Hepatitis B vaccines, hepatitis B immunoglobulin, and a combination of the two all prevent the infection from developing in newborns of mothers who are positive for hepatitis B surface antigen, reported Chuanfang Lee, a clinical pharmacist at Copenhagen University Hospital, and associates.
The researchers conducted a metaanalysis of 26 randomized trials that evaluated vaccine or immunoglobulin effectiveness and included newborns. The average duration of follow-up was 19 months, with a range of 6–60 months.
Compared with placebo or no intervention, hepatitis B vaccination significantly decreased the risk of transmission of the infection from mother to newborn. There was no difference between plasma-derived and recombinant vaccines. “However, more infants who received recombinant vaccine achieved antibody levels to hepatitis surface antigen,” the investigators said (BMJ 2006 Jan. 27 [E-pub doi:10.1136/bmj.38719.435833.7C]).
There was no difference in effectiveness between high-dose and low-dose vaccine, or among different vaccination schedules. “Furthermore, our subgroup analyses did not show a strong association between timing of injection (within 12, 24, or 48 hours [of birth]) and magnitude of effects,” they said.
However, because the number of infants in these trials was small, larger trials are needed to confirm that all doses, schedules, and forms of vaccine are equivalent, the investigators cautioned.
Hepatitis B immunoglobulin also lowered the risk of infection, compared with placebo or no intervention. The vaccine plus immunoglobulin combination was superior to vaccine alone. Few of the trials reported adverse events, so a metaanalysis of adverse events could not be carried out.