Hepatitis B immunisation coverage of infants born to chronic carrier mothers in Victoria

Abstract: Infants born to HBsAg– (hepatitis B surface antigen) carrier mothers are highly likely to become chronic hepatitis B (HB) carriers themselves unless their status is recognised at birth and they are immunised with three doses of HB vaccine, the first within 48 hours of birth, concurrent with hepatitis B immune globulin (HBIG). This study was designed to determine how many infants born in Victoria to carrier mothers completed three doses of HB vaccine. We sent the names of all infants of HBsAg–carrier mothers notified in Victoria between 1.7.91 and 30.6.92 to the appropriate local government immunisation providers and requested information on how many doses of HB vaccine, DTP (diphtheria–tetanus–pertussis) or CDT (combined diphtheria–tetanus), and OPV (oral polio vaccine) they had received. The HBsAg–carrier prevalence of women giving birth in Victoria in 1991–92 was at least 0.52%. Of the 336 infants notified, 239 (71.1%) were recorded in local government records. Of these 239, 90.8% received at least two doses and 80.8% received at least three doses of hepatitis B vaccine. There was no significant difference in the number who received three doses of HB vaccine compared with three doses of DTP or CDT vaccine. Of the entire cohort of 336, only 57.4% were documented as being completely immunised against hepatitis B. HB immunisation coverage for these infants needs to be improved. The high rate of loss to follow–up, especially between the maternity hospital and the community, is disturbing. Mechanisms for intensive prospective follow–up of these infants should be developed to prevent loss to follow–up and to encourage full immunisation against HB. Improving HB immunisation coverage of infants in high HBsAg–prevalence ethnic groups and introduction of universal infant HB immunisation may lead to increased coverage of infants of carriers by serving as back–up mechanisms for those lost to follow–up.     

云南HBsAg阳性孕产妇生产婴儿免疫应答及感染状况分析

目的 了解云南省乙肝表面抗原（HBsAg）阳性孕产妇所生婴儿在实施母婴阻断后的免疫应答及乙肝感染状况。方法 筛查出全云南省2011年1-6月入院分娩的HBsAg阳性孕产妇,实施母婴阻断后以其所生婴儿为调查对象,于7-12月龄采集静脉血2 mL,分离出血清标本先统一采用ELISA法做乙肝血清学5项指标检测,筛选出HBsAg阳性的标本采用荧光定量PCR法进行乙肝病毒载量（HBV DNA）检测,筛选出HBsAg阴性且乙肝表面抗体（anti-HBs,抗-HBs）阳性的标本采用化学发光法做抗-HBs定量检测。结果 共收集到调查对象3 026人,母婴阻断实施后免疫应答率为92.43%,有效免疫应答率为80.04%;低、无免疫应答者占16.09%;母婴阻断失败率为3.87%。本次调查共检出10种乙肝血清标志物组合模式,检出率最高为模式6,占74.62%：其次为模式5,占14.44%：再次为模式7,占3.70%：模式4占3.37%。母婴阻断失败组中,HBV DAN含量>5×10⁷ IU/mL占45.30%;500~5×10⁷ IU/mL占39.32%;<500 IU/mL占15.38%;HBeAg阳性率为79.49%。产生免疫应答组检出3种血清组合模式,乙肝病毒e抗体（anti-HBe,抗-HBe）阳性率为3.79%,乙肝病毒核心抗体（anti-HBc,抗-HBc）阳性率为23.20%。定量检测抗-HBs,抗体水平>1 000 mIU/mL的高免疫应答者占66.93%,抗体水平在100~1 000 mIU/mL的中免疫应答者占19.66%,抗体水平在10~100 mIU/mL的低免疫应答者占13.41%。经统计分析,产生免疫应答抗-HBs的抗体水平高低与婴儿体内是否携带抗-HBe、抗-HBc及性别无关。结论 对HBsAg阳性孕产妇所生婴儿实施母婴阻断,并建立健全产后对婴儿追踪机制,对预防和控制婴儿感染乙肝起关键作用。     

