浅谈乙型肝炎病毒的母婴传播途径和预防方法

我国是乙型肝炎的高流行区,无症状慢性乙型肝炎病毒（HBV）携带者超过1．2亿,其中接近半数是通过母婴传播造成的。因此,阻断HBV母婴传播对于控制我国乙型肝炎的流行具有重要意义。为了提高乙型肝炎的预防水平,现将HBV母婴传播途径和预防方法浅谈如下：     

乙型肝炎表面抗原阳性孕妇胎儿宫内感染相关因素分析

乙型肝炎病毒(HBV)感染是全世界关注的卫生问题,我国是HBV感染的高发区,据流行病学调查,在人群中HBV携带率高达10%~15%。母婴垂直传播是人群中HBV携带的主要原因之一,因此,阻断HBV母婴传播是控制乙型肝炎流行的重要措施。HBV母婴传播主要通过三条途径造成:产前经胎盘引起胎儿宫     

乙型肝炎病毒宫内感染的研究现状及今后工作重点

乙型肝炎(乙肝)呈世界范围流行，我国是高发区，全世界约有3．5亿乙肝病毒(HBV)慢性感染者，我国乙肝表面抗原(HBsAg)携带者就达1亿多，其中1／3以上是母婴传播所致，乙肝疫苗和乙肝高效价免疫球蛋白的应用使母婴间的水平传播及产中、产后的传播得到有效控制，但HBV母婴传播中的宫内感染尚不能用乙肝疫苗完全阻断。若按一般人群HBsAg携带率为10％，HBV宫内感染率为5％～10％保守估计，     

妊娠合并乙肝患者的护理

乙型病毒性肝炎是由乙型肝炎病毒引起的肝脏炎性损害,是我国目前流行较广泛、危害人体健康较严重的传染病之一.据国家肝炎基金会的资料显示,全球20亿HBV感染者中,我国就有6.9亿,通过母婴传播的占35%-40%.因此在临床工作中,做好妊娠合并乙型肝炎患者的护理和隔离预防工作,可以有效地阻断母婴之间的垂直传播.     

乙肝病毒母婴传播的途径与预防措施的研究(综述)

乙型肝炎是一种严重危害人类健康的世界性传染病,我国是乙肝高发区,人群感染率高达60％, 乙肝表面抗原携带者亦高达10％-15％。一般来说, 乙型肝炎高流行区孕妇HBsAg的阳性率为5％- 10％,其中约三分之一者HBeAg阳性。乙肝病毒 (HBV)母婴垂直传播是乙肝的主要传播方式之一, 故阻断母婴垂直传播是减少乙肝发病率的关键。因此,研究母婴垂直传播的可能途径,特别是母婴垂     

乙型肝炎病毒母婴传播及其免疫学预防的研究进展

母婴传播是HBV传播的主要途径之一,是人群中大量HBV慢性携带者形成的重要原因。乙型肝炎疫苗阻断HBV母婴传播的作用已被国内外的研究充分肯定。但仍有10～20％的母婴传播阻断失败。阻断失败的原因是什么,应该采取何种对策等问题为人们所关注。本文就HBV母婴传播的方式、免疫阻断的效果、阻断失败的原因及对策等方面的研究进展作一综述分析。     

深圳市计划妊娠夫妇HBV感染现况调查

正乙型肝炎(简称乙肝)是一种严重危害人类健康的病毒性传染病,呈世界流行趋势。根据2006年的乙肝血清流行病学调查,中国人口中有超过9300万名乙肝病毒(HBV)携带者,占总人口的7.18%~([1])。在新发HBV感染病例中,有50%来自母婴传播途径~([2]),父婴传播途径近年来也逐渐受到重视~([3]),从源头上阻断垂直传播是控制乙肝传播的关键。此外,妊娠合并HBV感染者不仅会增加子代感染HBV     

