Secular trend of the viral genotype distribution in children with chronic hepatitis B virus infection after universal infant immunization

Authors

  • Wan-Hsin Wen,

    1. Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    2. Department of Pediatrics, Cardinal Tien Hospital, Taipei, Taiwan
    3. School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
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  • Huey-Ling Chen,

    1. Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    2. Department of Primary Care Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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  • Yen-Hsuan Ni,

    1. Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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  • Hong-Yuan Hsu,

    1. Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    2. Department of Primary Care Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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  • Jia-Horng Kao,

    1. Department of Medical Research, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    2. Department ofHepatitis Research Center, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    3. Department of Graduate Institute of Clinical Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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  • Fu-Chang Hu,

    1. Department of Medical Research, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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  • Mei-Hwei Chang

    Corresponding author
    1. Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    2. Department ofHepatitis Research Center, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    3. Department of Graduate Institute of Clinical Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
    • Department of Pediatrics, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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    • fax: 886-2-23114592


  • Potential conflict of interest: Nothing to report.

Abstract

Genotypes B and C are the major hepatitis B virus (HBV) genotypes in Taiwan, and genotype C is associated with more severe liver disease than genotype B. Whether the implementation of the hepatitis B immunization program has affected the secular trend of the HBV genotype distribution remains unknown. We thus investigated the HBV genotypes in hepatitis B surface antigen (HBsAg)–carrier children born before the implementation of the universal infant immunization program and in those born afterward. One hundred seven children who were infected with HBV despite appropriate immunization were enrolled as immunized cases with HBV breakthrough infection. Each case was matched with two unimmunized HBsAg carriers according to the age at enrollment. HBV genotypes were determined with molecular methods. Compared with unimmunized HBsAg carriers, more immunized children had HBsAg-positive mothers (65.9% versus 100%, P< 0.001) and were infected with genotype C (16.4% versus 42.1%, P< 0.001). Among the children born to HBsAg-positive mothers, the mothers' and children's HBV genotypes were highly concordant in both unimmunized [κ = 0.97, 95% confidence interval (CI) = 0.90-1.00] and immunized children (κ = 0.97, 95% CI = 0.92-1.00). After adjustments for gender, maternal age, and delivery mode, immunized HBsAg-carrier children born to HBsAg-positive mothers had a higher likelihood of genotype C infection than unimmunized children (odds ratio = 3.03, 95% CI = 1.62-5.65, P = 0.001). However, the increased genotype C to genotype B ratio was not seen in the HBsAg-carrier mother pool in the postimmunization era. Conclusion: In the postimmunization era, most HBV breakthrough infections are due to maternal transmission, and immunized children born to genotype C mothers may have a higher rate of breakthrough infection than those born to genotype B mothers. (HEPATOLOGY 2011;53:429-436.)

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