乙型肝炎病毒感染免疫预防母婴传播的效果评估

目的针对乙型肝炎e抗原(HBeAg)阴性乙型肝炎病毒(HBV)感染母亲,母婴传播应用乙型肝炎疫苗联合乙型肝炎免疫球蛋白常规免疫预防的临床疗效,并观察分娩与喂养方式对乙型肝炎病毒母婴传播的影响,为临床治疗提供参考依据。方法随机选取医院乙型肝炎表面抗原(HBsAg)阳性产妇899名,到院参与的母亲230名,儿童250名,检测其乙型肝炎血清学标志物及丙氨酸氨基转移酶,采用SPSS 17.0软件进行统计分析。结果230名母亲注射与未注射乙型肝炎疫苗或乙型肝炎免疫球蛋白的儿童均无乙型肝炎病毒感染,抗-HBs阳性率为65.63%、78.29%;250名儿童中母亲行剖宫产与自然分娩均无乙型肝炎病毒感染,而抗-HBs阳性率77.14%、72.41%,差异无统计学意义;3种不同喂养方式的儿童均无乙型肝炎病毒感染,抗-HBs阳性率比较差异也无统计学意义。结论 HBsAg阳性但HBeAg阴性的产妇婴儿经免疫预防后几乎无乙型肝炎病毒感染情况,产妇孕晚期使用HBIG,分娩及喂养方式对乙型肝炎病毒母婴传播和新生儿对乙型肝炎疫苗的抗体无关联。     

Epidemiologic assessment of screening tests for antibody to human T lymphotropic virus type I (HTLV-I).

We tested 196 sera from a human T lymphotropic virus type I (HTLV-I) risk group (prostitute women) with two commercial "research" enzyme-linked immunoabsorbent assays (EIA) for HTLV-I antibodies. All tested sera were characterized by HTLV-I Western immunoblots and by HTLV-I radioimmunoprecipitation assays. The estimated sensitivities of the EIA tests were 93.8 percent and 100 percent, and the specificities were 98.8 percent and 95.8 percent, respectively, using recommended criteria for seropositivity (requiring reactivity to both gag p24 and env gp46 or gp61/68). Calculated negative predictive values remained excellent (greater than 99.9 percent and 100 percent, respectively) at lower seroprevalence rates but the positive predictive values were only 7.3 percent and 2.3 percent when calculated for a seroprevalence rate of 0.1 percent. These results emphasize the importance and need for additional HTLV-I supplementary serologic testing when screening populations with low HTLV-I seroprevalence rates.     

Timing of human immunodeficiency virus type 1 (HIV-1) transmission from mother to child: bayesian estimation using a mixture.

The timing of mother-to-child HIV transmission is not directly observable but influences the infected child's viral and immune status in the neonatal period. A hierarchical model was developed in a Bayesian framework to 'back-calculate' the timing of HIV-1 transmission from mother to child from the virological and immunological kinetics in the infected infant. Joint evolution of viral markers and immune response was modelled as a continuous time Markov process. The modelling of the period from infection to birth was based on a mixture of three distributions taking into account the various mother-to-child transmission pathways: In utero (early or late in gestation) and intrapartum (during the delivery process), integrating the fact that transmission is a continuum during the pregnancy. Gibbs sampling was used to estimate the marginal posterior distributions of the transition intensities between stages of HIV infection and those of the individual times from infection to birth. We applied our model to data on 135 perinatally HIV-1-infected children included in the French Prospective Study on Pediatric HIV infection. The model suggested that transmission occurred late in utero during the last month of pregnancy and that the day of delivery was a particularly critical time in HIV-1 transmission from mother to child. The paper ends with a discussion of model assumptions and a comparison with results obtained using a non-parametric method.     

2005-2017年许昌市预防艾滋病母婴传播现状分析

目的分析许昌市预防艾滋病母婴传播工作现状,为更好开展该工作提供依据。方法对许昌市预防艾滋病母婴传播数据资料进行分析。结果 2011-2017年许昌市男性婚检人群总HIV抗体阳性率高于女性(χ~2=8.199,P<0.05),产妇总HIV抗体阳性率高于婚检妇女(χ~2=10.222,P<0.05),2011-2017年报告的58例HIV抗体阳性产妇中,41.38%(24/58)为产时及产后发现。2005-2017年报告的87例HIV抗体阳性产妇中,母亲艾滋病母婴阻断药物服用率为68.97%;85例活产儿中,婴儿艾滋病母婴阻断药物服用率为91.76%;83例现存活婴儿中,1例HIV感染,75例未感染,7例未检测,校正母婴传播率为2.99%。结论许昌市预防艾滋病母婴传播效果显著。仍存在部分HIV阳性产妇发现较晚,阻断效率较低的风险;需采取综合措施,早发现早阻断HIV阳性孕产妇。     

