Changes of hepatitis B surface antigen variants in carrier children before and after universal vaccination in taiwan

✍ Scribed by Hong-Yuan Hsu; Mei-Hwei Chang; Shwu-Huey Liaw; Yen-Hsuan Ni; Huey-Ling Chen

• Book ID: 102240461
• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 93 KB
• Volume: 30
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510300511

✦ Synopsis

Mutants

of a determinant of hepatitis B surface antigen (HBsAg) identified in vaccinated children pose a potential threat to long-term success of vaccination programs. We examined the mutants of a determinant (residues 110-160) of HBsAg in hepatitis B virus (HBV) DNA-positive children identified during previous serosurveys in Taipei undertaken just before (1984), 5 years after (1989), and 10 years after (1994) universal vaccination began. In HBV DNApositive children from 3 surveys, the prevalence of a determinant mutants increased from 8 of 103 (7.8%) in 1984 to 10 of 51(19.6%) in 1989 and 9 of 32 (28.1%) in 1994 and was higher in those fully-vaccinated than unvaccinated (12/33 vs. 15/153, P ‫؍‬ .0003). Most amino acid changes of the variants clustered in residues 125-129 and 140-149. In all 27 children with detectable mutants, the mean age of those vaccinated was younger than those unvaccinated (4.8 ؎ 3.8 vs. 7.9 ؎ 2.3 yrs, P F .05); and mutations occurred in a region with greatest local hydrophilicity (residues 140-149) more frequently in those vaccinated than in those unvaccinated (10/12 vs. 6/15, P ‫؍‬ .0253). More mutated residues and more mutations at neutralizing epitopes, such as N146, C147, T148, and C149, were found in the 1994 survey. Vaccinated children may contract variant infections through vertical or horizontal transmission. Universal vaccination has accelerated an accumulation of HBsAg a determinant mutants with amino acid changes critical for immune escape in vaccinated children who became carriers, suggesting that new vaccination strategies should be considered. (HEPATOLOGY 1999;30: 1312-1317.)

PATIENTS AND METHODS

A mass hepatitis B vaccination program was launched in Taiwan in July, 1984. The details of the program have previously been described. A baseline seroepidemiologic study of children just before the program launch was conducted in 1984. In 1989 and 1994, we conducted postvaccination studies in the same district of Taipei City. In 1994, this district had a population of 174,985, of Abbreviations: HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; PCR, polymerase chain reaction; ALT, alanine transaminase.

From the Departments of 1 Emergency Medicine and 2 Pediatrics and the