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。     

Ante-natal screening for hepatitis B surface antigen: an appraisal of its value in a low prevalence area.

The costs and projected benefits of universal screening for hepatitis B virus (HBV) infection in pregnant women in East Anglia are calculated and compared with current practice. By adjusting data from West Midlands region for ethnicity, the prevalence of maternal hepatitis B surface-antigen (HBsAg) positivity in East Anglia is predicted to be 0.083% (1 in 1200). Published data on health risks of perinatal HBV infection and on immunisation efficacy are used to derive benefits of screening. The marginal direct cost of screening is identified from regional sources. Current clinical practice in East Anglia identifies 7 surface-antigen positive mothers per year, whereas 22 are expected. Routine antenatal screening in East Anglia would prevent 2.6 additional childhood carriers per year (compared with current practice), resulting in the prevention of 0.7 deaths per year occurring 40-50 years in the future. The direct cost per (undiscounted) life-year saved would be Pounds 2437, not including savings on treatment for chronic hepatitis B infection. Routine prenatal screening for maternal HBsAg should be introduced without delay and continue even if HBV vaccination is introduced into the UK childhood immunisation schedule.     

Screening for Hepatitis B in partners and children of women positive for surface antigen,Burkina Faso

ObjectiveTo evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus (HBV) attending antenatal care.MethodsWe identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso. At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to be screened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivity among family members.FindingsOf 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%) partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, who attended the woman’s first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity was associated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariable analysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49–29.48) or having a mother with HBV DNA level ≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61–29.00).ConclusionIn low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected household contacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viral load or infectivity should be a priority for testing and linkage to care.     

Hepatitis B vaccination among high-risk adolescents and adults--San Diego,California, 1998-2001

The national strategy to eliminate hepatitis B virus (HBV) transmission is based on 1) screening all pregnant women for hepatitis B surface antigen and post-exposure vaccination of infants of infected mothers; 2) vaccinating all infants as part of the childhood vaccination schedule; 3) vaccinating children and adolescents not vaccinated previously; and 4) vaccinating adolescents and adults in groups at increased risk for infection. These strategies have been implemented successfully in the United States except for the vaccination of adults and older adolescents at high risk. This report describes the initial findings of a hepatitis B vaccination program for potentially high-risk adolescents and adults conducted in areas of San Diego County, California. The findings indicate that high rates of hepatitis B vaccination can be achieved in clinics and programs that serve persons at high risk for HBV infection through the integration of hepatitis B vaccination into routine preventive health-care services. Improved efforts to vaccinate adolescents and adults at increased risk for HBV infection are critical to reduce disease incidence and prevent chronic HBV infection.     

Prevalence of hepatitis B in an indigent, multi-ethnic community clinic prenatal population

Perinatal infection of hepatitis B virus (HBV) from an infected asymptomatic woman to her offspring is now a preventable disease. A chart review was undertaken to document the prevalence of asymptomatic HBV infection in a high-risk, predominantly minority, indigent, and immigrant family practice clinic population and to evaluate the frequency of accepted known risk factors for those subjects with positive hepatitis B surface antigen (HBsAg) screening tests. Records for 464 pregnant women entering the prenatal program between January 1, 1983, and April 30, 1987, were reviewed. Twenty-three (5.3%) were found positive for the HBsAG, all were asymptomatic. Results of a logistic regression on multiple risk factors for HBV infection revealed that ethnicity was the sole predictor of a positive HBsAg screening test, with 13% of the Asian patients and 1% of the Latino subjects positive for HBsAg. Other historical factors such as previous sexually transmitted disease and past history of transfusion were not predictive. These results reaffirm that a screening program for asymptomatic HBV infection in selected prenatal populations can identify a significant number of infants at risk for risk for perinatal infection.     

