 158, 95% confidence interval: 5.05-4958, P < 0.01). Birth weight < 2500 g was associated with a poor immune response to vaccination (odds ratio = 34, 95% confidence interval: 3.01-383.86, P < 0.01).

CONCLUSION

Despite a failure rate of immunoprophylaxis higher than the World Health Organization target, this study showed that the combination of immunoglobulin and HBV vaccine was effective in preventing MTCT of HBV. Therefore, further studies are needed to better understand the challenges associated with immunoprophylaxis failure in infants in Djibouti city.

Keywords: Hepatitis B surface antigen; Infants; Hepatitis B immunoglobulin; Hepatitis vaccine; Djibouti

Core Tip: This study evaluated the effectiveness of hepatitis B virus (HBV) vaccination and immunoglobulin administration in infants born to hepatitis B surface antigen-positive mothers. The mother-to-child transmission rate was 4%, increasing to 67% in hepatitis B e antigen (HBeAg)-positive women with a viral load > 200000 IU/mL. A seroprotective response was achieved in 84% of infants, and immunoprophylaxis failure was associated with maternal HBV DNA levels and positive HBeAg status. This combination has been shown to be effective in preventing HBV mother-to-child transmission in HBeAg-negative women and demonstrated the value of peripartum prophylaxis for women at risk.