Mavilia Marianna G, Wu George Y
Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA.
J Clin Transl Hepatol. 2017 Jun 28;5(2):119-129. doi: 10.14218/JCTH.2016.00067. Epub 2017 Jun 7.
Vertical transmission (VT) is the primary route of transmission of viral hepatitis in children. The rate of VT ranges from 1-28% with hepatitis B virus (HBV) and 3-15% with hepatitis C virus (HCV). VT for both viruses can occur during the intrauterine or peripartum period. VT of HBV primarily occurs by intrauterine transmission (IUT). Hepatitis B surface antigen is unable to cross the placenta and, therefore, relies on processes like transplacental leakage, placental infection, cellular transmission by peripheral blood mononuclear cells, and germline transmission. HCV can also infect the fetus by IUT. Both viruses also have the potential for transmission during delivery, when there is increase chance of maternal-fetal blood exposure. HBV and HCV share some common risk factors for VT, including maternal viral load, human immunodeficiency virus co-infection and neonatal sex. Prevention of VT differs greatly between HBV and HCV. There are several alternatives for prevention of HBV VT, including antiviral medications during the third trimester of pregnancy and HBV vaccine, as well as hepatitis B immunoglobulin administration to infants post-partum. In contrast, there are no preventative interventions available for HCV. Despite these differences, the key to prevention with both viruses is screening women prior to and during pregnancy.
垂直传播（VT）是儿童病毒性肝炎的主要传播途径。乙肝病毒（HBV）的垂直传播率为1%-28%，丙肝病毒（HCV）为3%-15%。两种病毒的垂直传播都可发生在子宫内或围产期。HBV的垂直传播主要通过宫内传播（IUT）。乙肝表面抗原无法穿过胎盘，因此，依赖于胎盘渗漏、胎盘感染、外周血单核细胞的细胞传播和种系传播等过程。HCV也可通过IUT感染胎儿。在分娩期间，当母婴血液接触机会增加时，两种病毒都有传播的可能性。HBV和HCV的垂直传播有一些共同的危险因素包括母亲病毒载量、人类免疫缺陷病毒合并感染和新生儿性别。HBV 和HCV垂直传播的预防方法有很大差异HBV垂直传播的预防有几种选择，包括孕期第三个月使用抗病毒药物和HBV疫苗，以及产后给婴儿注射乙肝免疫球蛋白。相比之下，目前没有针对HCV的预防干预措施。尽管存在这些差异，但两种病毒预防的关键都是在孕前和孕期对女性进行筛查。