孕产妇乙肝表面抗原阳性筛查及筛查后健康干预现况调查

目的:了解孕产妇乙肝表面抗原筛查及筛查后对HBsAg阳性孕产妇实施健康干预的现况。方法:采用等容量抽样法,在贵州省黔东南州抽取8个县,每个县随机抽取1家县级医院,随机抽取82名2010年分娩且HBsAg阳性的孕产妇作为调查对象开展现场调查。结果:黔东南州孕产妇HBsAg筛查率为97.68%,HBsAg阳性率为6.14%。在82名HBsAg阳性的被调查者中,仅54.88%的人知道自己在孕产期曾做过HBsAg的筛查,26.83%的人仍不知道自己是HBsAg感染者;48.78%的人被告知要忌烟酒,47.56%的人被告知必要时需要治疗;39.02%的人被告知HBsAg阴性的家庭成员需要接种乙肝疫苗;69.52%的人被告知接种乙肝疫苗可预防乙肝。82名孩子中仅14.63%的孩子接受了高剂量乙肝疫苗的接种,11.76%的孩子同时接种了乙肝免疫球蛋白。虽然98.78%的人都愿意在全程接种后对孩子抽血进行乙肝免疫效果的检测,但实际上仅19.51%的孩子在接种后进行了检测。结论:在贵州省黔东南州孕产妇HBsAg筛查率较高,但HBsAg阳性孕产妇对筛查知识了解较少,在筛查后得到的健康干预和帮助较少。建议完善孕产妇HBsAg筛查规范,加强落实对孕产妇及孩子的健康干预。     

Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination.

To develop a protocol for prevention of hepatitis B virus (HBV) transmission in Wisconsin prisons, we interviewed 619 male prisoners at incarceration to obtain information on hepatitis B risk factors. We defined previous infections by the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc). Logistic regression was used to develop a model of relative risk (RR) of HBV infection. Use of illicit intravenous (IV) drugs was the most important risk factor because of a high prevalence of IV drug use and an RR which ranged from 2.93-7.47. Other important risk factors were: prior hepatitis or jaundice (RR = 6.28), race (RR = 2.54 for Blacks, RR = 3.28 for Latinos), transfusion (RR = 3.00), and age. Previous imprisonment was not an independent risk factor for HBV, hence selective serologic screening and vaccination of prisoners are justified rather than mass screening and vaccination. Based upon prevalence of hepatitis B markers in subgroups, it is necessary to screen prisoners with prior hepatitis or jaundice, prior transfusion, and users of IV drugs. The identification of HBsAg carriers by such screening could prevent infection of "household" contacts. Users of IV drugs who are susceptible to HBV infection should be vaccinated. The remaining prisoners constitute a low-risk group for HBV infection and do not require serologic screening or vaccination.     

Universal screening for hepatitis B among pregnant women led to 96% vaccination coverage among newborns of HBsAg positive mothers in Denmark

In Denmark selective screening programs of pregnant women for hepatitis B missed 30-50% of high-risk groups and in late 2005 a universal screening of pregnant women for HBsAg was implemented.During a 2-year period a prospective enhanced surveillance of the universal screening was performed to examine the effectiveness of universal HBV-screening of pregnant women and HBV-immunizations of their newborn, and to provide a prevalence-estimate for HBV in Denmark. On a opt out basis all women in Denmark attending antenatal care were tested for hepatitis B serology. Vaccination data of the newborns and households of HBsAg positive pregnant women were assembled.Among 140,376 HBsAg tests of pregnant women, 371 (0.26%) were positive. The prevalence among women of Danish origin was 0.012% and 2.74% among foreign born women, highest for women from Southeast Asia (14.5%). Genotype C was the most prevalent (37%) and 13% had a HBVDNA ≥10⁸ IU/ml. The prevalence estimate of chronic hepatitis B in Denmark was 0.2-0.3% in the general population.Among children born within the project period, 96% received vaccination at birth compared to 50% of siblings born prior to universal screening. During 3 years of passive follow-up two transmissions (0.5%) have been notified. Among children born of the positive mothers prior to the trial-period 7.3% had been notified.Thus the prevalence of HBV positive mothers has more than doubled in Denmark over the last 40 years, but among women of Danish origin it has decreased 10-fold. By replacing selective screening with universal, identification of newborns in need of HBV-immunization was increased from 50% to almost complete coverage, and also identifies mothers with high viral load for evaluation of pre-term treatment to interrupt in utero transmission.     

