Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
J Pediatric Infect Dis Soc. 2018 Dec 3;7(4):290-295. doi: 10.1093/jpids/pix062.
Perinatal transmission is the major mode of hepatitis B virus (HBV) transmission and drives HBV endemicity in the US territory of Guam. We assessed correlates of prenatal hepatitis B surface antigen (HBsAg) screening and HBsAg positivity among pregnant women and evaluated the care of infants of HBsAg-positive women.
Demographic and clinical data were abstracted from the maternal medical records of 966 randomly selected live infants born in 2014. Frequencies were calculated, and prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using Poisson regression.
Among the mothers of the 966 infants, 78.2% were Pacific Islanders, 56.9% were >25 years old (born before universal infant hepatitis B vaccination in Guam), 89.0% received prenatal care (PNC), 96.7% underwent prenatal HBsAg screening, and 2.0% were HBsAg positive. Approximately 15% of the women who did not have PNC were not screened for HBsAg. Receipt of PNC was associated with HBsAg screening (adjusted PR, 1.13 [95% CI, 1.04-1.23]), and HBsAg positivity was associated with a maternal age of >25 years (adjusted PR, 6.80 [95% CI, 1.32-35.08]). All 18 infants of the HBsAg-positive mothers received hepatitis B vaccine, and 17 (94.4%) received hepatitis B immunoglobulin.
Although the prenatal HBsAg screening prevalence in this sample was high, the maternal HBsAg prevalence among women in this sample was more than 14 times and 2 times the prevalence among US-born Pacific Islander/Asian women and all women in the continental United States, respectively. Improving access to PNC, ensuring that all pregnant women in Guam (especially those born before universal hepatitis B vaccination) are screened for HBsAg, and adopting postexposure prophylaxis for infants of HBsAg-positive mothers as standard clinical practice are important for preventing perinatal HBV transmission and reducing HBV endemicity.
围产期传播是乙型肝炎病毒（HBV）传播的主要模式，也是导致美国关岛 HBV 地方性流行的原因。我们评估了孕妇产前乙型肝炎表面抗原（HBsAg）筛查和 HBsAg 阳性率的相关因素，并评估了 HBsAg 阳性孕妇所生婴儿的护理情况。
从 2014 年随机选择的 966 例活产婴儿的产妇病历中提取人口统计学和临床数据。计算频率，并使用泊松回归估计患病率比（PR）和 95%置信区间（CI）。
在 966 名婴儿的母亲中，78.2%是太平洋岛民，56.9%年龄>25 岁（在关岛普遍进行婴儿乙型肝炎疫苗接种之前出生），89.0%接受产前护理（PNC），96.7%接受产前 HBsAg 筛查，2.0%为 HBsAg 阳性。大约 15%未接受 PNC 的女性未进行 HBsAg 筛查。接受 PNC 与 HBsAg 筛查相关（调整后的 PR，1.13 [95%CI，1.04-1.23]），HBsAg 阳性与母亲年龄>25 岁相关（调整后的 PR，6.80 [95%CI，1.32-35.08]）。所有 18 名 HBsAg 阳性母亲所生婴儿均接种了乙型肝炎疫苗，17 名（94.4%）接种了乙型肝炎免疫球蛋白。
尽管该样本中产前 HBsAg 筛查的流行率较高，但该样本中妇女的 HBsAg 流行率是美国出生的太平洋岛民/亚洲妇女和美国大陆所有妇女的流行率的 14 倍和 2 倍以上。增加获得 PNC 的机会，确保关岛的所有孕妇（特别是在普遍乙型肝炎疫苗接种之前出生的孕妇）都接受 HBsAg 筛查，并将 HBsAg 阳性母亲所生婴儿的暴露后预防作为标准临床实践，对于预防围产期 HBV 传播和降低 HBV 地方性流行至关重要。
