阻断乙肝妊娠患者母婴垂直传播的研究进展

乙型肝炎病毒（hepatitis B virus,HBV）感染是一个世界性的公共卫生问题,全球有近3亿HBV携带者,其中我国占45%。母婴垂直传播是HBV的重要传播途径,估计约有30%的HBV感染是通过母婴传播获得[1],故阻断母婴垂直传播是降低乙肝发病率的关键。因此,研究母婴垂直传播的阻断措施,是目前全社会关注的问题。     

乙肝免疫球蛋白联合乙肝疫苗阻断乙肝病毒母婴传播的效果观察

乙型肝炎(简称乙肝)是由乙型肝炎病毒(HBV)引起的传染病,其病程迁延,易转为慢性肝炎、肝硬化及肝癌,母婴传播是HBV传播的主要途径之一,经此途径传播的婴儿至少可携带HBV 10年以上[1].故阻断HBV母婴传播对控制乙肝具有十分重要的意义.为了解乙肝免疫球蛋白(HBIG)联合乙肝疫苗阻断母婴HBV的传播的效果,笔者对188例乙肝HBsAg、HBeAg双阳性的孕妇开展母婴HBV阻断研究,经观察效果良好,现报告如下.     

联合免疫阻断乙肝病毒宫内感染的临床探讨

乙肝病毒（HBV）感染是一个社会性的问题，母婴传播是HBV传播的主要途径之一，也是人群携带者形成的主要原因。慢性携带者有40％～50％是母婴传播造成的，乙肝大三阳母亲所生的新生儿几乎均有HBV宫内感染，大部分发展成为慢性携带者。因此，探讨母婴传播免疫，提高阻断HBV宫内传播的效果，对于保护高危易感孕妇，防止所生的新生儿成为慢性携带者具有十分重要的意义。我院通过孕晚期乙肝五项指标测定和荧光定量PCR检测HBVDNA，应用乙肝免疫球蛋白（HBIG）和乙肝疫苗联合免疫，明显降低了新生儿HBV的携带率。[第一段]     

HBIG阻断乙肝E抗原阳性孕妇宫内母婴传播的Meta分析

[目的]系统评价乙肝免疫球蛋白（HBIG）对HBeAg阳性孕妇乙肝病毒（HBV）宫内母婴传播的阻断效果,有针对性的对重点人群制定更加有效的乙肝免疫策略。[方法]通过电脑检索,对国内有关HBeAg阳性孕妇晚期使用HBIG阻断母婴传播的随机对照试验进行固定效应模型的Meta分析。[结果]母婴阻断的Meta分析OR值为0．22（0．15～0．33）。[结论]Meta分析结果显示：HBeAg阳性孕妇通过注射HBIG能有效阻断HBV的宫内母婴传播,建议在孕期28、32、36周注射HBIG200IU,以减少HBV的官内母婴垂直传播。     

河源市397例乙型肝炎母婴阻断实施效果及影响因素研究

目的 观察乙肝免疫球蛋白和乙肝疫苗联合免疫方案在乙型肝炎病毒（HBV）母婴传播中的阻断效果及影响因素。方法 对397例乙肝表面抗原（HBsAg）阳性产妇及所生婴幼儿进行分析,观察乙肝疫苗和乙肝免疫球蛋白接种的免疫效果,采用多因素Logistic回归方法分析母婴阻断效果的影响因素。结果 397例HBsAg阳性产妇所生新生儿中HBsAg阳性婴幼儿38例,母婴阻断失败率为9.57%。分娩方式、母亲乙肝DNA病毒含量、母亲HBeAg阳性情况不同的婴幼儿免疫效果差异有统计学意义（均P<0.01）。母亲HBeAg阳性（OR=20.323）、阴道自然分娩（OR=4.425）、血清HBV高载量（OR=4.027）增加母婴阻断失败风险。结论 高危新生儿接种乙肝疫苗和乙肝免疫球蛋白后具有显著的母婴阻断效果。母亲HBeAg表达模式、分娩方式及HBV载量为影响阻断的重要因素。     

早产儿乙肝病毒母婴阻断的相关研究进展

正乙肝病毒(hepatitis B virus,HBV)的主要传播途径之一是母婴传播,对HBV感染母亲分娩的新生儿实施正确、有效的母婴阻断是预防和控制乙肝的重要措施。我国每年出生早产儿超过全球早产儿总数的10%,出生后乙肝疫苗(hepatitis b vaccine,HBvac)的免疫接种结局有待进一步研究。本文就早产儿HBV母婴阻断相关研究进展综述如下。     

