A 12-year cohort study on the efficacy of plasma-derived hepatitis B vaccine in rural newborns

AIM:To understand the anti HBs persistence and the long-term preventive efficacy in rural newborns after vaccination with plasma-derived hepatitis B vaccine.METHODS:In the time of expanded program on immunization (EPI), the newborns were vaccinated with 10&mgr;gcenter dot3 doses of hepatitis B vaccine and 762 newborns who were HBsAg negative after primary immunization were selected for cohort observation from 1986 to 1998. Their serum samples were detected qualitatively and quantitatively for hepatitis B infecting markers, including HBsAg, anti-HBs and anti-HBc by SPRIA Kits. The annual HBsAg positive conversion rate was counted by life-table method.RESULTS:(1)The anti-HBs positive rate was 94.44% for the babies born to HBsAg negative mothers and 84.21% for those born to HBsAg positive mothers in the 1st year after immunization, and dropped to 51.31% and 52.50% in the 12th year respectively.GMT value was dropped from 31.62 to 3.13 and 23.99 to 3.65 in the 2nd to the 12th year respectively. There was a marked drop in GMT at the 3rd to the 5th year, and in anti HBs positive rate at the 9th to the 10th year. (2) In the period of 12 years observation, the person-year HBsAg positive conversion rates were 0.12% (5/4150.0) in newborns born to HBsAg negative mothers and 0.20% (1/508.0) in those born to HBsAg positive mothers, and none of the HBsAg positive converted children became HBsAg chronic carriers. Compared with the baseline before immunization, the protective rates were 97.19% and 95.32% respectively.CONCLUSION:The protective efficacy of plasma-derived hepatitis B vaccine persisted at least 12 years, and a booster dose seems not necessary within at least 12 years after the primary three-doses immunization to newborns born to HBsAg negative mothers.     

Relationship between HBV viremia level of pregnant women and intrauterine infection:neated PCR for detection of HBV DNA

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Hepatitis B virus infection status in the PBMC of newborns of HBsAg positivemothers

AIM To study the hepatitis B virus (HBV) status in peripheral blood mononuclear cells (PBMC) and itsrelationship with serum HBV infection in newborns of hepatitis B surface antigen (HBsAg) positive mothers.METHODS Blood specimens were collected by femoral puncture from newborns of HBsAg positive motherswithin 24 hours after birth between February, 1997 and May, 1998. All sera were examined for HBV DNAand HBsAg by nested polymerase chain reaction (nPCR) and enzyme-linked immunosorbent assay (ELISA).PBMC were separated from above blood specimen of newborns. Fifty-five FBMC smear of newborns wereobtained whose sera were HBV DNA positive and 38 PBMC smear were randomly selected from newbornswhose'sera were HBV DNA negative. These Ninety-three smear of newborns' PBMC at birth were detectedfor HBV DNA by in situ polymerase chain reaction (IS PCR) and in situ hybridization (ISH) using digoxin-labelled HBV DNA probe.RESULTS Twenty-seven (49.09%) out of 55 HBV DNA positive newborns sera had HBV DNA in PBMCand 4 (10.53%) out of 38 HBV DNA negative newborns sera were detected for HBV DNA in their PBMC byISH. Sixty-two HBV DNA negative newborns PBMC by ISH were examined for HBV DNA by IS PCR. Ten(35.71%) out of 28 HBV DNA positive newborns sera had HBV DNA in their PBMC. Two (5.88%) out of 34 HBV DNA negative newborns sera were found HBV DNA in their PBMC. Total positive rates of PBMCHBV DNA (by ISH and/or IS PCR) were 67.27% (37/55) in those newborns with HBV DNA positive seraand 15.79% (6/38) in those newborns with HBV DNA negative sera.CONCLUSION HBV DNA in PBMC were found in most of newborns who had HBV DNA positive sera.But HBV DNA in PBMC also were positive in some of newborns who were negative for HBV DNA in theirsera at birth. It suggests that intrauterine HBV infection may be demonstrated only by HBV infection intheir PBMC and should be served as diagnosis index for intrauterine HBV infection. HBV infection in PBMCmay play some role in HBV intrauterine infection and its persistence, but it needs to study furthermore.     

