Yonghao G, Pumei D, Jianhui Y, Jin X, Yanyang Z, Zhe W
Henan Centre for Disease Control and Prevention, Zhengzhou, China.
J Viral Hepat. 2017 Aug;24(8):687-695. doi: 10.1111/jvh.12694. Epub 2017 Mar 13.
Approximately, 240 million people have chronic hepatitis B worldwide, with mother-to-child-transmission (MTCT) accounting for most cases. Therefore, Henan Province, China launched a public health programme to prevent MTCT. To determine the efficacy of this health programme, a survey was carried out in Huixian and Xinan counties, which are located in northern and western Henan. All infants born in these two counties between January 1, 2013 and March 31, 2014 to a mother positive for hepatitis B surface antigen (HBsAg) were surveyed. In total, there were 438 mother-infant pairs. A blood sample was collected from all mothers and infants and the following Hepatitis B virus (HBV) markers, antibodies, and antigens were measured: HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, and HBV-DNA. All mothers and 5.3% (23/438) of the infants were HBsAg positive. All infants received three doses of the hepatitis B vaccine (HepB) and the postvaccination serological test (PVST) showed that the appropriate interval for PVST may be 1-8 months after the final HepB dose. Multivariable analysis showed that infants without a timely first and second dose of the HepB, with an HBeAg-positive mother and mothers who had not received hepatitis B immune globulin during pregnancy were implicated in MTCT. The stratified analysis using maternal HBeAg as a marker showed that maternal HBeAg may be a strong risk factor for MTCT. To prevent MTCT in middle China, several courses of action are recommended. The first is to optimize the screening method for the mother to allow HBeAg and HBsAg-positive mothers to receive medical treatment during pregnancy and a timely birth dose of the vaccine to all infants. Second, all infants with an HBsAg-positive mother should be tested for anti-HBs and HBsAg at 7-14 months old and any anti-HBs-nonresponse infants should receive an additional three dosesof the vaccine.
全球约有2.4亿人患有慢性乙型肝炎，其中大多数病例是母婴传播（MTCT）。因此，中国河南省启动了一项预防母婴传播的公共卫生项目。为了确定该卫生项目的效果，在位于河南北部和西部的辉县和新安县进行了一项调查。对2013年1月1日至2014年3月31日期间在这两个县出生的、母亲乙肝表面抗原（HBsAg）呈阳性的所有婴儿进行了调查。总共有438对母婴。采集了所有母亲和婴儿的血样，并检测了以下乙肝病毒（HBV）标志物、抗体和抗原：HBsAg、抗-HBs、抗-HBc、HBeAg、抗-HBe和HBV-DNA。所有母亲和5.3%（23/438）的婴儿HBsAg呈阳性。所有婴儿均接种了三剂乙肝疫苗（HepB），接种后血清学检测（PVST）表明，PVST的合适间隔可能是在最后一剂HepB后1至8个月。多变量分析表明，未及时接种第一剂和第二剂HepB、母亲HBeAg呈阳性以及在孕期未接受乙肝免疫球蛋白的母亲与母婴传播有关。以母亲HBeAg为标志物的分层分析表明，母亲HBeAg可能是母婴传播的一个强风险因素。为了预防中国中部地区的母婴传播，建议采取以下几项措施。首先，优化母亲的筛查方法，使HBeAg和HBsAg呈阳性的母亲在孕期接受治疗，并给所有婴儿及时接种出生剂量的疫苗。其次，所有母亲HBsAg呈阳性的婴儿应在7至14个月大时检测抗-HBs和HBsAg，任何抗-HBs无反应的婴儿应额外接种三剂疫苗。
