Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
Vaccine. 2011 Nov 21;29(50):9303-7. doi: 10.1016/j.vaccine.2011.10.028. Epub 2011 Oct 19.
In Denmark selective screening programs of pregnant women for hepatitis B missed 30-50% of high-risk groups and in late 2005 a universal screening of pregnant women for HBsAg was implemented. During a 2-year period a prospective enhanced surveillance of the universal screening was performed to examine the effectiveness of universal HBV-screening of pregnant women and HBV-immunizations of their newborn, and to provide a prevalence-estimate for HBV in Denmark. On a opt out basis all women in Denmark attending antenatal care were tested for hepatitis B serology. Vaccination data of the newborns and households of HBsAg positive pregnant women were assembled. Among 140,376 HBsAg tests of pregnant women, 371 (0.26%) were positive. The prevalence among women of Danish origin was 0.012% and 2.74% among foreign born women, highest for women from Southeast Asia (14.5%). Genotype C was the most prevalent (37%) and 13% had a HBVDNA ≥10(8) IU/ml. The prevalence estimate of chronic hepatitis B in Denmark was 0.2-0.3% in the general population. Among children born within the project period, 96% received vaccination at birth compared to 50% of siblings born prior to universal screening. During 3 years of passive follow-up two transmissions (0.5%) have been notified. Among children born of the positive mothers prior to the trial-period 7.3% had been notified. Thus the prevalence of HBV positive mothers has more than doubled in Denmark over the last 40 years, but among women of Danish origin it has decreased 10-fold. By replacing selective screening with universal, identification of newborns in need of HBV-immunization was increased from 50% to almost complete coverage, and also identifies mothers with high viral load for evaluation of pre-term treatment to interrupt in utero transmission.
在丹麦，针对乙型肝炎的孕妇选择性筛查计划漏掉了 30-50%的高危人群，因此 2005 年底实施了针对所有孕妇的乙型肝炎表面抗原（HBsAg）普遍筛查。在接下来的两年时间里，对这种普遍筛查进行了前瞻性强化监测，以检验乙型肝炎病毒（HBV）普遍筛查和为新生儿接种乙肝疫苗的有效性，并提供丹麦 HBV 流行率的估计值。丹麦所有参加产前保健的妇女都可以选择自愿接受乙型肝炎血清学检测。新生儿的疫苗接种数据和 HBsAg 阳性孕妇的家庭信息都被记录在案。在 140376 例 HBsAg 检测中，有 371 例（0.26%）为阳性。丹麦裔妇女的流行率为 0.012%，而外国出生的妇女则为 2.74%，其中东南亚裔妇女的流行率最高（14.5%）。基因型 C 最为常见（37%），13%的患者乙型肝炎病毒脱氧核糖核酸（HBV DNA）载量≥108 IU/ml。丹麦普通人群中慢性乙型肝炎的流行率估计为 0.2-0.3%。在项目期间出生的儿童中，96%在出生时就接种了疫苗，而在普遍筛查之前出生的兄弟姐妹中，只有 50%接种了疫苗。在 3 年的被动随访中，有 2 例（0.5%）通报了传播。在试验前出生的阳性母亲所生的儿童中，有 7.3%被通报。因此，在过去 40 年中，丹麦 HBV 阳性母亲的比例增加了一倍以上，但丹麦裔母亲的比例则下降了 10 倍。通过用普遍筛查取代选择性筛查，HBV 免疫需求新生儿的识别率从 50%提高到了几乎完全覆盖，还能识别出病毒载量高的母亲，以评估是否需要提前分娩来中断宫内传播。