60例孕妇HBV血清标志物水平与母婴传播的关系分析

目的 探讨孕妇乙型肝炎病毒（HBV）血清标志物水平与母婴传播的关系。方法 采取60例孕妇、脐带、新生儿血清用美国雅培试剂做HBV血清标志物（HBVM）包括：HBsAg、HBsAb、HBeAg、HBeAb、HBcAb定量分析,用荧光定量PCR法测HBV DNA。结果 HBsAg、HBeAg、HBcAb阳性母亲的新生儿脐血HBV M阳性率91．67％,新生儿血HBV M阳性率85％,母血HBsAg、HBeAg、HBcAb滴度显著高于脐血、新生儿血,且母血、脐血、新生儿血HBV M水平依次降低;HBV DNA阳性率也依次降低,分别为58、33％、10％、6、67％,滴度也依次降低。HBsAg、HBeAb、HBcAb阳性母亲,HBsAg、HBcAb阳性母亲和单项HBsAg阳性母亲的新生儿脐血、新生儿血HBV M阳性率较低。新生儿血以HBeAg阳性为主,滴度明显高于正常值,HBsAg滴度仅略高于正常值。结论 母婴垂直传播与母亲HBeAg高滴度有密切关系,与母亲HBV DNA阳性或阴性关系并不十分密切。检测脐血和新生儿血HBsAg、HBV DNA阴性并不能排除HBV感染,不如检测HBsAg、HBeAg更有意义,更经济。     

南宁市区511例HBV阳性孕妇的新生儿HBV感染情况调查

目的 调查南宁市区乙型肝炎病毒(HBV)阳性孕妇的新生儿HBV感染情况.方法 将511例乙肝表面抗原(HBsAg)阳性的孕妇按HBsAg、HBeAg、抗-HBc三项指标阳性者分为"大三阳"组,共191例,HBsAg、抗-HBe、抗-HBc三项指标阳性者为"小三阳"组,共320例,并对其所生的新生儿在出生后24 h内进行乙肝两对半的检测.结果 "大三阳"组孕妇的新生儿HBV感染92例,感染率48.17%;"小三阳"组孕妇的新生儿HBV感染12例,感染率3.75%;两组比较χ2=145.575,P<0.01,差异有统计学意义.结论 孕妇乙肝"大三阳"是新生儿发生HBV感染的高危因素,应加强HBV阳性孕妇的宫内阻断,减少新生儿发生HBV感染.     

A randomized controlled clinical trial： Interruption of intrauterine transmission of hepatitis B virus infection with HBIG

AIM: To evaluate the efficacy of interruption of intrauterine infection of HBV with HBIG in pregnant women with positive HBeAg and HBsAg. METHODS: A prospective randomized controlled trial was adopted. Sixty cases with positive HBeAg and HBsAg were coincident with the criteria of inclusion, and 8 cases were excluded. Fifty-two cases were analyzed (28 cases in trial group and 24 in control group). All cases in trial group received 200 IU HBIG intravenously every 4 wk for 3 times from the 28th wk. The cases of control group received placebo in the same way. All pregnant women were detected for HBeAg and HBV-DNA at the beginning of the trial and end of the trial (delivery). The cord blood of all newborns were collected for detecting HBeAg and HBV-DNA simultaneously. RESULTS: For investigation of HBeAg of newborns in trial group, 6 of 28 cases of newborns had positive HBeAg, the HBeAg positive rate being 21.4%, the total rate of 95% CI being 8%-41%. In control group, 19 of 24 cases of newborns had positive HBeAg, HBeAg positive rate was 79.2%, the rate of 95%CI being 5%-93%. By statistical analysis, x2 = 17.26, P < 0.01, RR = 0.27, 95% CI (6.3×10-6, 8.6×10-5). For investigation of HBV-DNA of newborns in trial group, 7 of 28 cases of newborns had positive HBV-DNA, HBV-DNA positive rate being 25%, the total rate of 95% CI being ll%-45%. In control group, 20 of 24 cases of newborns had positive HBV-DNA, HBV-DNA positive rate was 83.3%, the total rate of 95% CI being 63%-95%. By statistical analysis, x2 = 17.62, P < 0.01, RR = 0.30, 95% CI (1.5×10-5, 1.7×10-4). The results indicated that there was significant difference in HBeAg positive rate and HBV-DNA positive rate of newborns between the two groups. In trial group, 7 of 28 newborns had HBV-DNA positive, but the HBV-DNA load of newborns was lower than that of their mothers. In control group, 20 of 24 newborns still had HBV-DNA positive, and the HBV-DNA load of newborns was close to those of their mothers. Statistical analysis indicated that there was no significant difference in HBV-DNA load between postnatal women without HBIG intervention and their filial generations (T = 81.5, P > 0.1). CONCLUSION: It is effective and safe to prevent in-trauterine infection of HBV with HBIG from the 28th wk in pregnant women with positive HBeAg and HBsAg. In clinical application, those pregnant women with negative HBeAg and positive HBV-DNA also need to be interrupted by HBIG.     

