Okun N B, Larke R P, Waters J R, Joffres M R
Department of Obstetrics and Gynecology, University of Alberta, Edmonton.
CMAJ. 1990 Dec 15;143(12):1317-21.
Prenatal screening for hepatitis B surface antigen (HBsAg) restricted to women with defined risk factors for chronic hepatitis B virus (HBV) infection fails to identify many carriers. A centralized program of routine HBsAg screening for all pregnant women in Alberta was introduced in 1985. We collected and analysed data for the first 2 years of the program in Edmonton to determine the frequency of risk factors for HBsAg positivity, the proportion of multiparous HBsAg-positive women not identified in previous pregnancies, the efficiency and cost-effectiveness of providing immunoprophylaxis to infants at risk of HBV infection and the degree of success in inducing adequate protection. A total of 149 women (158 pregnancies) were found to be HBsAg positive. Risk factors were readily ascertainable for 85% of the women; the remaining 15% would not have been identified through risk-selective screening. The most common risk factors were Oriental ethnic origin, history of hepatitis, jaundice or multiple transfusions of blood or blood products, and occupational exposure to blood. Although 86% of the multiparous HBsAg-positive women had risk factors, only 7% had been identified in previous pregnancies. The Alberta program appears to be cost-effective. We conclude that only routine prenatal screening will identify all infants at risk of perinatal HBV infection and that a comprehensive public health program involving central laboratories, private physicians and public health staff can be highly effective and efficient in protecting infants against hepatitis B.
仅对有慢性乙型肝炎病毒（HBV）感染特定危险因素的女性进行乙型肝炎表面抗原（HBsAg）产前筛查，会导致许多携带者漏检。1985年，艾伯塔省引入了一项针对所有孕妇的HBsAg集中常规筛查计划。我们收集并分析了该计划在埃德蒙顿实施的头两年的数据，以确定HBsAg阳性危险因素的出现频率、经产妇中既往妊娠未被检出的HBsAg阳性女性比例、为有HBV感染风险的婴儿提供免疫预防的效率和成本效益，以及诱导充分保护的成功程度。共发现149名女性（158次妊娠）HBsAg呈阳性。85%的女性的危险因素易于确定；其余15%通过风险选择性筛查无法被检出。最常见的危险因素是亚裔血统、肝炎病史、黄疸或多次输血及血液制品，以及职业性接触血液。虽然86%的经产妇HBsAg阳性女性有危险因素，但既往妊娠中仅7%被检出。艾伯塔省的该计划似乎具有成本效益。我们得出结论，只有常规产前筛查才能识别所有有围产期HBV感染风险的婴儿，并且一个由中心实验室、私人医生和公共卫生人员参与的全面公共卫生计划在保护婴儿预防乙型肝炎方面可以非常有效且高效。