HBsAg阳性母亲的新生儿乙型肝炎疫苗免疫后追踪观察

目的探讨不同方案乙型肝炎疫苗免疫，对母亲ＨＢｓＡｇ阳性新生儿的免疫持久性。方法在２０３名ＨＢｓＡｇ阳性母亲的新生儿出生时，按不同方案和剂量注射乙型肝炎疫苗，免疫后６年内连续进行抗－ＨＢｓ和ＨＢｓＡｇ携带情况的追踪观察。结果６年内抗－ＨＢｓ阳性率一直高于９０％；新生儿免疫后抗－ＨＢｓ在７月龄到１岁形成高峰，在１～２岁期间下降了４８．８２％，２～６岁期间保持相对稳定；８例抗－ＨＢｓ阴转后３～５年仍未被感染；１４例抗－ＨＢｓ阴转１～２年后又产生抗－ＨＢｓ；无一例成为ＨＢｓＡｇ携带者。结论乙型肝炎疫苗免疫后６～１０年可不进行加强免疫。     

Materno-fetal transmission of hepatitis B virus in Ivory Coast. Plea for mass vaccination

BACKGROUND: Hepatitis B is a major public health problem in the developing countries of Africa and Asia because the prevalence of HBs antigen carriers is high. In Ivory Coast, the prevalence of HBs antigen carriers is more than 8% (6 to 29%). In these countries, in which hepatitis B is highly endemic, most infections with hepatitis B virus (HBV) occur during early childhood. The chronic carriage of HBV was found to be common in children, who played a key role in maintaining the high level of endemicity in these areas. Vaccines against HBV are effective and their introduction as part of the Expanded Program of Immunization (EPI), as recommended by the WHO, is feasible. OBJECTIVE: The aim of this study was to evaluate the prevalence of HBs antigen in pregnant women and to determine the rate of maternal transmission of HBV to the fetus, to demonstrate the importance of HBs antigen screening during pregnancy and the immunization of babies in the Ivory Coast. PATIENTS AND METHODS: Between August 1995 and February 1996, 395 women in the last three months of pregnancy (age 25 +/- 6.9 years) were screened for HBs antigen. Those testing positive were also screened for HBe antigen. Transmission of HBV in utero was studied with 322 mothers and their offspring. HBs antigen was assayed in the cord blood of the offspring of HBs antigen-positive mothers. If the test for HBs antigen was positive, HBe antigen was also assayed. Second-generation ELISA tests (MONOLISA HBs Ag and MONOLISA HBe Ag from Sanofi Pasteur) were used. Babies from HBs antigen-positive mothers were vaccinated at birth with three doses of GenHevac B.     

HBsAg阳性母亲与婴幼儿HBV血清标志物关系

目的了解HBsAg阳性母亲及其经乙肝高效价免疫球蛋白联合乙肝疫苗免疫的婴幼儿乙型肝炎病毒（HBV）血清标志物变化及转归情况。方法对125例HBsAg阳性母亲及其128例婴幼儿（双胎3例）进行随访调查,并分别于婴幼儿7月龄、24~36月龄应用酶联免疫吸附试验检测母亲和婴幼儿血清HBV主要标志物。结果7月龄随访83例婴幼儿,24~36月龄随访75对母子。128例婴幼儿出生时HBsAg阳性4例,随访时仅1例持续阳性,其余出生时HBsAg阴性的94例婴幼儿随访中未发现HBsAg阳转;HBsAg、HBeAg双阳性的26例母亲所产婴幼儿出生时20例HBeAg阳性,随访时除1例HBsAg为阳性的婴幼儿HBeAg仍持续阳性外,余均转阴,未见婴幼儿出现HBeAg阳转;婴幼儿抗-HBe和抗-HBc在7月龄和远期随访中逐渐阴转。结论乙肝病毒经胎盘所致的宫内感染率约为3.13%（4/128）,出生后转为慢性感染者约为25.00%（1/4）;HBeAg可通过人类胎盘从母亲传递给胎儿,但在7月龄前消失;出生于HBsAg阳性母亲的婴幼儿在婴幼儿期单独抗-HBe和（或）抗-HBc阳性,不能说明处于HBV感染状态。     

Outcomes from a Canadian public health prenatal screening program for hepatitis B: 1997-2004

BACKGROUND: Without appropriate prophylaxis, the rate of vertical transmission of hepatitis B virus (HBV) can be as high as 95%. Alberta's provincial prenatal program screens all pregnant women for HBV, and provides prophylaxis to infants born to HBV-infected women. Canadian data on the outcomes of such programs are limited. METHODS: We conducted a retrospective review of data from pregnant Albertan women who were Hepatitis B Surface Antigen (HBsAg) positive from 1997-2004. We describe the frequency of hepatitis B immunoglobulin (HBIG) and vaccine administration, follow-up serology and pregnancy outcomes. RESULTS: In total, 1,485 HBsAg-positive pregnant women were identified; an average of 186 women annually (range: 125-216). Of the 980 infants eligible to have completed prophylaxis and serological follow-up, 82.0% were appropriately immunized and serologically tested, 11.3% had complete immunization but no serology testing and 6.6% were incompletely immunized. Of infants with complete immunization and follow-up, 3.7% failed to mount an immune response and 2.1% were infected. CONCLUSION: A high proportion of infants born to carrier mothers are receiving appropriate post-natal prophylaxis in Alberta. Future research should examine maternal factors that may increase the vertical transmission of HBV.     