采取联合免疫措施阻断HBV母婴传播效果观察

目的 探讨阻断乙型肝炎病毒（HBV）母婴传播的效果。方法 携带HBV的孕妇，在妊娠28、32、36W各肌注一次乙肝免疫球蛋白（HBIC）；新生儿在出生后24h（最好6h）内和1月龄时各肌注一次HBIC，在2、3、5月龄各肌注一次乙肝疫苗。结果 检测1岁龄幼儿静脉血清，携带HBV者4例，感染率约为5．1％，HBV母婴阻断效果为94．9％。结论 孕期采用联合免疫措施，可有效阻断HBV母婴传播。     

乙型肝炎病毒宫内垂直传播的预防

我国是乙肝流行高发区,母婴传播是乙肝病毒(HBV)的重要传播途径,阻断其母婴传播是控制乙肝流行的关键。HBV母婴传播途径主要有宫内感染、产时感染、产后感染,目前国内外对如何预防HBV母婴传播的产时及产后感染已取得了很大成就,但对如何预防其宫内感染尚未找到有效措施,成为人们关注的焦点。本文就近几年来HBV宫内感染的预防研究进展作一综述。     

武汉市乙型肝炎病毒母婴传播阻断现况研究

我国是HBV感染的高发区,≥3岁人群中HBsAg阳性率约占9.09%[1].宫内感染是HBV母婴传播的主要途径,乙型肝炎(乙肝)疫苗和HBIG联合免疫可有效阻断HBV母婴传播的产时(后)感染,但采用主被动联合免疫后HBsAg阳性母亲的婴儿免疫失败率仍然有20%～30%[2].本研究对近年武汉市江岸区HBsAg阳性孕妇采取的乙肝母婴传播阻断措施的实施状况及干预后婴幼儿HBV感染情况进行调查.     

接种重组乙型肝炎疫苗(酵母)阻断乙型肝炎病毒母婴传播的影响因素分析

目的探讨接种重组乙型肝炎(乙肝)疫苗(HepB)(酵母)阻断乙肝病毒(HBV)母婴传播的影响因素。方法在北京市、甘肃省和浙江省宁波市选择1997～2005年孕期或住院分娩时检测乙肝病毒表面抗原(HBsAg)阳性的母亲及其儿童,进行问卷调查和采集血清标本,用固相放射免疫法检测HBV血清学标志物,分析儿童HBsAg的影响因素,在单因素的基础上进行多因素非条件Logistic回归分析,探索接种重组HepB(酵母)阻断HBV母婴传播的影响因素。结果共调查719名儿童,HBsAg阳性率为10.01%。HepB接种剂量、母亲HBV感染状况和母乳喂养是接种重组HepB(酵母)阻断HBV母婴传播的主要影响因素,而分娩方式、母亲孕期是否联合免疫乙肝免疫球蛋白(HBIG)等,对接种重组HepB(酵母)阻断HBV母婴传播不产生影响。结论筛查母亲HBV感染状态、对HBsAg阳性母亲的新生儿联合免疫10μg×3重组HepB(酵母)对提高阻断HBV母婴传播的效果具有重要意义。剖宫产、母亲孕期接种HBIG不能提高阻断HBV母婴传播的效果。母乳喂养对阻断HBV母婴传播效果的影响还需进一步研究。     

Strategies to prevent and control hepatitis B and C virus infections: a global perspective

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of acute and chronic liver disease worldwide. Chronic infection with these viruses often leads to chronic liver disease, including cirrhosis or primary hepatocellular carcinoma. Both HBV and HCV are bloodborne viruses; however, HBV is transmitted efficiently by both percutaneous and mucosal exposures, and HCV is transmitted predominantly by percutaneous exposures. Because the relative importance of various modes of transmission of these viruses differs by country, the choice of specific prevention and control strategies depends primarily on the epidemiology of infection in a particular country. Comprehensive hepatitis B prevention strategies should include (1) prevention of perinatal HBV transmission, (2) hepatitis B vaccination at critical ages to interrupt transmission and (3) prevention of nosocomial HBV transmission. The prevention of hepatitis C is problematic because a vaccine to prevent HCV infection is not expected to be developed in the foreseeable future. From a global perspective, the greatest impact on the disease burden associated with HCV infection will most likely be achieved by focusing efforts on primary prevention strategies to reduce or eliminate the risk for transmission from nosocomial exposures (e.g. blood transfusion, unsafe injection practices) and high-risk practices (e.g. injecting drug use).     

Risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus and hepatitis B vaccination status in Yunnan province,China

ObjectiveTo explore the risk factors associated with immunoprophylaxis failure against mother to child transmission of hepatitis B virus (HBV) and hepatitis B vaccination status in Yunnan province, China.MethodsMulticenter cluster sampling was used to select pregnant women who were positive for hepatitis B surface antigen (HBsAg). HBV immunoprophylaxis was carried out for the newborns. Blood samples were collected and tested for HBV markers from 7 to 10 month old infants. The factors were analyzed by univariate and logistic regression.ResultsA total of 2765 mothers and their infants were enrolled. The failure rate of prevention of mother to child transmission (PMTCT) was 4.12%. The rate of timely HepB1 vaccination within 24 h was 98.04%, the rate of three-dose vaccination was 92.30% and the rate of hepatitis B immune globulin (HBIG) administration was 68.97%. Place of residence, maternal education, gestational age and birth weight were related to administration of HBV immunoprophylaxis. It was remarkable that the rate of HBIG administration of infants was only 63.89% with whose mothers were both HBsAg and hepatitis B e antigen (HBeAg)-positive. Further analysis showed that there were three risk factors associated with HBV immunoprophylaxis failure: mothers who were positive for HBsAg and HBeAg, maternal HBVDNA level, and HBIG administration or not.ConclusionsPMTCT of HBV was well implemented in Yunnan. However, in order to achieve optimal prevention of vertical HBV transmission, it is mandatory to make additional efforts to improve the implementation of regulatory HBV immunoprophylaxis, especially for HBsAg-positive pregnant women.     

HBV宫内传播研究在乙型肝炎防控工作中发挥着重要的作用

全新的HBV宫内传播研究包括了宫内显性感染和宫内隐匿性感染,HBV宫内显性感染即传统意义上的HBV宫内感染,虽然HBV宫内感染历经了几十年的研究,但是干预效果甚微,导致母婴传播成为乙型肝炎（乙肝）主要的传播途径。随着科学技术的发展,人们更多认识到HBV宫内隐匿性感染,使得HBV宫内传播的定义得到进一步完善和拓展,HBV宫内隐匿性感染的研究将填补HBV垂直传播防控的空白领域,拓展的新研究角度将决定乙肝防控新的决策方向和内容,为我国乙肝预防控制工作发挥重要作用。     

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。     

深圳市2011-2014年孕妇乙型肝炎病毒感染状况分析

目的 了解2011-2014年深圳市孕妇乙型肝炎病毒（hepatitis B virus,HBV）感染状况,为预防和控制乙型肝炎（简称乙肝）母婴传播提供科学依据。方法 对到助产机构初次进行产前检查的孕妇免费检测乙肝两对半,并由助产机构责任医生将孕妇的基本信息及检测结果录入自主研发的信息管理系统,通过SPSS 19.0进行统计分析。结果 深圳市孕妇乙肝表面抗原（hepatitis B surface antigen,HBsAg）阳性率、乙肝表面抗体（antibody to hepatitis B surface antigen,抗-HBs）阳性率、乙肝病毒e抗原（hepatitis B e antigen,HBeAg）阳性率、乙肝病毒e抗体（antibody to hepatitis B e antigen,抗-HBe）阳性率及乙肝病毒c抗体（antibody to hepatitis B core antigen,抗-HBc）阳性率分别为8.40%、47.84%、3.11%、12.28%、21.24%。不同年份、户籍类型、年龄、文化程度和职业的孕妇HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc这五项指标阳性率之间的差异均有统计学意义（均有P<0.001）。结论 深圳市孕妇HBsAg阳性率仍高于全国水平,半数以上孕妇没有检测到抗-HBs,流动人口孕妇HBV感染状况较常住人口严重。加强深圳市孕妇的免疫接种和查漏补种,有助于控制乙肝母婴传播。     

