Biondi Mia J, Marchand-Austin Alex, Cronin Kirby, Nanwa Natasha, Ravirajan Vithusha, Mandel Erin, Goneau Lee W, Mazzulli Tony, Shah Hemant, Capraru Camelia, Janssen Harry L A, Sander Beate, Feld Jordan J
Viral Hepatitis Care Network Study Group/Toronto Centre for Liver Disease (Biondi, Mandel, Shah, Capraru, Janssen, Feld), University Health Network, Toronto, Ont.; Arthur Labatt Family School of Nursing (Biondi), Western University, London, Ont.; Public Health Ontario Laboratory (Marchand-Austin, Cronin, Ravirajan, Goneau, Mazzulli), Toronto, Ont.; National Microbiology Laboratory (Cronin), Public Health Agency of Canada, Winnipeg, Man.; Public Health Ontario (Nanwa, Ravirajan, Sander); ICES Central (Nanwa, Sander); Sinai Health System/University Health Network (Mazzulli); Institute of Medical Sciences (Feld), University of Toronto, Toronto, Ont.
CMAJ. 2020 Oct 26;192(43):E1299-E1305. doi: 10.1503/cmaj.200290.
Ontario is 1 of 5 provinces that immunize adolescents for hepatitis B virus (HBV), despite the World Health Organization recommendation for universal birth dose vaccination. One rationale for not vaccinating at birth is that universal prenatal screening and related interventions prevent vertical transmission. The aims of our study were to evaluate the uptake and epidemiology of prenatal HBV screening, and to determine the number of children in Ontario with a diagnosis of HBV before adolescent vaccination.
We extracted data from ICES, Public Health Ontario and Better Outcomes & Registry Network (BORN) Ontario databases. We assessed prenatal screening uptake and prevalence of prenatal hepatitis B surface antigen (HBsAg) from 2012 to 2016, as well as subsequent hepatitis B e-antigen (HBeAg) and HBV DNA testing and percent positivity. We used age and region to subcategorize the results. In a separate unlinked analysis, we evaluated the number of children positive for HBV aged 0-11 years who were born in Ontario from 2003 to 2013.
From 2012 to 2016, 93% of pregnant women were screened for HBV, with an HBsAg prevalence of 0.6%. Prevalence of HBsAg increased with age, peaking at older than 45 years at 3%. North Toronto had the highest overall prevalence of 1.5%, whereas northern Ontario had the lowest. Of women who were HBsAg positive, HBeAg and HBV DNA tests were subsequently ordered in 13% and 38%, respectively. Of children born in Ontario between 2003 and 2013, 139 of 23 759 tested positive for HBV.
Prenatal HBV screening is not universal and subsequent evaluation is poor, limiting optimal intervention and possibly contributing to some Ontario-born children being given a diagnosis of HBV before age 12 years. These findings underscore the limitations of the province's adolescent vaccination strategy.
安大略省是为青少年接种乙型肝炎病毒（HBV）疫苗的5个省份之一，尽管世界卫生组织建议进行普遍的出生剂量疫苗接种。不在出生时接种疫苗的一个理由是，普遍的产前筛查和相关干预措施可预防垂直传播。我们研究的目的是评估产前HBV筛查的接受情况和流行病学，并确定安大略省在青少年接种疫苗前被诊断为HBV的儿童数量。
我们从ICES、安大略省公共卫生部门和安大略省更好结果与登记网络（BORN）数据库中提取数据。我们评估了2012年至2016年期间产前筛查的接受情况和产前乙型肝炎表面抗原（HBsAg）的患病率，以及随后的乙型肝炎e抗原（HBeAg）和HBV DNA检测及阳性率。我们按年龄和地区对结果进行了细分。在一项单独的非关联分析中，我们评估了2003年至2013年在安大略省出生的0至11岁HBV检测呈阳性的儿童数量。
2012年至2016年期间，93%的孕妇接受了HBV筛查，HBsAg患病率为0.6%。HBsAg患病率随年龄增长而增加，在45岁以上达到峰值，为3%。北约克的总体患病率最高，为1.5%，而安大略省北部最低。在HBsAg呈阳性的女性中，随后分别有13%和38%的人接受了HBeAg和HBV DNA检测。在2003年至2013年在安大略省出生的儿童中，23759人中有139人HBV检测呈阳性。
产前HBV筛查并不普遍，后续评估也很差，这限制了最佳干预措施，并可能导致一些在安大略省出生的儿童在12岁之前被诊断为HBV。这些发现凸显了该省青少年疫苗接种策略的局限性。