The end of the Australia antigen? An ecological study of the impact of universal newborn hepatitis B vaccination two decades on

Background

A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced.

Methods

A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs.

Findings

Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43–0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11–0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women.

Interpretation

The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.     

Less refusal to participate in HIV screening among pregnant women in the Amsterdam region since the introduction of standard HIV screening using the opting-out method

In 2003 the Municipal Health Service in Amsterdam started to screen pregnant women for HIV according to the opting-out method. In this method the HIV test is routinely included in the prenatal screening along with hepatitis B virus (HBV) and syphilis. If the woman does not want to be tested for HIV then she must actively opt out of this test. This screening method was chosen because in the universal screening method used in 2002, women had to give their explicit consent to test for HIV and this led to a high refusal rate (13.6%), especially among women from AIDS-endemic countries. After the introduction of the opting-out method, the refusal rate fell from 3% in the first quarter of 2003 to 1.4% in the last quarter of 2003. None of the women refused to be tested for HBV or syphilis. In 2003, the HIV prevalence among pregnant women was 0.3% (35/13.621). The experiences with this screening method in Amsterdam were used to implement the national opting-out method for HIV screening in pregnant women, which was introduced on 1 January 2004.     

Hepatitis B Prevalence Among Asian Americans in Michigan: An Assessment to Guide Future Education and Intervention Strategies

Free HBV (hepatitis B virus) screening was offered at 8 health fairs to Asian Americans in Southeast and West Michigan for two and a half years as a community service to study the prevalence of hepatitis B among Asian Americans in Michigan as a first step in reducing the incidence of hepatitis B. The screening included a 4 ml blood sample and a questionnaire assessing demographics and family history of hepatitis B; tests included the HBV surface antigen and antibody. 567 people participated in the study. About 6% of the participants had chronic hepatitis B (HBV carriers), 54% had the antibody (either had the disease before or were vaccinated) and 40% had no antibody or antigen (never infected by HBV and should be vaccinated to get protection). More than 95% of the participants were immigrants. Participants indicated in the family history that 10% had relatives with hepatitis B, 5% with liver cirrhosis, and 3% with liver cancer. Results of our screening supported our hypothesis that prevalence of hepatitis B among Asian Americans in Michigan would be similar to that in Asian Americans on the East and West coasts. We need to develop a strategy in Michigan to address this disease. In conducting this study, it was noticed that there was still resistance by Asian Americans to participate in clinical studies. An education intervention that is delivered in native Asian languages and in a culturally sensitive manner is needed to effectively raise awareness of hepatitis B among Asian Americans.     

性滥与乙型肝炎病毒感染的关系

首次在国内对性滥群体感染乙型病毒性肝炎的情况进行了调查,结果性滥者乙肝的感染率达82.18%,HBsAg阳性率达21.78%,均较对照组高约4倍之多,说明性滥是乙肝传播的重要途径,性滥者是乙肝最危险的传染源之一。     

The Impact of Gender Differences in Attitudes and Beliefs Concerning HBV Vaccination and Screening in the Lao Community

Liver cancer incidence is increasing among Asian Americans. Laotians in the US have greater risk of liver cancer death compared to other Asian American groups. However, ethnicity is not the only disparity; Laotian men are at increased risk of liver cancer compared to Laotian women. Use of hepatitis B virus (HBV) vaccination and screening is low among Laotians. The impact of gender differences in attitudes and beliefs concerning HBV vaccination and screening is unknown. This secondary analysis of a cross-sectional community-based participatory research study. Although men were more likely to believe that infection with HBV is preventable, and treatable, causes liver cancer, and that healthy persons should be vaccinated, of those who thought people should get vaccinated, women were four times more likely to receive vaccine than men (adj. OR 4.0, CI 1.2–19). Understanding and addressing gender differences may increase HBV screening and vaccination uptake, thus reducing disparities within the Laotian community.     