Nationwide vaccination: a success story in Taiwan

In the early 1980s, 15-20% of the population of Taiwan were estimated to be hepatitis B virus (HBV) carriers. A programme of mass vaccination against hepatitis B was therefore launched in 1984. In the first 2 years, newborns of all HBVsurface antigen (HBsAg)-positive mothers were vaccinated. Since 1986, all newborns, and then year by year pre-school children, primary school children, adolescents, young adults and others have also been vaccinated. Vaccination coverage is over 90% for newborns, with 79% of pregnant women screened for HBsAg. The proportion of babies born to highly infectious carrier mothers who also became carriers decreased from 86-96% to 12-14%; the decrease was from 10-12% to 3-4% for babies of less infectious mothers. Between 1989 and 1993, the prevalence of HBsAg in children aged 6 years also fell from 10.5 to 1.7%. The average annual incidence of hepatocellular carcinoma in children aged 6-14 years decreased significantly from 0.7 per 100,000 in 1981-1986 to 0.36 per 100,000 in 1990-1994 (P<0.01). Similarly, the annual incidence of hepatocellular carcinoma in children aged 6-9 years declined from 0.52 per 100,000 for those born in 1974-1984 to 0.13 per 100,000 for those born in 1986-1988 (P<0.001). The mass vaccination programme is highly effective in controlling chronic HBV infection and in preventing liver cancer in Taiwan. If a coverage rate of 90% of all newborns vaccinated against hepatitis B can be maintained, by the year 2010 the carrier rate in Taiwan is expected to decline to <0.1%.     

Factors influencing the durability of hepatitis B vaccine responses

The World Health Organization recommends the implementation of universal hepatitis B (HB) vaccination, and global coverage for this vaccine reached 84% in 2015. In Japan, the policy aimed at preventing mother-to-child transmission of HB virus (HBV) initially commenced as a specific vaccination program for infants born to mothers who were positive for HB surface antigen. In 2016, universal HB vaccination was implemented in this country to cover unvaccinated individuals at risk of horizontal HBV transmission. Although HB vaccination has been shown to be highly efficacious and safe, the issues of vaccine non-responders and of the loss of antibodies directed against HB surface antigen (anti-HBs) in HB vaccine recipients remain. To gain better insight into these problems, we previously performed an immunological analysis on adult vaccine recipients after they received an initial HB vaccination. We found that the course of successful HB vaccination is composed of the following distinct phases: 1) acquisition of anti-HBs antibody, 2) attainment of high anti-HBs antibody titers, and 3) maintenance of acquired anti-HBs antibody levels. In this review, we describe the significance of HB vaccination and suggest a potential means of improving the impact of HB vaccination based on our immunological analysis.     

阻断乙型肝炎母婴传播的初步研究

本文报告了四川地区阻断乙型肝炎母婴传播的研究结果。筛检孕妇HBsAg和HBeAg双阳性,或HBsAg阳性效价≥1:512的孕妇所产新生儿作为研究对象。80例新生儿按随机、双盲、安慰剂对照原则分成3组:疫苗组、疫苗加HBIG组和对照组。随访观察12个月时,乙肝感染保护率分别为88.0%和92.0%。认为国产乙肝疫苗和HBIG阻断乙肝母婴传播效果较好,单独疫苗接种效果亦较满意。     

Evaluation of a universal hepatitis B vaccination program and antenatal screening for hepatitis B surface antigen: Results from a real-world study 2015–2016

