Lee C et al. (2006) Effect of hepatitis B immunization in newborn infants of mothers positive for hepatitis B surface antigen: systematic review and meta-analysis. BMJ 332: 328–336

Perinatal mother-to-child transmission accounts for ∼50% of all new hepatitis B infections. The risk of transmission depends on the mother's antigen status—the highest transmission rates are seen in mothers who are positive for both hepatitis B surface antigen and e antigen. A plasma-derived and a recombinant hepatitis B vaccine are available; both require repeated injections to induce adequate protection. Immunoglobulin provides immediate but short-term protection.

A systematic review and meta-analysis of 26 randomized, controlled trials showed that immunizing the infants of mothers who were positive for hepatitis B surface antigen prevented hepatitis B infection effectively. Both vaccines had similar efficacy, although the combination of a vaccine plus immunoglobulin was more effective than either vaccine alone. The efficacy of immunization did not correlate with the mother's e-antigen status or the vaccination schedule used, although the authors note that few infants were included.

There were insufficient data to show that vaccination benefited children of mothers who were negative for e antigen (transmission rates are, in general, markedly lower in this group, compared with mothers positive for both antigens). Infants born to such mothers are often asymptomatic and only transiently infected. Most trials did not adequately report adverse events, but the available data indicated that immunization was safe.

Recombinant vaccine gave higher antibody titers to hepatitis B surface antigen than plasma-derived vaccine, and its use might reduce the inadvertent transmission of other blood-borne infections. Optimal dose and vaccination schedules remain to be determined.