孕妇感染乙型肝炎病毒的状态与宫内感染关系的研究

目的　探讨孕妇感染乙型肝炎病毒 (HBV)的状态与宫内感染的关系。方法　采用酶联免疫吸附(ELISA)及荧光定量PCR法对产前孕妇进行乙型肝炎两对半免疫学标志联合测定和HBVDNA载量检测 ;新生儿分娩后取脐动脉血检测HBVDNA载量。根据上述检测结果研究孕妇感染HBV的状态与宫内感染的关系。结果乙型肝炎e抗原 (HBeAg)和HBVDNA阳性的孕妇发生宫内感染率分别为4 6 .0 3% ,90 .4 8% ;HBeAg和HBVDNA阴性孕妇为 3.97% ,32 .5 4 % ;两组孕妇宫内感染率和HBVDNA阳性率比较 ,差异均有高度显著性 (P <0 .0 1)。孕妇血清中不同载量HBVDNA与新生儿宫内感染率进行直线回归分析 ,相关系数为 0 .96 73,成正相关。结论　以HBVDNA的载量作为观察指标研究分析孕妇HBV感染状态与宫内垂直传播的关系较免疫学指标HBeAg更加直接可靠 ;孕妇血清HBVDNA载量多是造成宫内感染的主要因素之一。     

Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009–2017)

BackgroundMother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90 % of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990 s, however up to 10 % of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown.MethodsWe conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7 days.ResultsAmong 690,052 live births, 6118 births (0.90 %) were linked to 4196 women with a record of HBV infection. 89.4 % of all Victorian infants (n = 616,879), and 96.8 % of infants linked to women with a positive record of CHB (n = 5,925) received birth dose within 7 days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR = 0.67, 95 %CI = 0.66, 0.69; CHB linked records aOR = 0.17, 95 %CI = 0.11, 0.25).Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births.ConclusionAn approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.     

HBsAg阳性孕妇对预防乙型肝炎病毒母婴传播知识知晓率的调查

目的调查乙型肝炎表面抗原（hepatitisBsurfaceantigen,HBsAg）阳性孕妇对预防乙型肝炎病毒（hepatitisBvirus,HBV）母婴传播知识的知晓率。方法以2012年2～7月在南京鼓楼医院进行产前检查的孕妇为调查对象,发放“预防乙肝母婴传播知识调查表”,调查其对HBV相关知识的知晓率,重点调查HBsAg阳性孕妇对HBV母婴预防知识的知晓率。结果共发放问卷465份,收回有效问卷374份（80．4％）,其中HBsAg阴性者221份（59．1％）,HBsAg阳性者153份（40．9％）。HBsAg阳性者中,96．1％知晓HBV有传染性,但仅49．7％能正确回答其传播方式;84．3％清楚HBV可以预防,但仅58．2％知道疫苗正规接种应包括3针;88．9％知其子女易感,45．1％因此有延迟怀孕的想法,仅20．9％知道必须同时给其新生儿接种乙肝疫苗和注射乙肝免疫球蛋白（hepatitisBimmuneglobulin,HBIG）以防止母婴感染;分别有45．8％和23．5％错误地认为剖宫产和人工喂养可以有效防止母婴传播。结论HBsAg阳性孕妇对预防乙肝母婴传播知识的知晓率不高,应制订相应的宣教措施,提高孕妇对合理预防HBV母婴传播的知晓率。     