联合检测HBV前S1抗原和核心抗原的临床意义

探讨联合检测血清HBV前s1抗原（preSl）和核心抗原（HBcAg）（均为HBV核酸相关抗原，nucleic acids related antigen，HBV NRAg）的意义及临床价值。方法：采用ELISA法对393份HBsAg、HBV DNA双阳性的血清和612份HBsAg阴性血清进行HBV NRAg检测，所有标本均采用多区段巢式PCR确认阳性、阴性，采用荧光定量PCR法进行HBV DNA定量分析。结果：393份HBsAg、HBV DNA双阳性血清中，HBV NRAg阳性为382份，其阳性率为97．2％；612份HBsAg阴性的血清标本中，609份确认为HBV DNA阴性，其中检出2份HBV NRAg阳性，607份为阴性，其HBV NRAg的阴性率为99．7％（607／609），另3份HBsAg阴性血清HBV DNA阳性者，其HBV NRAg均为阳性。结论：联合检测preSl和HBcAg的HBV NRAg可作为临床HBV感染的筛选及判断HBV复制的有意义的补充项目。     

乙肝疫苗联合乙型肝炎免疫球蛋白接种阻断血清HBsAg阳性母亲HBV母婴传播效果分析*

目的 分析乙肝疫苗联合乙型肝炎免疫球蛋白（HBIG）接种阻断血清HBsAg阳性母亲乙型肝炎病毒（HBV）母婴垂直传播的效果。方法 在血清HBsAg阳性母亲所分娩的712例新生儿中,356例接受标准乙肝疫苗,另356例在接种乙肝疫苗的同时,接受 HBIG接种,比较1~10岁儿童接种成功率和HBV母婴垂直传播阻断率。结果 在56例1~2岁、234例3~4岁、249例5~6岁、135例7~8岁和38例9~10岁年龄组儿童,血清抗-HBs阳性率分别为89.3%、87.6%、81.1%、83.7%和76.3%,HBsAg阳性率分别为0.0%、0.4%、0.4%、1.5%和2.6%,各年龄组比较,无显著性统计学差异（P>0.05）;联合接种与乙肝疫苗接种组血清抗-HBs阳性率分别为84.3%和64.3%,血清HBsAg阳性率分别3.1%和15.2%,两组差异显著（P<0.05）;在血清HBsAg/HBeAg双阳性母亲所分娩的儿童,246例联合接种组血清HBsAg阳性率为1.6%,显著低于162例只接种乙肝疫苗组的11.7%（P<0.05）,而在血清HBsAg阳性母亲所分娩的儿童,110例联合接种与194例只接种乙肝疫苗组比,血清HBsAg阳性率无显著性差异（2.7%对6.2%,P>0.05）。结论 对血清HBsAg/HBeAg双阳性母亲所分娩的新生儿,给予乙肝疫苗联合HBIG接种可能更有效地阻断HBV母婴垂直传播。     

Low rate of occult hepatitis B virus infection among anti-HBc positive blood donors living in a low prevalence region in Brazil