乙肝疫苗全程及规范接种对HBV母婴阻断效果的影响

目的 分析儿童乙肝疫苗（HepB）全程接种及规范接种在乙肝母婴阻断中的作用。方法 采用队列研究的方法,以2017年佛山市HBsAg阳性产妇及其所分娩活产儿为对象,通过回顾性病历采集、儿童预防接种信息检索、儿童乙肝两对半检查结果的前瞻性跟踪管理等方法,采集母婴阻断结果及相关的影响因素。结果 本研究共追踪到母婴阻断结果的儿童5 615人,阻断成功率99.4%,失败率为0.6%;儿童出生后1年内乙肝疫苗的全程接种率为96.7%,其中三针规范（按照“0/1/6”完成）接种率为65.9 %;单因素及多因素分析结果均显示产妇HBeAg阳性（OR = 6.76,95%CI:3.22～14.19）、HepB未全程接种（OR = 2.86,95%CI:1.02～8.07）、HepB未规范接种（OR = 2.33,95%CI:1.12～4.85）是母婴阻断失败的危险因素。结论 加强HBV感染产妇分娩儿童预防接种的管理,提高儿童乙肝疫苗1年内全程及规范接种率,实施HBeAg阳性孕妇孕期抗病毒治疗,是实现全市乙肝母婴零传播的关键。     

The importance of imported infections in maintaining hepatitis B in The Netherlands

In The Netherlands, in May 1999 an enhanced surveillance of hepatitis B was begun to collect detailed information of patients with acute hepatitis B virus (HBV) infection. The objective was to gain insight in transmission routes and source of infection of new HBV cases. Through public health services, patients were interviewed on risk factors. It appeared that the majority (59%) acquired the infection through sexual contact; 52% of these by homosexual and 48% by heterosexual contact. In 60% of the heterosexual cases, the source of infection was a partner originating from a hepatitis B-endemic region. Sexual transmission is the most common route of transmission of acute hepatitis B in The Netherlands and introduction of infections from abroad plays a key role in the current epidemiology of HBV. As well as prevention programmes targeted at sexual high-risk groups, prevention efforts should focus more on the heterosexual transmission from HBV carriers.     

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.     

Preventing transmission of hepatitis B virus from people with chronic infection

BACKGROUND: People with chronic hepatitis B virus (HBV) infection are the major source of HBV transmission in the United States. The Public Health Service recommends prevention counseling for HBV-infected people and vaccination of their household contacts and sexual partners. OBJECTIVES: To describe the implementation of these recommendations by community physicians. METHODS: Telephone survey of 69 people with chronic HBV infection and their healthcare providers, October 1997 through November 1997, in San Diego, California. MAIN OUTCOME MEASURES: Counseling of people with chronic HBV infection and vaccination of their household contacts and sexual partners. RESULTS: Forty-three percent of providers reported providing prevention counseling to their HBV-infected patients to reduce transmission; 16% of patients reported receiving counseling. For the 32 pairs for which both the patient and provider could be reached and the patients were aware of their HBV infection, 20 (63%) providers reported counseling patients, and 10 (50%) of these providers' patients reported receiving counseling. Fifty-five percent of providers recommended vaccination of contacts; 13% of eligible adult household contacts and sexual partners and 20% of eligible child household contacts had begun hepatitis B vaccination. CONCLUSIONS: Prevention counseling of people with chronic HBV infection and vaccination of their contacts occur infrequently despite guidelines and an effective vaccine. Collaborative efforts between providers and people involved in public health are needed to improve delivery of these preventive health services.     

Risk factors related to the failure of prevention of hepatitis B virus Mother-to-Child transmission in Yunnan,China

ObjectiveTo investigate the relationship between the failure of prevention of hepatitis B virus Mother-to-Child transmission and HBV serological pattern, viral load as well as HBV genotypes.Methods2765 pairs of mother-infant matched samples were collected. These pregnant women were HBsAg positive and delivered at hospital from January 1st, 2011 to June 30th, 2011. Of these samples, 26 pairs of sera samples were randomly selected from 114 pairs of samples which failed in the prevention of hepatitis B virus Mother-to-Child transmission. Serological tests, viral load and genotype detection were performed for further analysis. Additionally, the selected subjects were followed and tested again in 2014.ResultsHBeAg positive rates were 76.92% and 69.23% in mother group and infant group respectively, showed no statistical difference. The average HBV DNA levels were >2 × 10⁵ IU/ml in both mother group and infant group. Genotype analysis revealed that 11 pairs of mother-infant matched samples belonged to C gene type and another 11 pairs were B gene type. Different genotypes were observed in 4 pairs of mother-infant matched samples.ConclusionHbeAg positive and high HBV DNA level were two major risk factors of HBV mother to child transmission. Additionally, nosocomial infection was another potential way of HBV vertical transmission, especially in remote area of Yunnan province.