Ranger-Rogez Sylvie, Denis François
Laboratoire de Virologie, CHU Dupuytren, 2 Avenue Martin Luther King, 87042 LIMOGES Cédex, France.
Expert Rev Anti Infect Ther. 2004 Feb;2(1):133-45. doi: 10.1586/14787210.2.1.133.
Approximately 350 million people are estimated to be chronically infected with hepatitis B virus, leading to an important public health problem. In highly endemic areas where 8 to 15% of people are chronically infected with hepatitis B virus, the risk for the neonate to be perinatally infected by the chronically infected mother, then to become chronically infected themselves, is very high. In those countries, the World Health Organization recommends hepatitis B vaccination systematically at birth, independent of hepatitis B virus maternal status. This vaccination program has begun to induce a rapid decrease in the number of acute hepatitis B virus infections and has also had a secondary effect of a decrease in related sequels. Lamivudine (Zeffix, GlaxoSmithKline), when associated with the immunization of the neonate, was recently demonstrated to dramatically reduce the residual risk of perinatal transmission. In intermediate and low endemicity areas, a systematic hepatitis B surface antigen screening is recommended during pregnancy, allowing, in the case of positivity, a selective hepatitis B virus neonate immunization during the first 12 h of life. Hepatitis B virus vaccination of children born to hepatitis B surface antigen-positive mothers confers long-term immunity.
据估计,约有3.5亿人长期感染乙肝病毒,这引发了一个重大的公共卫生问题。在乙肝病毒高流行地区,8%至15%的人长期感染乙肝病毒,新生儿在围产期被慢性感染的母亲感染,进而自身也被慢性感染的风险非常高。在这些国家,世界卫生组织建议在出生时系统地接种乙肝疫苗,无论母亲的乙肝病毒感染状况如何。这一疫苗接种计划已开始使急性乙肝病毒感染病例数迅速减少,并且还产生了相关后遗症减少的附带效果。最近有研究表明,拉米夫定(泽菲克,葛兰素史克公司生产)与新生儿免疫联合使用时,可显著降低围产期传播的残余风险。在乙肝病毒中度和低度流行地区,建议在孕期进行系统性乙肝表面抗原筛查,若筛查呈阳性,则可在新生儿出生后的12小时内进行选择性乙肝病毒免疫接种。乙肝表面抗原呈阳性的母亲所生儿童接种乙肝病毒疫苗可提供长期免疫力。