Selective unresponsiveness to HBsAg vaccine in newborns related with an in utero passage of HBV DNA

Abstract

Thirty-four out of 158 (22%) newborns to mothers chronically infected by the hepatitis B virus (HBV) did not produce antibodies (Ab) to HbsAg 1 month after the last injection of the HBV vaccine supplemented with HBV specific immunoglobulins. Ar birth the HBV genome was detected by polymerase chain reaction in the peripheral blood mononuclear cells (PBMC) of a large majority (28 out of 34) of these non-responder newborns but never in the other newborns who responded to the HBsAg vaccine. HBV genome was detected in serum, only in some cases (nine out of 34) and never in absence of HBV DNA in PBMC. For nine our of 14 followed newborns, the absence of response was transitory since anti-HBs Arts appeared after 15 Months, without booster; while the HBV had disappeared Unresponsiveness was specific of the HBV envelope protein since all late responders and 15 months non-responders to the HBsAg vaccine produced normal levels of Abs to the three poliovirus serotypes, to tetanus toxoid and to the pneumococcus polysaccharides. An in utero induced immune tolerance to law doses of HBsAg appears as the most plausible hypothesis to explain this unresponsiveness to HBV vaccine. (C) 1997 Elsevier Science Ltd.