Babies of hep b moms

Dear Group, I am very ashamed of having to admit that despite being diagnosed in 2019, I did very little research on the disease. I was diagnosed when pregnant with my first child. I wasn’t told much then - only that I have low viral level and that my liver is doing fine. Most importantly, I was told that my baby will be vaccinated at birth (passive and active vaccine). My first child has never had hep b and her vaccine seems to be working. My younger child, though, was born when my viral load was much higher - I did not know that because my hepatologist never discussed it with me and I never asked. She was born without the virus (tests for HBS AG, anti hbc IgM and HBV DNA confirm that) and was vaccinated at birth. Only after she was born did I find out that I need to start anti viral therapy. This is when I started researching and I realised that I put my own child at risk. She is hbs ag negative and there is no HBV DNA in her blood at present, but anti hbc and anti hbe are present. She is anti hbs positive (over 1000 ml/unit). I consulted specialists and they said she probably got them from me and that they will disappear in time. What I do not understand is why they did not test it at birth - why they tested only hbs ag, anti hbc IgM is a mystery to me. Why not anti hbc total? That way we could have the certainty and although I do know I am entirely to blame for this, there is a part of me that resents the fact that no one ever mentioned it to me that I need to be extra careful. I had the impression that the passive and active vaccine will make sure that she stays free of the virus. I was told number of things about keeping her safe and healthy but no one cared to point out to me the necessity to be super careful while breastfeeding and so on. Experts in the house can you please confirm that she might lose anti hbc and anti hbe in time? I found some research papers on ant hbc being transmitted through placenta but ant hbe is new to me… Thank you in advance!

Dear Natti,

Firstly there is no blame on you! It is unfortunate what has happened in your case but its not your fault. There is also no shame in not doing “research”: it is a very complicated subject and daunting when you are the one that is infected. Please give yourself a break.

For your children, they were both vaccinated at birth which is excellent. Remember that birth vaccination works well in most cases to prevent the development of chronic HBV infection. In these cases, children will go on to lead healthy lives without concern as they will always have immune control over the virus.

You are right about the HBcAg IgM - this test only evaluates the presence of very recently acquired infection which is not resolving. A better test would be HBcAg IgG which is present regardless of acute, resolved or chronic infection.

Anti-HBc does not matter. What does matter is HBsAg and HBV DNA. When these both remain negative, the body has full control over the virus.

Best regards,

Thank you @availlant. In some other threads on this forum, though, the possible reactivation is mentioned. I know it can only happen when your immune system is down but how down does it have to be? A cold or flu run down your immune system as well. Will that be enough to cause a viral reactivation in her system? How likely is she to lose anti hbc and anti hbe? I consulted it with a hepatologist who said that this is common but at this stage there is no way of telling if she has had the antibodies from me or the infection. Or is there maybe a way to check this?

Hi Natti,

Your physician is correct, if you breastfeed your baby they will get antibodies from you (in the colostrum) which will persist for sometime. This would need to be checked in a year or so.

We do not have any reported cases in the literature of reactivation of HBV from seasonal infections or common bacterial infections. Although you may feel run down this does not mean you are immunosuppressed.

On the other hand, reactivation of HBV is observed when patients are put on immunosuppressive medications for autoimmune diseases or cancer.

Best regards,

Thank you @availlant. I am keeping my fingers crossed for this to be the case. She tested positive for anti hbc total and antibody hbe one month after the third vaccine when she was 7 months old and we are now waiting to repeat the test when she is over 1 year old. Thank you. Much appreciated!

Dear @Natti,

I’m sorry about you having to go through this situation. I want you to know that although my mother passed it to me (and she feels guilty about it), I have never blamed her in any way and am in a way sort of glad that I have something to be so passionately fighting for. @availlant is right that you do not deserve to feel the way you do, because there was so little information provided to you.

Regarding HBe and HBc antibodies, I don’t know if they would ever lose them (not sure about if there are any studies on this) but these are not really important for liver disease. What is important is that they have anti-HBs and no HBsAg, which means they are at very low risk of any liver disease in the future. As @availlant mentions, this only becomes an issue if they are ever under any very strong immuno-suppression (very very rare, basically only in the case of if they have an organ transplant or are treated for blood cancer).

Hope this helps,
TT

Thank you @ThomasTu.
Much appreciated.

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