HBV感染孕妇其肝功能情况对新生儿HBV感染的影响

[目的]探讨乙型肝炎病毒感染的孕妇,其分娩前肝功能情况与新生几感染HBV的关系.[方法]67例慢性乙型肝炎的孕妇与1373例乙肝病毒携带者的孕妇,其新生儿出生后2 h内静脉取血,进行血中乙肝病毒标志物含量的比较.[结果]HBV感染合并妊娠,其分娩时肝功能异常与肝功能正常孕妇所生新生儿在宫内从母体获得的HBV标志物无差异.[结论]新生儿从母体获得的HBV标志物与母亲肝功能无关.     

乙肝免疫球蛋白在乙肝感染孕妇产前阻断中的作用

目的 对合肥市乙肝感染孕妇母婴阻断结果进行分析,评价现行的产前阻断方式的有效性,为阻断乙肝病毒垂直传播提供依据。方法 利用已经建立的合肥市乙肝感染孕妇监测系统,按照乙肝感染孕妇乙型肝炎病毒-DNA（hepatitis B virus-DNA,HBV-DNA）滴度的风险区和产前是否注射乙肝免疫球蛋白分组,在婴儿一周岁时检测乙肝五项,乙肝表面抗原（hepatitis B surface antigen, HBsAg）阳性者为阻断失败。同时对注射乙肝免疫球蛋白（hepatitis B immune globulin,HBIg）的乙肝感染孕妇进行注射前和注射后HBV-DNA病毒滴度监测,以研究产前注射乙肝免疫球蛋白对乙肝病毒垂直传播的影响。结果 2009-2013年全市共监测乙肝感染孕妇395例,对照组的阳性率为2.74%,阻断组的阳性率为3.88%。χ2检验显示两组间阳性率差异无统计学意义。注射HBIg的乙肝感染孕妇注射前和注射后HBV-DNA病毒滴度变化差异无统计学意义。结论 乙肝感染孕妇产前注射乙肝免疫球蛋白的效果有待进一步研究。     

Adherence to chronic hepatitis B screening guidelines for persons from intermediate to high prevalence Countries

The adherence to the CDC guideline on screening non-U.S. born persons for hepatitis B virus infection was assessed. A retrospective cohort study was conducted at University of Washington primary care clinics using the electronic medical records. Persons from hepatitis B virus prevalent countries were identified using country of origin and language. Of 2329 eligible for screening, only 617 (26.5%) were screened. The prevalence of HBsAg was 35 (5.7%). Among women of reproductive age (18–44 years, n?=?906), 238 (26.3%) were screened, and 7 (2.9%) were HBsAg positive. Low screening practice for chronic hepatitis B infection, and high infection prevalence among those screened was noted. The findings indicate that potentially three out of every one detected case may be missed. Urgent efforts are needed to scale up and consistently implement HBV screening at primary care clinics.

     

Sreening of pregnant women for hepatitis B markers in a French Provincial University Hospital (Limoges) during 15 years

Abstract. During the 15 years from January 1984 to December 1998 the Limoges University Hospital screened 22,859 pregnant patients for hepatitis B surface antigen (HBs Ag) and identified 149 positives. The overall prevalence (0.65%) was intermediate between prevalences observed among women of French origin (0.29%), French West Indies islands (5.68%) and of foreign origin particulary South East Asian origin (7.14%) and Sub Saharan African origin (6.52%). Hepatitis B Virus (HBV) replication markers was detected with relative low frequence (HBe Ag: 14.4%; HBV-DNA: 13.7–20%) among HBs Ag positive mothers. Markers of delta hepatitis virus was found among 10.5% of the HBs Ag carrier pregnant women. During the 15 years study period variations of the global prevalence were not statistically significant. Universal prenatal screening and infant immunisation could greatly contribute to the control of HBV infection if the polemic about the hepatitis B vaccination recently propagated in France will not have a negative effect on the acceptance and national programme of vaccination.