Background and AimsUniversal vaccination against hepatitis B virus (HBV) in infancy was implemented in Israel in 1992. This population-based study aimed to evaluate the coverage rate and cost-benefit of the HBV vaccination program among infants in Israel and the Hepatitis B surface antigen (HBsAg) status in their mothers.MethodsUsing the database of a health maintenance organization with 2 million members, we retrospectively identified, all the infants born in 2015–2016 and their mothers. Maternal data collected included age, ethnicity, country of birth and HBsAg status during pregnancy. HBV vaccination coverage among infants was calculated. A cost-benefit analysis of the HBV vaccination program was conducted based on the actual costs of HBV infection treatments in all HBsAg positive mothers.ResultsOur cohort included 72,792 mothers who gave birth to 77,572 live infants. A total of 71,107 (97.7%) mothers were screened for HBV during pregnancy, of them 124 (0.2%), who gave birth to 132 infants were HBsAg positive. HBV vaccination coverage rates were 94%, 93% and 89%, for the first, second and third dose, respectively. Birth dose coverage of 95% among infants born to HBsAg positive mothers was significantly higher compared to HBsAg negative or unscreened mothers (p < 0.001). The percentage of HBsAg positivity among mothers who were born in Israel, the Former Soviet Union or Ethiopia, were 0.1%, 0.8% and 5%, respectively (p < 0.001). Ethnic differences were not found between HBsAg positive and HBsAg negative mothers. Calculated benefit-to-cost ratios were 1.24:1 and 4.15:1, with and without antenatal HBsAg screening, respectively.ConclusionsThe Israeli vaccination program against HBV infection is epidemiologically and economically justified. High coverage rates among infants born to HBsAg positive mothers reflect very good adherence to the vaccination program and antenatal screening. Higher HBsAg positivity rates among immigrant mothers identify a high-risk population for HBV infection.     

Hepatitis B seroprevalence and anamnestic response amongst Taiwanese young adults with full vaccination in infancy, 20 years subsequent to national hepatitis B vaccination

The long-term protective effect of hepatitis B virus (HB) vaccination against HB infection and the necessity for routine booster vaccination in young-adult age subsequent to full HB immunization at birth remain issues of some debate currently. This study is aimed at evaluating the seroprevalence of HB infection and the response to HB booster vaccination amongst young-adult university students who had previously undergone full vaccination during their infancy. Eight hundred and forty-three subjects (mean age 18.7+/-0.4 years), 492 males and 351 females, with a complete HB vaccination during infancy were enrolled into this study. The prevalence of natural HB infection, chronic HB-carrier status, and HB-na?ve group was, respectively, 4.1%, 1.4%, and 62.3%. Amongst 316 study subjects who were na?ve to HB infection and had received one HB booster at time of university entrance health examination, 49.6%, 91.4%, and 97.5% of the participants with a serum anti-HBs level <0.1, 0.1 to <1.0 and 1.0 to <10.0mIU/mL prior to the booster vaccination, respectively, developed an anamnestic response (i.e., >/=10mIU/mL) to a booster dose of HB vaccine. Full implementation of national-wide HB vaccination program in 1986 has significantly reduced the incidence of HB infection and associated carrier rate in Taiwan. Approximately three-quarter of the subjects who were na?ve to HB infection and had received one HB booster demonstrated an anamnestic response to a booster HB vaccine. The higher the anti-HBs titers remained for an individual subsequent to primary vaccination, the greater the anamnestic response observed. Additional long-term follow-up studies are needed for young adults initially vaccinated for HB in their infancy.     

Effects of hepatitis B immunization on prevention of mother-to-infant transmission of hepatitis B virus and on the immune response of infants towards hepatitis B vaccine

Background

Combined immunization with hepatitis B immunoglobulin (HBIG) plus hepatitis B vaccine (HB vaccine) can effectively prevent perinatal transmission of hepatitis B virus (HBV). With the universal administration of HB vaccine, anti-HBs conferred by HB vaccine can be found increasingly in pregnant women, and maternal anti-HBs can be passed through the placenta. This study was designed to evaluate the effect of hepatitis B immunization on preventing mother-to-infant transmission of HBV and on the immune response of infants towards HB vaccine.

Method

From 2008 to 2013, a prospective study was conducted in 15 centers in China. HBsAg-positive pregnant women and their infants aged 8–12 months who completed immunoprophylaxis were enrolled in the study and tested for HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc). Antepartum administration of HBIG to HBsAg-positive women was based on individual preference. HBsAg-negative pregnant women and their infants of 7–24 months old who received HB vaccines series were enrolled and tests of their HBV markers were performed.

