新生儿接种疫苗后的显性和隐匿性乙型肝炎感染：母婴传播和乙肝疫苗有效性。
Overt and occult hepatitis B infection after neonatal vaccination: mother-to-infant transmission and HBV vaccine effectiveness.
机构信息
Department of Clinical Laboratory, Anqing Municipal Hospital, Anqing 246003, China.
Department of Epidemiology, School of Public Health, Fudan University, No.130 Dong'an Road, Xuhui District, Shanghai 200032, China; Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, Fudan University, No.130 Dong'an Road, Xuhui District, Shanghai 200032, China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200233, China; Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
出版信息
Int J Infect Dis. 2021 Mar;104:601-609. doi: 10.1016/j.ijid.2021.01.045. Epub 2021 Jan 27.
OBJECTIVES
Overt and occult hepatitis B infection (HBI) among mothers and infants were investigated, and the effectiveness of vaccination against HBI was evaluated based on transmission types.
METHODS
A hospital-based cohort was built with 2,734 mothers and 330 mother-infant pairs. Their demographic data were collected. Serological HBV markers, nested-PCR for HBV genes, viral load detection, and phylogenetic analysis were done.
RESULTS
The overall prevalence of HBI among mothers was 12.1% (330/2,734), with 10.4% for the overt type and 1.8% for the occult type. In 330 out of 1,650 (20%) mother-infant pairs, the overall, type-I (from overt mother to overt infant), type-II (from overt mother to occult infant), and type-Ⅲ (from occult mother to occult infant) transmissions were 1.9% (1/54), 5.6% (3/54) and 0.0% (0/7). The refinement of HBI classification improved the estimate of vaccine effectiveness against HBI from 74.4%-80.9% to 94.4%, which was more prominent for type-II. One mother-infant pair with type-II transmission shared nearly identical complete sequences. However, the high rate of lost-to-follow-up could not be ignored.
CONCLUSIONS
During the transition period, HBV is mainly transmitted from the overt type of HBI mother to infant. Intensive prenatal screening for mothers is vital.
目的
调查母亲和婴儿的显性和隐匿性乙型肝炎病毒（HBV）感染情况，并根据传播类型评估乙型肝炎病毒免疫预防的效果。
方法
采用医院为基础的队列研究方法，纳入 2734 名母亲和 330 对母婴，收集其人口统计学数据。进行血清 HBV 标志物检测、HBV 基因巢式 PCR、病毒载量检测和系统进化分析。
结果
母亲 HBI 的总体患病率为 12.1%（330/2734），显性型为 10.4%，隐匿型为 1.8%。在 1650 对母婴中，330 对母婴（20%）中存在总体、I 型（从显性母亲到显性婴儿）、II 型（从显性母亲到隐匿性婴儿）和 III 型（从隐匿性母亲到隐匿性婴儿）传播，传播率分别为 1.9%（1/54）、5.6%（3/54）和 0.0%（0/7）。细化 HBI 分类后，乙型肝炎病毒免疫预防对 HBI 的估计效果从 74.4%至 80.9%提高到 94.4%，对 II 型的效果更为显著。1 对具有 II 型传播的母婴共享了几乎完全相同的完整序列。然而，失访率过高不容忽视。
结论
在过渡时期，HBV 主要由显性 HBI 母亲传播给婴儿。对母亲进行强化产前筛查至关重要。
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