OBJECTIVE: The aim of this study was to determine the rate of occult hepatitis B virus (HBV) infection among blood donors living in a geographic region of low (5.6%) anti-HBc prevalence. SUBJECTS AND METHODS: Sera from 150 candidate blood donors whose blood was rejected due to total anti-HBc reactivity (despite absence of HBsAg) were tested for anti-HBs and IgM anti-HBc antibodies, as well as for HBeAg/anti-HBe. Serum HBV DNA was sought by using a PCR assay able to amplify part of the surface gene. Viral load was measured in the PCR positive samples. RESULTS: The pattern 'anti-HBc alone' (without HBsAg and anti-HBs antibodies) was found in 64 (42.7%) subjects. IgM anti-HBc and anti-HBe antibodies were detected in 2 (1.3%) and 80 (53.3%) samples, respectively. No sample was HBeAg-reactive. HBV DNA was repeatedly found in five (3.3%) samples, three of which were anti-HBs positive and two anti-HBs negative. All five HBV DNA positive samples showed a low viral load (<1000copies/ml). CONCLUSIONS: The data indicated a low rate of occult infection among anti-HBc positive, HBsAg negative blood donors living in a region of low prevalence of infection. Viral load was very low in all HBV infected subjects.     

HBsAg和HBsAb双阳性检测结果的初步分析

目的对临床检测中少见的HBsAg和HBsAb双阳性结果进行分析,寻找可能的产生原因。方法对3家医院初筛HBsAg和HBsAb双阳性的81份血标本进行同种和不同种试剂盒复检,并检测HBsAg145位氨基酸变异（G145R变异）、HBVDNA基因型和血清型分析。结果81份双阳性标本经复检有30例（37％）仍然为双阳性;对30例复检双阳性标本应用不同试剂盒再次检测,HBsAg／HBsAb仍为双阳性者18例（22．2％）;18例双阳性标本G145R检测全部为阴性;其中8例HBV DNA阳性血清的基因型分布为B型2例和C型6例,血清型分布为adw2例、adr5例和ayr1例,与9份对照血清的检测结果比无显著性差异。结论HBsAg和HBsAb双阳性检测结果大多数与操作或试剂的质量有关,少数可能为S基因变异或不同血清型的再次感染等有关。     

乙型肝炎表面抗原和乙型肝炎e抗原双阳性的乙型肝炎病毒携带产妇进行母乳喂养的安全性

目的探讨乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)和乙型肝炎e抗原(hepatitis B e antigen,HBeAg)双阳性的乙型肝炎病毒(hepatitis B virus,HBV)携带产妇采用母乳喂养对其所生婴儿HBV感染率的影响.方法采用前瞻性队列研究方法,纳入2016年2月至2018年5月在浙江大学医学院附属妇产科医院进行产前检查及分娩的HBsAg和HBeAg双阳性携带HBV产妇及其所生的婴儿各323例,将其分为母乳喂养组和人工喂养组.采用化学发光免疫分析法和聚合酶链反应-荧光探针法,分别检测两组婴儿在出生<24 h及7月龄时的血清HBV标志物和HBV DNA的阳性率.统计学方法采用x2检验.结果最终纳入297例患者,其中母乳喂养组149例,人工喂养组148例.母乳喂养组与人工喂养组婴儿在出生<24 h及7月龄时的HBsAg、抗-HBs、HBeAg、HBV DNA>100 IU/mL的阳性率比较,差异均无统计学意义(均P>0.05).母乳喂养组出生<24 h新生儿抗-HBs阳性率为58.39%(87/149),低于7月龄时的95.97%(143/149);母乳喂养组出生<24 h新生儿HBeAg阳性率为65.10%(97/149),高于7月龄时的13.42%(20/149);差异均有统计学意义(x2=59.75、40.49,均P<0.01).母乳喂养组出生<24 h新生儿的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.01%(3/149)和2.68%(4/149),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.68%(4/149)和2.68%(4/149),两个时间点比较差异均无统计学意义(均P>0.05).人工喂养组出生<24 h新生儿抗-HBs阳性率为47.97%(71/148),低于7月龄时的95.94%(142/148);人工喂养组出生<24 h新生儿HBeAg阳性率为55.41%(82/148),高于7月龄时的19.59%(29/148);差异均有统计学意义(x2=85.37、39.84,均P<0.01).人工喂养组出生<24h新生儿的HBsAg和HBV DNA>100IU/mL阳性率分别为4.73%(7/148)和1.35%(2/148),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为1.35%(2/148)和1.35%(2/148),两个时间点比较差异均无统计学意义(均P>0.05).结论母乳喂养不是增加HBsAg和HBeAg双阳性HBV携带产妇垂直传播风险的决定性因素,建议这类产妇在正规预防的前提下进行母乳喂养.     