Results

1202 HBsAg-positive mothers and their infants aged 8–12 months were studied and 40 infants were found to be HBsAg positive with the immunoprophylaxis failure rate of 3.3%. Infants with immunoprophylaxis failure were all born to HBeAg-positive mothers of HBV-DNA ≥ 6 log₁₀ copies/ml. Among infants of HBeAg-positive mothers, immunoprophylaxis failure rate in vaccine plus HBIG group, 7.9% (29/367), was significantly lower than the vaccine-only group, 16.9% (11/65), p = 0.021; there was no significant difference in the immunoprophylaxis failure rate whether or not antepartum HBIG was given to the pregnant woman, 10.3% (10/97) vs 9.0% (30/335), p = 0.685. Anti-HBs positive rate was 56.3% (3883/6899) among HBsAg-negative pregnant women and anti-HBs positive rate was 94.2% in cord blood of anti-HBs-positive mothers. After completing the HB vaccine series, anti-HBs positive rate among infants with maternal anti-HBs titers of <10 IU/L, 10–500 IU/L and ≥500 IU/L was 90.3% (168/186), 90.5% (219/242) and 80.2% (89/111) respectively, p = 0.011. Median titers of anti-HBs (IU/L) among infants in the three groups was 344.2, 231.9 and 161.1 respectively, p = 0.020.

Conclusions

HBIG plus HB vaccine can effectively prevent mother-to-infant transmission of HBV, but no HBV breakthrough infection was observed in infants born to HBeAg-negative mothers who received HB vaccine with or without HBIG after birth. Antepartum injection of HBIG has no effect on preventing HBV mother-to-infant transmission. High maternal titer of anti-HBs can transplacentally impair immune response of infants towards HB vaccine.     

A nationwide vaccination programme in Italy against hepatitis B virus infection in infants of hepatitis B surface antigen-carrier mothers

In order to prevent hepatitis B virus (HBV) infection of infants of hepatitis B surface antigen (HBsAg)-positive mothers, a nation-wide immunization programme was initiated in Italy in January 1984. During the first 3 years (1984-86), 651,667 out of 1726,000 pregnant women (37.8%) were screened for HBsAg; the percentage of mothers screened increased from 32% in 1984 to 51% in 1986 in 15 of the 21 Italian regions, where data by year were available. HBsAg was present in 15,640 mothers (2.4% of those screened); range by region 0.3-6.4%. All newborns of HBsAg-positive women, regardless of the mother's status of hepatitis Be antigen (HBeAg), were given a single dose (0.5 ml Kg-1) of a hepatitis B immune globulin within 24 h after birth and the first dose of plasma-derived hepatitis B vaccine within 7 days after birth. The immunization coverage rate was 80% in the 3-year period. Protective antibodies were found in greater than 97% of a sample of 1071 infants, immunized from different regions. No serious reactions were observed. On the basis of this field experience, it may be concluded that a nation-wide hepatitis B vaccination programme for infants of HBsAg-carrier mothers would be highly immunogenic and safe. Its implementation, however, requires continuous public education and cooperation from physicians.     

Hepatitis B virus infection in HIV-exposed infants in the Western Cape,South Africa

Hepatitis B virus infection (HBV) is a significant public health problem in sub-Saharan Africa. Universal infant vaccination with the hepatitis B (HB) vaccine has been implemented within the South African Expanded Programme of Immunization since April 1995 with concomitant reduction in HBV infection in children. However, the first vaccine dose is only administered at six weeks of age. This delay may lead to a failure to reduce the risk of perinatal HBV transmission to infants born to HIV/HBV co-infected women, in whom HBV infection is often upregulated. The aim of this study was to determine the prevalence of HBV infection in babies born to HIV-infected mothers in the Western Cape, South Africa. HBV serological markers were tested in all infant serum samples and following HB viral load testing, sequencing and genotyping were also performed. Three of 1000 samples screened tested positive for HBsAg and HBV DNA. An additional infant tested positive for HBV DNA alone. All babies had received the HB vaccine at 6, 10 and 14 weeks. The prevalence of HBV infection was therefore 4/1000 (0.4%; 95% CI, 0.01–0.79%). Three of four infants and all four mothers were followed-up. Two infants were persistently positive for HBsAg with viral loads above 10⁸ International Units per millilitre. All four maternal samples were positive for HBsAg and HBeAg and one was also positive for anti-HBe. Sequencing analysis of two mother–child HBV pairs showed 100% sequence identity. This study demonstrates HBV infection in HIV-exposed infants despite HB vaccination from 6 weeks of age. A more strategic approach is needed to prevent mother to child transmission of HBV, including screening of pregnant women, HBV-targeted antiviral therapy and HB birth dose vaccine.     

