冈比亚孕妇中乙型肝炎病毒母婴传播的残余风险及护理流程中的差距：婴儿-B研究

Residual Risk of Hepatitis B Virus Mother-to-Child Transmission and Gaps in Care Cascades Among Pregnant Women in the Gambia: The INFANT-B Study.

作者信息

Ndow Gibril, Bangura Rohey, Vo-Quang Erwan, Touray Fatoumata, Jatta Abdoulie, Barry Jainaba, Mahmoud Isatou, Bah Sulayman, Nyassi Fatou Bintou, Ceesay Amie, Bola-Lawal Queen, Touray Alhagie B, Drammeh Sainabou, Cham Hawa, Bojang Lamin, Cloherty Gavin, Lo Gora, Bittaye Mustapha, Badjie Sheriff, Toure-Kane Coumba, D'Alessandro Umberto, Shimakawa Yusuke, Lemoine Maud

机构信息

Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, the Gambia.

Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, United Kingdom.

出版信息

J Infect Dis. 2025 Sep 15;232(3):630-638. doi: 10.1093/infdis/jiaf214.

DOI:10.1093/infdis/jiaf214

PMID:40304086

Abstract

BACKGROUND

Elimination of hepatitis B virus (HBV) is not achievable without prevention of mother-to-child transmission (MTCT). In its 2024 guidelines, the World Health Organization identified major research gaps on HBV MTCT in Africa. Following the implementation of antenatal HBV screening in The Gambia, we estimated the rate of HBV MTCT and the peripartum care cascade among pregnant women.

METHODS

This multicenter nonrandomized interventional study was conducted in urban and rural antenatal clinics in The Gambia. Following mass and individual sensitization, consecutive pregnant women were offered HBV testing and blood collection for further retrospective HBV MTCT risk assessment including HBV DNA viral load and HBeAg serology. HBsAg-positive mothers and their babies were prospectively followed up to 6 to 9 months postpartum. The primary end point was the rate of HBV MTCT defined by the proportion of HBsAg-positive babies.

RESULTS

Between 2019 and 2022, 9697 of 9708 (99.9%) pregnant women accepted HBV screening; 449 of 9697 tested positive (hepatitis B surface antigen [HBsAg] prevalence, 4.6%; 95% CI, 4.2-5.1). Among 428 traceable live births, 216 (49.6%) babies were successfully tested for HBV; 6 of 216 were HBsAg positive, giving a 2.8% rate of MTCT (95% CI, 1.1%-6.2%). Major gaps in HBV prevention and care services were identified: 64% of newborns did not receive HBV birth dose vaccine, 25% of HBsAg-positive pregnant women refused to give blood for further risk stratification, and 62% were not linked to care after delivery. A small proportion (<2%) of women were eligible for postpartum treatment according to the 2017 guidelines of the European Association for the Study of the Liver and the 2024 guidelines of the World Health Organization.

CONCLUSIONS

In The Gambia, the residual risk of HBV MTCT exceeds the elimination absolute target. Strategies to improve the peripartum and postpartum HBV care cascade are urgently needed.

摘要

背景

不预防母婴传播（MTCT）就无法实现消除乙型肝炎病毒（HBV）的目标。世界卫生组织在其2024年指南中指出了非洲在HBV母婴传播方面的主要研究空白。在冈比亚实施产前HBV筛查后，我们估计了孕妇中HBV母婴传播率及围产期保健服务流程情况。

方法

这项多中心非随机干预研究在冈比亚城乡的产前诊所开展。在进行大规模和个体化宣传后，为连续就诊的孕妇提供HBV检测及采血服务，以便进一步进行回顾性HBV母婴传播风险评估，包括HBV DNA病毒载量和HBeAg血清学检测。对HBsAg阳性母亲及其婴儿进行前瞻性随访直至产后6至9个月。主要终点是由HBsAg阳性婴儿比例定义的HBV母婴传播率。

结果

2019年至2022年期间，9708名孕妇中有9697名（99.9%）接受了HBV筛查；9697名中449名检测呈阳性（乙肝表面抗原[HBsAg]流行率为4.6%；95%置信区间，4.2% - 5.1%）。在428例可追踪的活产婴儿中，216名（49.6%）婴儿成功进行了HBV检测；216名中有6名HBsAg呈阳性，母婴传播率为2.8%（95%置信区间，1.1% - 6.2%）。确定了HBV预防和保健服务方面的主要差距：64%的新生儿未接种HBV首剂疫苗，25%的HBsAg阳性孕妇拒绝献血以进行进一步风险分层，62%的产妇产后未获得后续保健服务。根据欧洲肝脏研究协会2017年指南和世界卫生组织2024年指南，一小部分（<2%）妇女符合产后治疗条件。