深圳市预防与控制梅毒母婴传播实施策略初探

目的探讨阻断梅毒母婴传播和降低新生儿先天梅毒发病的策略,最大限度地控制和降低先天梅毒的发生.方法设立专项防治经费,启动深圳市预防与控制梅毒母婴传播项目,开展妊娠梅毒免费普查及综合干预工作,及时发现孕产妇人群中的梅毒感染者,阻断或降低梅毒母婴传播及新生儿先天梅毒的发生,并对其进行效果评估及成本效益分析.结果深圳市预防与控制梅毒母婴传播项目实施以来,共检测孕妇186 517例,检出梅毒阳性777例,阳性率4.16‰.对555例孕产妇梅毒患者进行追踪随访,选择继续妊娠330例,终止妊娠181例,失访44例.检测孕产妇梅毒患者所生婴儿126例,快速血浆反应素环状卡片试验(RPR)初筛阳性109例,最终确诊先天梅毒24例.项目的实施成功阻断了87.30%产妇梅毒可能造成的母婴传播.2003年深圳市先天梅毒报告24例,比2002年同期减少39例,下降61.90%.结论实施预防与控制梅毒母婴传播项目适合深圳市情,将为广东省乃至全国探索梅毒防治提供行之有效的策略和经验.     

Integrating family planning and prevention of mother to child HIV transmission in Zimbabwe

Objective

The objective was to integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health.

Study Design

HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n= 33) or intervention (n= 65) cohort, based on study entry date, and followed for 3 months postpartum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge and HIV disclosure, and were assessed with Fisher’s Exact Tests, binomial tests and t tests.

Results

The intervention cohort reported increased control over condom use (p=.002), increased knowledge about IUDs (p=.002), increased relationship power (p=.01) and increased likelihood of disclosing their HIV status to a partner (p=.04) and having that partner disclose to them (p=.04) when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~ 2% at baseline to > 80% at 3 months postpartum (p<.001).

Conclusions

FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond.

Implications

This study provides a rigorously evaluated intervention to integrate FP education into ante- and postnatal care for HIV-positive women and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.     

河南省实施HIV母婴传播干预措施效果分析

目的 了解实施艾滋病母婴传播干预措施对人类免疫缺陷病毒(HIV)母婴传播的影响。方法 对河南省31个重点县HIV阳性孕产妇及所生婴幼儿干预状况进行调查。调查新生儿出生时服药情况、喂养方式及其母亲的分娩方式、服用抗病毒药物等情况,比较服药组与未服药组幼儿人类免疫缺陷病毒(HIV)阳性率的差异。结果 实施药物阻断组艾滋病母婴传播率为3.45%,未实施药物阻断组的母婴传播率为15.38%,2组间差异有统计学意义,P<0.01。阳性产妇实施药物阻断措施后,自然分娩方式HIV传播率明显低于剖宫产方式的传播率。结论 对阳性孕产妇新生儿及时服用抗病毒药物并对婴儿实施纯人工喂养等措施,可有效降低HIV母婴传播率。建议在实施母婴传播干预措施的地区,不主张将HIV抗体阳性作为剖宫产的指征,最好选择自然分娩方式。     

HIV和HCV母婴垂直传播影响因素的比较

由于人类免疫缺陷病毒和丙型肝炎病毒有相同的传染途径,在母婴垂直感染中存在着相同因素,也存在着不同因素,共同感染在垂直传播中是常见现象,也产生相互影响。为了更好地预防和控制两病毒引起的疾病,揭示其机制。该文将近几年的研究进展,从母体因素、分娩因素、婴儿喂养方式和宫内感染方面以及人类免疫缺陷病毒和丙型肝炎病毒共同感染对母婴垂直传播的影响作以综述。     