乙型肝炎母婴传播及阻断观察

乙型肝炎病毒(HBV)在母婴传播是重要传播途迳之一。也是HBV在人群中周转循环的重要环节。湛江市为乙型肝炎高发区(人群中HBsAg携带率达10～15％).积极开展乙肝母婴传播的调查及阻断的研究对控制乙肝流行,增强下一代素质,有重要意义.我们在1984年5月至1986年5月进行了观察研究。     

乙型肝炎病毒母婴传播阻断研究进展

HBV母婴传播是HBV传播的重要途径,而宫内传播又是母婴传播的主要途径,其危害大、治疗难,因此做好母婴传播的阻断,尤其宫内传播阻断,对控制HBV传播意义重大。此文就HBV母婴传播的阻断方法及疗效研究进展进行综述。     

乙型肝炎病毒母婴阻断免疫预防策略综述

乙型肝炎（乙肝）病毒（Hepatitis B Virus,HBV）母婴传播是全球不容忽视的重要公共卫生问题,是现阶段婴幼儿感染HBV的主要方式。目前,接种乙肝疫苗和乙肝免疫球蛋白是阻断HBV母婴传播的主要措施。现就全球HBV母婴阻断免疫预防策略进行综述,为我国预防控制乙肝提供依据。     

通过“预防为主”切断母婴传播促进我国乙型肝炎和肝癌发病率持续下降

全世界共有600万~1 000万乙型肝炎（乙肝）慢性患者，联合国制定的《2030年可持续发展议程》中要求消灭肝炎，并要求到2030年减少90%慢性患者。上海市接种乙肝疫苗后，乙肝发病率已减少了85%，肝癌发病率下降1/2。2015年，联合国要求乙肝母婴传播阻断成功率要达到95%以上，乙肝新感染人数要减少90%。为了早日实现联合国目标，根据上海市经验，建议在乙肝疫苗接种阻断母婴传播时，坚持做到"3个96%"，即婴儿出生24 h内接种率达到96%，出生后1、6个月疫苗加强时继续2个96%。抓住切断母婴传播关键环节，我国预防肝炎定有希望，有可能提前达到消灭乙肝和控制肝癌的任务。     

The risk factors of transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China

We aimed to evaluate the present situation and possible risk factors of HBV transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China. Two hundred and twenty one HBsAg carrier mothers and 247 children born to them were finally recruited in Wuwei city, Gangsu province, China in 2010. Serum samples were taken from those HBsAg carrier mothers and their children. Children who had detectable HBsAg or HBV DNA were considered to be HBV infection. Conditional logistic regression model was used to identify potential risk factors of HBV mother-to-child transmission. Of the 247 children born to HBsAg carrier mothers, 8 (3.24%) were HBsAg positive, 15 (6.07%) were HBV DNA positive. The rate of HBV mother-to-child transmission was 7.29% (18/247). The univariate analysis and multivariate analysis showed that maternal HBV DNA positive (OR = 4.83, 95% CI: 1.38–16.98, p = 0.0140), the delayed injection of the first dose of HBV vaccine after premature birth (OR = 9.73, 95% CI: 1.78–53.21, p = 0.0087) and the missing use of HBV vaccine (OR = 8.29, 95% CI: 1.42–48.23, p = 0.0186) were significantly associated with an increased risk for HBV mother-to-child transmission. The rate of HBV infection of the children received HBV vaccine and HBIG together after birth (2.56%, 4/156) was lower than those children received HBV vaccine alone (11.39%, 9/79) (χ² = 7.83, p = 0.0052). In conclusion, the rate of mother-to-child transmission of HBV was still high in the northwest of China. Besides the positivity of maternal HBV DNA and the missing of HBV vaccination after birth, the delayed injection of the first dose of HBV vaccine after premature birth was also a possible independent risk factor for HBV mother-to-child transmission. The HBV prevention and treatment guidelines should make it clear that all of the new born infants need to receive HBV vaccine injection after birth in 24 h, including the premature infants.     

