Biroscak Brian J, Fiore Anthony E, Fasano Nancy, Fineis Patrick, Collins Michael P, Stoltman Gillian
Communicable Disease and Immunization Division, Michigan Department of Community Health, Lansing, Michigan, USA.
Pediatrics. 2003 Jun;111(6 Pt 1):e645-9. doi: 10.1542/peds.111.6.e645.
Hepatitis B vaccine is recommended for all infants, and the series may be started during the delivery admission. For infants who are born either to women who are positive for hepatitis B surface antigen (HBsAg) or to women whose HBsAg status is unknown, vaccination should be started within 12 hours of birth to prevent perinatal and early childhood hepatitis B virus infection. Because of concerns about mercury exposures from vaccines that contain thimerosal, the United States Public Health Service (USPHS) and the American Academy of Pediatrics (AAP) recommended in July 1999 that the first dose of hepatitis B vaccine be deferred until 2-6 months of age but only for infants who are born to HBsAg-negative women. To assess the impact on birth-dose vaccine coverage for infants who are born to women with unknown HBsAg status, we measured coverage before and after July 1999.
A sample of Michigan infants who were born to women whose HBsAg status was either unknown or missing were identified by reviewing newborn screening cards for infants who were born during 1) March-April 1999 (before recommendation changes [T1]); 2) July 15-September 15, 1999 (immediately after recommendation changes [T2]); and 3) March-April 2000 (6 months after resumption of pre-1999 practices were recommended [T3]). We verified maternal HBsAg screening and newborn hepatitis B vaccination by reviewing infant and maternal hospital records.
Of 1201 infants who were born to women whose HBsAg status was indicated as unknown or missing on the newborn screening card during the 3 time periods, 216 (18%) were born to women whose status was truly unknown at the time of delivery, as determined by medical record review. During T1, 53% of these 216 infants received hepatitis B vaccine before hospital discharge, compared with 7% of infants who were born during T2 and 57% of infants who were born during T3. During T1, 19% of these infants received hepatitis B vaccine within 12 hours of birth compared with 1% of infants who were born during T2 and 14% of infants who were born during T3.
Hepatitis B vaccine birth-dose coverage for infants who were born to women whose HBsAg status was unknown at the time of delivery was already low in Michigan before the July 1999 USPHS/AAP Joint Statement but decreased significantly during the 2 months after the USPHS/AAP Joint Statement. Abrupt changes in established vaccination recommendations for lower risk children may lead to decreased coverage among higher risk children. Increases in hepatitis B vaccine coverage at birth are necessary to reduce the risk of perinatal infection for infants who are born to women with unknown HBsAg status.
建议所有婴儿接种乙肝疫苗，接种程序可在分娩住院期间开始。对于母亲乙肝表面抗原（HBsAg）呈阳性或HBsAg状态不明的婴儿，应在出生后12小时内开始接种疫苗，以预防围产期和儿童早期乙肝病毒感染。由于担心含硫柳汞疫苗的汞暴露问题，美国公共卫生服务部（USPHS）和美国儿科学会（AAP）于1999年7月建议，仅对于母亲HBsAg呈阴性的婴儿，首剂乙肝疫苗接种应推迟至2至6月龄。为评估对母亲HBsAg状态不明的婴儿出生时接种疫苗覆盖率的影响，我们测量了1999年7月前后的覆盖率。
通过查阅1999年3月至4月（建议变更前[T1]）、1999年7月15日至9月15日（建议变更后即刻[T2]）、2000年3月至4月（建议恢复1999年前做法6个月后[T3]）出生婴儿的新生儿筛查卡，确定密歇根州母亲HBsAg状态不明或缺失的婴儿样本。我们通过查阅婴儿和母亲的医院记录核实母亲HBsAg筛查及新生儿乙肝疫苗接种情况。
在这3个时间段内，新生儿筛查卡显示母亲HBsAg状态不明或缺失的1201名婴儿中，经病历审查确定，216名（18%）婴儿的母亲在分娩时其状态确实不明。在T1期间，这216名婴儿中有53%在出院前接种了乙肝疫苗，而在T2期间出生的婴儿中这一比例为7%，在T3期间出生的婴儿中这一比例为57%。在T1期间，这些婴儿中有19%在出生后12小时内接种了乙肝疫苗，而在T2期间出生的婴儿中这一比例为1%，在T3期间出生的婴儿中这一比例为14%。
在1999年7月USPHS/AAP联合声明发布前，密歇根州母亲分娩时HBsAg状态不明的婴儿乙肝疫苗出生时接种覆盖率就已较低，但在USPHS/AAP联合声明发布后的2个月内显著下降。针对低风险儿童既定接种建议的突然改变可能导致高风险儿童的接种覆盖率下降。提高乙肝疫苗出生时接种覆盖率对于降低母亲HBsAg状态不明的婴儿围产期感染风险是必要的。