阻断乙型肝炎病毒母婴传播对血清病毒转录体的影响

目的进一步探讨阻断乙型肝炎病毒（HBV）母婴垂直传播的效果，明确携带HBV孕妇干预治疗对保护婴儿抗-HBV感染的意义。探讨乙型肝炎病毒转录体（RNA）检测在母婴传播诊断中的意义。方法将91例HBsAg／HBeAg呈阳性孕妇分成两组。其中治疗组为61例，以乙肝免疫球蛋白（HBIG）与左旋咪唑涂布剂阻断治疗；对照组为30例。治疗组在孕26周起开始阻断治疗，自母亲及其婴儿血清和母亲乳汁中提取核酸，经PCR及RT—PCR分别扩增HBV DNA和RNA，Southern—blotting验证反应的特异性，取代表性产物克隆、测序，检测血清HBV DNA及全长型（IRNA）和顿挫性转录体（trRNA）。结果治疗组和对照组新生儿外周血HBV DNA、fRNA和trRNA的阳性率分别为3．3％，3．3％，47．5％和6．7％，13．3％。70．0％。治疗组的前二项指标明显低于对照组，差异有显著意义（P〈0．01），但trRNA差异无显著意义（P〉0．05）。结论携带HBV孕妇于孕晚期给予HBIG和左旋咪唑涂布剂阻断治疗后，婴儿HBV DNA和fRNA携带率明显降低。治疗组和对照组均有超过1／2的患儿携带trRNA。trRNA在HBV母婴垂直传播过程中有可能是一个出现更早期的可检测指标，有助于确定新生儿HBV感染的状态。     

武汉市孕产妇艾滋病母婴传播相关知识与获取途径分析

艾滋病母婴传播已成为15岁以下儿童感染艾滋病的最主要途径[1].充足的艾滋病知识能够降低艾滋病危险行为的发生[2],充足的艾滋病母婴传播知识对于促进人群接受艾滋病自愿检测至关重要[3],一旦孕产妇人群掌握了充足的艾滋病母婴传播知识和了解了医疗干预在阻断艾滋病母婴传播的重要作用,孕产妇人群对于艾滋病检测的接受程度将大为改善[4～6],而如果没有正确的艾滋病传播知识,会引起人们不必要的恐慌,加剧人们对于艾滋病病毒感染者的歧视[7],从而对人们咨询检测艾滋病和寻求更多的医疗援助产生阻碍[8].     

HTLV-1 and tropical spastic paraparesis. 2. The human T-cell lymphotropic virus type 1

Human T-lymphotropic viruses (HTLV) are causally associated with adult T-cell leukaemia and with a progressive form of lower limb paralysis known as tropical spastic paraparesis. HTLV-1 is endemic in parts of Japan, the Caribbean, West Africa and probably South America, and is associated with disease in these areas. Horizontal transmission is probably most common through sexual intercourse which, it is postulated, must be more efficient from male to female because virus carriage is more prevalent in women in endemic areas. Vertical transmission appears to be principally through breast milk. Poor housing and hygiene may facilitate transmission.     

乙肝疫苗和免疫球蛋白阻断乙肝母婴传播效果研究

目的 了解乙肝疫苗和乙肝免疫球蛋白阻断乙肝母婴传播的效果及乙肝母婴传播的影响因素.方法 从深圳市3家医院随机抽取HBsAg阳性产妇中其新生儿已接种乙肝疫苗和乙肝免疫球蛋白者共158对,随访调查母亲乙肝感染情况、分娩和喂养方式等,并检测婴幼儿血清中HBsAg和HBsAb水平.结果 调查婴幼儿中,HBsAg阳性率为6.96%,HBsAb阳性率为56.33%.不同年龄组间HBsAg阳性率差异无统计б庖?P>0.05),但HBsAb阳性率差异有统计学意义(χ2=11.759,P＝0.008).母亲为乙肝大三阳和小三阳所生的婴幼儿HBsAg阳性率分别为14.29%和2.94%,两者差异有统计学意义(P<0.05).母亲孕期接种和未接种乙肝免疫球蛋白的婴幼儿HBsAg阳性率分别为8.57%和7.77%,顺产和剖腹产婴幼儿HBsAg阳性率分别为9.68%和3.08%,母乳喂养和人工喂养婴幼儿HBsAg阳性率分别为6.45%和7.69%,上述差异均无统计学意义(P>0.05).结论 在本研究中,婴幼儿接种乙型肝炎疫苗和乙肝免疫球蛋白可以有效降低HBV垂直传播率;阻断效果与母亲是否患大三阳有关,与是否接种乙肝免疫球蛋白、生产及喂养方式无关.     