2006年广州市荔湾区部分儿童乙肝表面抗原抗体调查

[目的]了解荔湾区10岁以下儿童乙型肝炎抗原携带情况,为今后制定科学的免疫规划提供依据.[方法]对10岁以下(包括10岁)本市户籍儿童进行随机抽查,检测乙肝表面抗原携带情况,并对其进行分析.[结果]检测了942名10岁以下儿童,乙肝表面抗原平均携带率0.74%,乙肝表面抗体平均阳性率72.40%.接种3针以上(含3针)与接种3针以下儿童的HBsAb(+)之间差异有统计学意义(P＜0.05);不同年龄及性别儿童的HBsAg(+)之间差异无统计学意义(P＞0.05).[结论]"十五"规划新生儿乙肝免疫预防策略有效地降低了10岁以下儿童乙肝表面抗原的携带率.     

Secular change in birthweight among southeast Asian immigrants to the United States.

We analyzed the Washington State births in 1980-1986 to Southeast Asian parents whose birth place was coded as being outside of the US. The mean birthweight increased from 3188 grams in 1980-81 to 3283 grams in 1986, an annual increment of about 18 grams (95% CI = 11, 25 grams). The prevalence of low birthweight (less than 2500 grams) decreased from 7.2 percent in 1980-81 to 5.4 percent in 1986, an annual reduction of 6.4 percent (95% CI = 1.3, 11.2 percent). In an analysis of information ascertained from the birth certificate, the change of paternal occupational status (from student to employed) was associated with 27 percent of the reduction in the prevalence of low birthweight, independent of maternal age, infant sex, and prior gravidity. A similar temporal change of birthweight during the same period of time was not observed among infants of US-born Asian mothers. Among the women who had two consecutive births from 1984 to 1986, the improvement of birthweight for the second birth compared to the first birth was much greater in infants born to the Southeast Asian mothers than that to White mothers. Our study suggests that living in the United States after immigration from their native countries has had a positive impact on the birthweight of infants born to Southeast Asian immigrants.     

Recent trends in the prevalence and secondary prevention of Down''s syndrome

Examination of data from the Glasgow Registry of Congenital Anomalies indicated that 184 infants with Down's syndrome were born (live or still) to mothers residing in the Greater Glasgow Health Board area between 1974 and 1986 inclusive. This represents a period prevalence of 1.1 per 1000 total births. Despite a strongly positive correlation between prevalence and maternal age, most of the Down's syndrome infants were born to mothers aged under 35 years. There was no evidence either of a recent decline in the annual prevalence rate or of a changing pattern of risk in relation to maternal age. Antenatal diagnosis resulted in the termination of less than a tenth of all Down's syndrome pregnancies. These findings point to a need for further aetiological research, for continued epidemiological monitoring, for an improvement in the relatively low uptake of amniocentesis by older mothers, and for the development of a screening test which can be offered to the entire pregnant population.     

中国乙型肝炎不同流行区最佳免疫策略研究

目的比较在乙型肝炎不同流行区接种乙型肝炎疫苗的成本效益,探讨最佳免疫策略。方法采用成本效益分析方法和综合权重评分法,筛选高中低流行区最佳免疫策略。结果隆安、上海和济南三地接种乙型肝炎疫苗均获明显的经济效益;定义的不同流行区均以低剂量免疫策略（１０μｇ×３方案）的效益成本比值最大,高、中、低流行区分别为４９．９１、５４．５３、３７．６８;具有较高免疫保护率的高剂量免疫策略可获最大净效益;权重综合评分分析显示,低剂量免疫策略为最佳乙型肝炎免疫策略。结论建议经济较落后地区实行低剂量免疫策略,期望获得较大效益成本比;经济发达地区实施高剂量免疫策略,以获较大净效益并明显降低人群ＨＢｓＡｇ阳性率     

Increased risk of developing chronic HBV infection in infants born to chronically HBV infected mothers as a result of delayed second dose of hepatitis B vaccination

This two-stage study (cross-sectional and case–control) assessed the effects of delayed second dose HB vaccination on the risk of developing chronic HBV infection in infants born to chronically HBV infected mothers. 521 infants enrolled received the first vaccination by the end of the day after birth, without HBIG. 15 of these infants were chronically HBV infected. In the case–control comparison, controlling for HBeAg in the mother, the risk of an infant becoming chronically infected was 3.74 times (95% CI = 0.97–14.39) higher if the interval between the first and the second doses exceeded 10 weeks. This finding suggests it is important that immunization programs ensure timely second dose vaccination to infants born to mothers with chronic HBV infection. Nevertheless, due to the small sample size, these findings should be verified by larger studies.     

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。