Hepatitis B prevention, diagnosis, treatment and care: a review

Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality worldwide. Chronic hepatitis B (CHB) infection is associated with an increased risk of cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). The likelihood of developing CHB is related to the age at which infection is acquired; the risk being lowest in adults and >90% in neonates whose mothers are hepatitis B e antigen positive. Treatment of CHB infection aims to clear HBV DNA and prevent the development of complications. There are currently seven drugs available for the treatment of CHB: five nucleos(t)ide analogues and two interferon-based therapies. Long-term treatment is often required, and the decision to treat is based on clinical assessment including the phase of CHB infection and the presence and extent of liver damage. A safe and effective HBV vaccine has been available since the early 1980s. Vaccination plays a central role in HBV prevention strategies worldwide, and a decline in the incidence and prevalence of HBV infection following the introduction of universal HBV vaccination programmes has been observed in many countries including the USA and parts of South East Asia and Europe. Post-exposure prophylaxis (PEP) with HBV vaccine +/- hepatitis B immunoglobulin is highly effective in preventing mother to child transmission and in preventing transmission following sharps injuries, sexual contact and other exposures to infected blood and body fluids. Transmission of HBV in the health care setting has become an increasingly rare event in developed nations. However, it remains a significant risk in developing countries reflecting the higher prevalence of CHB, limited access to HBV vaccination and PEP and a lack of adherence to standard infection control precautions.     

乙型肝炎表面抗原和e抗原阳性产妇所生新生儿乙型肝炎母婴传播阻断效果的影响因素

目的探讨乙型肝炎(乙肝)表面抗原(HBsAg)和e抗原(HBeAg)阳性产妇所生新生儿在出生后乙肝疫苗(HepB)和乙肝免疫球蛋白(HBIG)联合免疫以及完成HepB全程免疫后乙肝病毒(HBV)突破性感染的影响因素。方法2016年6月-2017年5月在南昌市2个县(区)选择HBsAg和HBeAg阳性产妇所生新生儿,在联合免疫和HepB全程免疫完成后1-2个月检测血清HBsAg和乙肝表面抗体(HBsAb),分析儿童母婴传播阻断失败率(HBsAg阳性率)。结果本研究共纳入278名婴儿,母婴传播阻断失败率为2.52%(7/278),HBsAb阳性率为96.8%(269/278)。产妇HBsAg阳性时间在2年以上是阻断失败的危险因素,而分娩方式、喂养方式、母亲和婴儿HBIG的使用情况和婴儿性别等与HBV阻断失败率无相关性。结论HepB和HBIG联合免疫对HBsAg和HBeAg阳性产妇所生新生儿具有较好的乙肝母婴传播阻断效果,建议加强育龄妇女HBsAg和HBeAg筛查。     

乙型肝炎病毒宫内传播机制研究进展

慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者中母婴传播占50％以上,围生期HBV感染者90％以上会发展为慢性携带者,且有较高肝硬化和(或)肝癌的发生风险.宫内感染是乙型肝炎疫苗+乙型肝炎免疫球蛋白联合免疫失败致HBV母婴传播的主要原因.HBV宫内感染途径有生殖细胞感染、经胎盘屏障渗漏、经胎盘细胞...     

长沙市乙肝感染产妇所生儿童免疫监测分析

目的 了解长沙市乙肝感染产妇所生儿童的免疫状态,为制定措施提供科学依据。方法 对长沙市2017年4月1日-2018年9月30日出生的常住乙肝感染产妇所生儿童进行母婴阻断,并按0、1、6月龄完成乙肝疫苗接种后1～6月儿童进行乙肝系列五项检测。结果 长沙市乙肝感染产妇所生儿童6 498人,完成乙肝免疫球蛋白及乙肝疫苗第1针为6 492人,注射率为99.9%;共检测儿童1 533人,乙肝母婴传播率为1.44%,乙肝表面抗体阳转率为80.8%,在城区与农村区域将两者作比较,差异具有统计学意义(χ²=7.022、32.497,P＜0.05)。结论 长沙市预防乙肝母婴传播工作取得了显著成效,应建立常规报告乙肝暴露儿监测信息机制,使部分母婴阻断成功而未产生乙肝表面抗体的儿童,得到及时再免疫而避免感染,进一步降低地区乙肝感染率。     