丙型肝炎病毒母婴垂直传播的危险因素分析与预防对策

目的分析丙型肝炎病毒(HCV)母婴垂直传播的相关因素及危险因素,探讨预防HCV母婴垂直传播的策略,降低HCV的母婴垂直传播发生率,为临床备孕及妊娠女性提高妊娠安全性、提高新生儿质量提供参考。方法选取医院2010年1月-2016年1月收治的126例HCV感染阳性孕妇,对其所分娩的新生儿进行HCV检测,判断是否为HCV感染,对新生儿母亲临床资料、围产期HCV感染相关指标、生产方式、产后喂养方式进行比较,分析影响HCV母婴垂直传播的相关因素。结果 126例HCV感染孕妇娩出新生儿126例,其中11例为HCV感染及母婴垂直传播,感染率8.73%;多因素logistic分析显示,合并HIV感染、HCV载量>1.0×10~6拷贝/ml、ALT>110IU/ml、阴道产、纯母乳喂养是HCV孕妇围产期新生儿发生HCV感染的独立危险因素(P<0.05)。结论 HCV母婴垂直传播危险因素大多数可以通过预防控制加以避免,临床应加强对HCV妊娠患者HCV载量、ALT、AST水平的随访,并采取措施进行控制,选择适合的生产及喂养方式,降低HCV的母婴垂直传播率。     

Prevalence of hepatitis C virus infection in a cohort of pregnant women in northern Greece and transmission of HCV from mother to child

The prevalence of hepatitis C virus (HCV) infection and the mother-to-child transmission of HCV were studied in 2408 pregnant women. Positive antiHCV were detected in 47 women (1.95%), 21 of whom (44.7%) were HCVRNA(+), but only seven had abnormal aminotransferases. Three/21 HCVRNA(+) women had an abortion. We lost contact with other 10 women. Thirty-four babies were tested for antiHCV, HCVRNA and levels of aminotransferases at birth and at the age of 6 and 12 months. AntiHCV were detectable in all babies at birth and these maternally acquired antibodies disappeared by the age of 12 months in all but two of who were infected with HCV. HCVRNA was detected at birth in one (6.25%) baby born out of 16 HCVRNA(+) mothers and this baby also had abnormal aminotransferases. However, HCVRNA was undetectable and aminotransferases returned to normal levels by the age of 6 months. In another baby born also from an HCVRNA(+) mother, the HCVRNA was detected for the first time at the age of 12 months. The HCV genotype from both babies was the same as their mother's. These results show that (a) the high prevalence in the group of pregnant women studied can possibly be attributed to the fact that 311/2408 (12.91%) of them came from the former eastern countries, where disposable syringes were not used but lately or were ex-drug addicts and (b) there is a low risk of perinatal mother-to-child transmission of HCV and this risk is related to the presence of HCVRNA in the carrier mother.     

乙型肝炎病毒母婴垂直传播的临床研究

[目的]了解上海市宝山区乙型肝炎病毒(HBV)垂直传播的现状,为优生优育的卫生宣教提供依据。[方法]对2010年9月—2011年6月在本院妇产科住院分娩的632例产妇中乙肝表面抗原(HBsAg)阳性或/和乙肝核心抗原(HBeAg)阳性的孕妇及其所产新生儿的脐带血进行HBV血清学标志物检测。[结果]HBV阳性孕妇共236例,占孕妇数的37.34%,其中HBsAg阳性者93例,占39.41%。在对应的236例新生儿脐带血中,HBV阳性56例,阳性率为23.73%,其中男婴30例,占男婴总数的22.90%,女婴26例,占女婴总数的24.76%。新生儿HBsAg阳性8例,占新生儿总数的3.38%。143例剖宫产新生儿的脐带血HBV阳性32例,阳性率为22.38%,93例阴道分娩新生儿的脐带血HBV阳性24例,阳性率为25.80%。[结论]胎盘可以阻止部分HBV进入胎儿体内。新生儿HBV阳性率与分娩方式及新生儿性别无关。     

Infectious states of human T lymphotropic virus type I and hepatitis B virus among Japanese immigrants in the Republic of Bolivia

Serologic tests for human T lymphotropic virus type I (HTLV-I) and hepatitis B virus infections were conducted in 1986 in two Japanese immigrant colonies located in Santa Cruz, Bolivia. A total of 322 adults (283 Japanese and 39 Bolivians) over age 35 years and 305 children (166 Japanese, 124 Bolivians, and 15 of mixed blood) aged 8-17 years were sampled at the time of a routine health checkup. The prevalence of antibody to HTLV-I was 17% in first-generation Japanese immigrants and 6% in second- or third-generation Japanese children. Prevalences among native Bolivians were 3% and 5% in adults and children, respectively. Seropositive Japanese immigrants and mothers showed clustering according to birthplace in endemic areas of Japan. The prevalence of either hepatitis B virus surface antigen (HBsAg) or antibody to HBsAg was 48% in Japanese adults, 21% in Japanese children, 13% in Bolivian adults, and 1% in Bolivian children. Seropositive adults did not show clustering according to birthplace, but children in one colony showed clustering and a narrow age range. A correlation of seropositivity between husbands and wives was found only for HTLV-I. The seropositivity was independent of whether an HTLV-I or a hepatitis B virus infection marker was present.