MMWR Morb Mortal Wkly Rep. 2024 Jul 25;73(29):648-655. doi: 10.15585/mmwr.mm7329a3.
In 2022, an estimated 5 million persons in the World Health Organization Region of the Americas (AMR) were living with chronic hepatitis B virus (HBV) infection, the leading cause of hepatocellular carcinoma and cirrhosis worldwide. Most chronic infections are acquired through mother-to-child transmission (MTCT) or horizontal transmission during childhood and are preventable with hepatitis B vaccination, including a birth dose (HepB-BD), followed by 2-3 additional doses (HepB3) in infancy. The Pan American Health Organization (PAHO) Elimination of MTCT of HBV infection strategy is intended to reduce chronic HBV infection (measured by hepatitis B surface antigen [HBsAg] seroprevalence) to ≤0.1% among children by achieving 1) ≥95% coverage with HepB-BD and HepB3; and 2) ≥80% of pregnant women received testing for HBsAg, and provision of hepatitis B immunoglobulin to HBV-exposed neonates. By 2012, all 51 AMR countries and territories (countries) provided HepB3 nationwide, and by 2021, 34 (67%) provided HepB-BD nationwide. Mathematical models estimate that HBsAg seroprevalence in children is ≤0.1% in 14 (28%) of 51 countries and at the regional level. Three (6%) of 51 countries met the 95% coverage targets for both HepB3 and HepB-BD during both 2021 and 2022. Of these, two have likely met criteria for the elimination of MTCT of HBV infection. However, in 2022, HepB3 coverage had declined by ≥10 percentage points in 15 (37%) of 41 countries with 2012 coverage data for comparison. These declines in HepB3 coverage, as well as the absence of HepB-BD in the routine immunization schedules in 17 countries, threaten PAHO's progress toward the elimination of MTCT of HBV infection. Efforts to introduce HepB-BD and maintain high HepB3 and HepB-BD coverage are needed.
2022 年，在世卫组织美洲区域（AMR）估计有 500 万人患有慢性乙型肝炎病毒（HBV）感染，这是全球导致肝细胞癌和肝硬化的主要原因。大多数慢性感染是通过母婴传播（MTCT）或儿童期的水平传播获得的，可通过乙型肝炎疫苗接种预防，包括出生时接种（HepB-BD），随后在婴儿期接种 2-3 剂（HepB3）。泛美卫生组织（PAHO）消除乙型肝炎病毒母婴传播感染战略旨在通过以下两个方面，将儿童中慢性 HBV 感染（通过乙型肝炎表面抗原 [HBsAg] 血清阳性率衡量）减少至≤0.1%：1）HepB-BD 和 HepB3 的覆盖率达到≥95%；2）≥80%的孕妇接受 HBsAg 检测，并为乙型肝炎病毒暴露的新生儿提供乙型肝炎免疫球蛋白。到 2012 年，AMR 的 51 个国家和领土（国家）都在全国范围内提供 HepB3，到 2021 年，34 个（67%）国家在全国范围内提供 HepB-BD。数学模型估计，在 51 个国家中的 14 个（28%）和区域层面，儿童的 HBsAg 血清阳性率≤0.1%。在 2021 年和 2022 年期间，有 3 个（6%）国家同时达到了 HepB3 和 HepB-BD 的 95%覆盖率目标。其中两个国家可能已经达到消除乙型肝炎病毒母婴传播感染的标准。然而，2022 年，在有 2012 年覆盖率数据可供比较的 41 个国家中，有 15 个（37%）国家的 HepB3 覆盖率下降了≥10 个百分点。HepB3 覆盖率的下降，以及 17 个国家常规免疫计划中没有 HepB-BD，威胁到 PAHO 消除乙型肝炎病毒母婴传播感染的进展。需要努力引入 HepB-BD 并保持高 HepB3 和 HepB-BD 覆盖率。
