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国际社会预防乙型肝炎病毒母婴传播障碍调查。

Survey of Impediments to Prevention of Mother-to-infant Transmission of Hepatitis B Virus by International Societies.

机构信息

Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.

Department of Pediatrics, Karolinska University Hospital, CLINTEC, Stockholm, Sweden.

出版信息

J Pediatr Gastroenterol Nutr. 2019 Dec;69(6):648-654. doi: 10.1097/MPG.0000000000002483.

Abstract

OBJECTIVE

Mother-to-infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV.

METHODS

A cross-sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5-member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers.

RESULTS

Among the participating countries/regions, 11% did not implement infant HBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers.

CONCLUSIONS

Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out-born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.

摘要

目的

母婴传播(MIT)是全球乙型肝炎病毒(HBV)感染的主要原因。本国际研究旨在评估预防乙型肝炎病毒母婴传播(MIT)的障碍。

方法

由国际儿科胃肠病学、肝病学和营养学学会联合会(FISPGHAN)制定了一项横断面调查。该调查发送给了 FISPGHAN 的 5 个成员学会的 HBV 专家,91 个国家/地区中有 63 个做出了回应。主要结局指标包括有疫苗接种计划的国家比例、HBV 疫苗第一针的接种时间、可供外出新生儿使用的 HBV 疫苗、HBV 疫苗和乙型肝炎免疫球蛋白的支付情况、妊娠期间 HBV 标志物筛查以及高传染性孕妇的抗病毒治疗。

结果

在所参与的国家/地区中,有 11%的国家/地区未实施婴儿 HBV 免疫接种计划。36%的国家/地区第一针疫苗接种时间超过 24 小时,100%的非洲国家/地区如此。45%的国家/地区无法为外出新生儿提供推荐的出生剂量,包括 92%的非洲国家/地区和 50%的拉丁美洲国家/地区。44%的国家/地区在妊娠期间不筛查母体病毒标志物,46%的国家/地区不为高病毒血症的孕妇提供第三孕期抗病毒治疗。

结论

我们的研究表明,在实现预防 HBV MIT 的目标方面存在多种障碍。提出了综合公共卫生计划,以提高疫苗接种率、为外出新生儿提供 HBV 疫苗、筛查母体 HBV 标志物、治疗高病毒血症孕妇,以克服这些障碍并实现预防 HBV MIT 的目标。

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