Clearance of neonatal anti HBc following hepatitis B vaccination: relationship to anti HBs levels
Oon, C.J.; Goh, K.T.; Lim, G.K.
Annals of the Academy of Medicine Singapore 20(2): 231-235
1991
ISSN/ISBN: 0304-4602 PMID: 1883182 Document Number: 369490
The persistence of antiHBc following hepatitis B virus (HBV) infection is sometimes regarded as evidence of a past infection, and the antiHBc inhibition of T-cell cytotoxic killing of HBV may be one way of tolerance leading to the carrier state. A model for studying the possibility of an immune tolerance occurring in the human situation was to observe the natural clearance rate of total antiHBc in babies who have acquired naturally maternal transferred antibodies, and to compare antiHBcIgG clearance and development of hepatitis B surface antigenaemia with the level of antibody to HBsAg (antiHBs), which is normally known to be virucidal. Two hundred and ninety-one normal infants who received hepatitis B vaccination in 1984 were followed and studied at six months, one, two and four years. AntiHBc was not found in any control infants born of HBsAg negative mothers. One child became antiHBc positive at four years reflecting acquired infection when antiHBs level had fallen to 36 mIU per ml. AntiHBc cleared in 66% of HBsAg pos./'e' neg. children at one year and completely by two years. In contrast, antiHBc clearance in children born of HBsAg pos./'e' pos. was inversely related to the antiHBs levels. Those with antiHBs levels over 50 mIU per ml cleared antiHBc more rapidly and were HBsAg negative, whereas in 28/49 (57%) HBs antigenaemia were associated more often with antiHBs under 10 mIU per ml and in 2/43 (5%) at levels between 11 to 50 mIU per ml. Two children who had later developed HBs antigenaemia in the presence of antiHBs after responding to earlier passive-active immunisation, suggest either defective antiHBs and/or the development of mutants or variants.