Vranckx R, Alisjahbana A, Meheus A
Institute of Public Health, Brussels, Belgium.
J Viral Hepat. 1999 Mar;6(2):135-9. doi: 10.1046/j.1365-2893.1999.00145.x.
The high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) in pregnant women is considered to be the most important factor contributing to the high carrier rate of HBsAg in some populations. Several factors, including the age at which infection occurs, predispose to the acquisition and frequency of the carrier state. The proportion of infected people who become chronic carriers ranges from about 80 to 95% for babies born to HBsAg/HBeAg-positive mothers. In this study of Indonesian infants receiving only active immunization against HBV, we measured the HBV markers passively acquired from their HBsAg-positive mothers. The relationship of these markers with vaccination response and with HBV infection status was studied longitudinally in the infants. In the exposed neonates from the HBsAg-positive mothers (n=61), the seroconversion rate to hepatitis B surface antibody (HBsAb) positivity was 95% after the first booster vaccination, with a geometric mean titre (GMT) of 2017 IUl-1. After 60 months, the GMT in this group decreased to 50 IUl-1. Four newborns in this group became HBsAg carriers. Of the four vaccination failures, three newborns were HBsAg/HBeAg positive at birth, suggesting that they had been infected in utero. No vaccination strategy (active alone, or passive/active) can prevent this transmission from occurring. One carrier was HBsAg negative at birth and up to month 4 but was HBsAg positive at month 12 and subsequently, suggesting a postnatal infection. Vaccination early in life can, to a large extent, prevent perinatal transmission and hepatitis B virus (HBV) infection later in infancy and childhood. In this study, the protective efficacy of the vaccination was 85% in the subcohort of neonates from HBeAg-positive mothers and 100% in the subcohort of neonates from HBeAg-negative mothers. Lack of maternal antibodies to hepatitis B core antigen (HBcAb) correlated strongly with transmission of HBV infection.
孕妇中乙肝表面抗原（HBsAg）和乙肝e抗原（HBeAg）的高流行率被认为是导致某些人群中HBsAg高携带率的最重要因素。包括感染发生时的年龄在内的几个因素，易引发携带状态的获得和频率。对于HBsAg/HBeAg阳性母亲所生的婴儿，成为慢性携带者的感染人群比例约为80%至95%。在这项针对仅接受乙肝疫苗主动免疫的印度尼西亚婴儿的研究中，我们检测了他们从HBsAg阳性母亲那里被动获得的乙肝病毒标志物。在婴儿中纵向研究了这些标志物与疫苗接种反应以及乙肝病毒感染状态之间的关系。在来自HBsAg阳性母亲的暴露新生儿（n = 61）中，首次加强免疫后乙肝表面抗体（HBsAb）阳性的血清转化率为95%，几何平均滴度（GMT）为2017 IUl-1。60个月后，该组的GMT降至50 IUl-1。该组中有4名新生儿成为HBsAg携带者。在这4名疫苗接种失败的新生儿中，有3名在出生时HBsAg/HBeAg呈阳性，表明他们在子宫内就已感染。没有任何疫苗接种策略（单独主动免疫，或被动/主动免疫）能够阻止这种传播的发生。有1名携带者在出生时及4个月时HBsAg呈阴性，但在12个月时及之后变为HBsAg阳性，表明是产后感染。生命早期接种疫苗在很大程度上可以预防围产期传播以及婴儿期和儿童期后期的乙肝病毒（HBV）感染。在这项研究中，疫苗接种在来自HBeAg阳性母亲的新生儿亚组中的保护效力为85%，在来自HBeAg阴性母亲的新生儿亚组中的保护效力为100%。缺乏乙肝核心抗体（HBcAb）与HBV感染的传播密切相关。
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