乙型肝炎病毒母婴传播产前免疫阻断的研究

目的评价不同方案乙型肝炎免疫球蛋白（HBIG）预防HBV宫内感染的疗效，探讨其作用机制，并了解其对病毒变异的影响。方法以无症状HBV携带孕妇及其新生婴儿为研究对象，将无症状HBV携带孕妇在产前检查时随机分为HBIG A组：26例孕妇于产前3、2、1妊娠月和分娩前分别肌肉注射HBIG200～400U（HBsAg阳性者注射HBIG200U、HBsAg和HBeAg双阳性者注射HBIG400U）；HBIG B组：29例孕妇于产前3、2、1妊娠月分别肌肉注射HBIG200U；对照组：26例孕妇产前未接受任何特殊治疗。3组均留取孕中期产检时（应用HBIG前）和临产日使用HBIG前后的静脉血标本，新生儿于生后联合免疫前留取外周血，酶免疫测定法（EIA）检测HBV标志，荧光定量聚合酶链反应（FQ-PCR）检测HBV DNA以及PCR扩增HBV DNA S基因区片段并测序。结果55例新生儿为HBIG组（A和B）母亲所生，宫内感染率为14．5％，对照组为35．7％（χ^2=4．896，P=0．027）。HBIG A组HBsAg和HBeAg双阳性母亲所生的8例新生儿有3例宫内感染，对照组8例新生儿均有宫内感染（χ^2=7．273，P=0．007）；HBIGB组7例新生儿有5例宫内感染，但差异无统计学意义（χ=2．637，P=0．104）。3组孕妇孕中期血清HBsAg与HBV DNA水平相当，但分娩前HBIG A组孕妇HBsAg及HBV DNA均低于HBIG B组和对照组。HBIG A组新生儿血清抗-HBs检出率为38．5％。3组产妇分娩前均未检测到抗-HBs。HBV S区碱基替代突变率和氨基酸变异数在HBIG组（A和B）和对照组之间差异均无统计学意义。18例宫内感染儿，HBV S区碱基替代突变率和氨基酸变异数在HBIG组（A和B）和对照组之间差异均无统计学意义。结论孕妇产前注射HBIG阻断HBV母婴传播的免疫效果肯定，按HBV携带不同状态使用两种不同剂量HBIG，并于分娩前加用一次，效果更佳；经胎盘使胎儿获得被动免疫是HBIG重要作用机制；无症状携带HBV孕妇产前使用HBIG并未增加HBV S区的变异，HBV S区变异并非是发生宫内感染的主要原因。     

Detection of HbsAg and HBV DNA in serum and saliva of HBV carriers

Serum and saliva samples from 23 patients known to be HBsAg-positive HBV carriers and 17 healthy control subjects were analyzed for hepatitis B virus (HBV) by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). All serum samples of the HBV carriers were positive for HBsAg, with 21 also positive for HBV DNA. In comparison, 22 saliva samples of HBV carriers were positive for HBsAg whereas only 11 of the 23 tested were positive for HBV DNA. Based on these results we have arrived at the conclusion that the saliva of HBV carriers might be potentially infectious and also that saliva testing could serve as an alternative technique for identifying HBV carriers.     

Potential infectivity of blood from HBsAg asymptomatic carriers due to the presence of HBV-DNA and comparison with other markers of HBV infection

Serum samples from 356 HBsAg positive asymptomatic carriers, which were titrated by reverse passive hemagglutination, were analysed for the presence of HBV-DNA, HBsAg and IgM anti-HBc. The samples were divided in three classes, according to the titers of HBsAg and IgM anti-HBc and the distribution of HBV-DNA and HBsAg among these classes was studied. In the high titer class of HBsAg, 65% of samples have one or both markers against only 19% in the low titer class. From the total of 356 samples, 121 gave positive results for IgM anti-HBc (33.9%). From these, 38.9% of HBV-DNA and 47.9% of HBeAg were observed, whereas in samples with absence of IgM anti-HBc, 18.3% and 16.6% were respectively found. A higher frequency of agreement between all these markers was found in the class of high titers of HBsAg; however, HBV-DNA was detected in the low titer class of HBsAg and little or no IgM anti-HBc, showing potential blood infectivity even in HBsAg positive borderline samples.     