Eliminating mother-to-child HIV transmission will require major improvements in maternal and child health services

Although some low- and middle-income countries have made progress toward eliminating mother-to-child transmission of HIV, others lack health systems that can deliver accessible and reliable care. We modeled how access to maternal and child health services and the effective delivery of interventions would affect efforts to eliminate HIV transmission during pregnancy and after childbirth in low- and middle-income countries. In countries with high HIV rates, our model predicts transmission rates of 19.7 percent at current levels of access and efficiency of maternal and child health and HIV treatment. Even if current treatment programs were carried out at or near perfect levels, we predict that significant residual mother-to-child transmission (7.9 percent) would remain. The model suggests that under current conditions, poor access to routine health services contributes three times more to overall mother-to-child HIV transmission than do current suboptimal levels of efficiency of anti-HIV-transmission interventions. We conclude that current efforts to optimize programs to prevent mother-to-child HIV transmission will not, on their own, eliminate HIV in newborns. Access to maternal and child health services will need to be dramatically improved, as will prevention measures, such as identifying and treating HIV before pregnancy.     

HIV与HBV单独感染及共感染对妊娠结局的影响

HIV和HBV有较高的流行率,威胁人类健康。越来越多的研究发现孕产妇HIV/HBV感染与不良妊娠之间存在联系,而且孕产妇HIV/HBV感染还会增加HIV、HBV母婴传播的风险。但目前有关这两种病毒共感染对不良妊娠结局和母婴传播的影响尚不清楚,有待进一步深入研究,为制定有效的预防措施提供科学依据,促进母婴健康。     

深圳市乙型肝炎母婴阻断结果分析

目的研究免疫阻断母婴垂直传播的效果和影响因素,探讨阻断乙型肝炎病毒母婴传播的有效方法,为阻断乙型肝炎母婴传播提供科学依据。方法运用回顾性调查方法,从辖区医院病案室或妇产科收集2011年1月至2011年12月乙肝表面抗原标志物阳性产妇以及其分娩新生儿作为研究对象,收集其流行病学材料,填写表面抗原阳性母亲儿童乙型肝炎感染情况调查表;同时采用酶联免疫法对随机抽取的产妇和新生儿进行乙型肝炎血清学检测和随访分析。结果对深圳光明新区内83例携带乙肝表面抗原阳性标志物的产妇和新生儿的随访分析结果显示：83例新生儿和其母亲全部随访成功：其中82例新生儿成功接种乙型肝炎疫苗,1例接种后仍携带乙肝表面抗原标志物;对83例产妇乙型肝炎标志物检测结果统计分析共得出9种模式,其中模式4为高危模式,母婴垂直感染概率高。结论对携带乙肝表面抗原阳性标志物产妇的新生儿出生后及时接种乙肝疫苗和乙肝免疫球蛋白是效地阻断乙肝的母婴垂直传播的重要手段,对携带血清学模型4的孕产妇应加以重视,井可考虑其他的阻断方式。     

Breast-feeding, Mastitis, and HIV Transmission: Nutritional Implications

In many developing countries, transmission of the human immunodeficiency virus (HIV) from mother to infant occurs through breast-feeding. Mastitis, an inflammatory process in the breast, may be common in lactating women in Africa and is associated with both higher HIV load in breast milk and mother-to-child transmission of HIV. Antioxidant micronutrient deficiencies may increase the risk of mastitis. Whether prevention, early diagnosis, and prompt treatment of mastitis will help reduce mother-to-child transmission of HIV in breast-feeding women needs further study.