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预防乙型肝炎病毒母婴传播的策略

Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus.

作者信息

Sintusek Palittiya, Wanlapakorn Nasamon, Poovorawan Yong

机构信息

Department of Pediatrics, Division of Gastroenterology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Thailand and Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI) Research Unit, Chulalongkorn University, Bangkok, Thailand.

Center of Excellence in Clinical Virology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.

出版信息

J Clin Transl Hepatol. 2023 Aug 28;11(4):967-974. doi: 10.14218/JCTH.2022.00332. Epub 2023 Mar 10.

Abstract

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the primary cause of chronic HBV infection worldwide. MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden. Antiviral treatment of hepatitis B surface antigen (HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV. However, for worldwide application of those strategies, feasibility, availability, cost, safety, and effectiveness should be considered. Cesarean section and breastfeeding avoidance in hepatitis B e antigen-positive mothers with a high viral load and without antiviral therapy during pregnancy could be an option, but more supporting evidence is needed. HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention, except in areas with limited resources. Timely HBV vaccination series administered soon after birth might be the mainstay of prevention. This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.

摘要

乙型肝炎病毒(HBV)的母婴传播(MTCT)是全球慢性HBV感染的主要原因。预防MTCT以及对感染者进行抗病毒治疗可以消除这一公共卫生负担。对乙型肝炎表面抗原(HBsAg)阳性的孕妇进行抗病毒治疗,并用HBV疫苗和乙型肝炎免疫球蛋白进行免疫预防,是干扰HBV母婴传播的最有效策略。然而,对于这些策略在全球范围内的应用,应考虑可行性、可及性、成本、安全性和有效性。对于孕期未接受抗病毒治疗且病毒载量高的乙型肝炎e抗原阳性母亲,剖宫产和避免母乳喂养可能是一种选择,但还需要更多的支持证据。在启动预防MTCT的抗病毒治疗和免疫预防时,建议对所有孕妇进行HBsAg筛查,但资源有限的地区除外。出生后尽快及时接种完整的HBV疫苗系列可能是预防的主要手段。本综述旨在简要介绍预防HBV母婴传播现有策略的有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d5b/10318275/7685c710bca2/JCTH-11-967-g001.jpg

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