不同方案阻断乙肝病毒母婴垂直传播的临床研究

探讨阻断乙型肝炎病毒母婴垂直传播的方法。将122例HBsAg( )孕妇分成四组，HBVac治疗组29例，HBIG组29例。左旋咪唑涂布剂与以上两者联合应用30例。未治疗组34例。均在孕26周开始干预观察，孕妇和新生儿血清HBV标志物（HBVM）检测采用ELISA法，122例孕妇按分娩方式不同分别观察对乙肝病毒母婴垂直传播影响；随访产妇及新生儿HBVM变化。脐血中HBsAg阳性率；HBVac治疗组为17.24%。HBIG治疗组为10.35%。联合治疗组为3.33%。未治疗组为23.53%。在不同的分娩方式中，急症剖宫产新生儿脐血HBsAg阳性率为13.04%，行择期剖宫产者为0，经阴道分娩者为16.67%。携带HBV孕妇于孕晚期给予HBVac,HBIG和左旋咪唑涂布剂联合以上两者治疗后，可有效阻断母婴之间传播。以联合治疗组效果最佳。不同分娩方式也影响传播，剖宫产术有助于阻断HBV母婴传播。     

Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection: Single center study in Egypt

AIM:To identify possible maternal risk factors for hepatitis B virus(HBV)acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen(HBs Ag)positive mothers.METHODS:Screening of 2000 pregnant females wascarried out using rapid test and confirmed by enzyme immunoassay.A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBs Ag positive female in addition to at least 2 pregnant HBs Ag negative females for each positive case.Infants of HBs Ag positive women were offered passive and active immunoprophylaxis within the 1st 48 h after birth,in addition to 2nd and 3rd doses of HBV vaccine after1 and 6 mo respectively.Infants were tested for HBs Ag and hepatitis B surface antibodies(HBs Ab)at six months of age.RESULTS:HBs Ag was confirmed positive in 1.2%of tested pregnant women.Risk factors significantly associated with HBV positivity were;history of injections(OR=5.65),history of seeking medical advice in a clinic(OR=7.02),history of hospitalization(OR=6.82),history of surgery(OR=4)and family history of hepatitis(OR=3.89)(P<0.05).Dropout rate was 28%for HBs Ag women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns.Immunoprophylaxis failure was detected in only one newborn(3.7%)who tested positive for HBs Ag at 6 mo of age;and vaccine failure(seronegative to HBs Ab after 4 doses of the vaccine)was detected in another one(3.7%).The success rate of the immunoprophylaxis regimen was 92.6%.CONCLUSION:This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.     

Perinatal transmission of hepatitis B virus and its prevention

In order to prevent liver cirrhosis and hepatocellular carcinoma in later life, it is essential to prevent HBV infection in infants. If the mother is chronically infected with HBV and is also positive for HBeAg, 80–90% of the newborns become chronically infected, whereas if the mother is positive for anti‐HBe, only some newborns will develop acute hepatitis or fulminant hepatitis. It is necessary to screen pregnant women for HBsAg and prevent mother‐to‐infant infection of HBV, treating the infant with hepatitis B hyperimmune globulin at birth, followed by HBV vaccination. In highly endemic areas of HBV, universal HBV vaccination of all newborns is advisable.     

Prevalence and determinants of hepatitis B virus markers in pregnant women in West Java, Indonesia

In Bandung, West Java, 300 consecutive pregnant women were screened for hepatitis B virus (HBV) markers at a prenatal consultation. The prevalence of HBsAg and of anti-HBs/anti-HBc was 4.7% (14/300) and 35.6% (107/300) respectively, while 59.7% (179/300) was sero-negative. Prevalence of HBV markers increased significantly with both age and parity. Women with less schooling and a low socioeconomic class seemed to be at higher risk for HBV infection (HBV-markers prevalence of 49.3% (35/71) and 58.3% (21/36) respectively). Among employed women, the subgroup of school-teachers had a significantly higher HBV-markers prevalence of 54.8% (23/42), with a HBsAg carrier rate of 11.9% (5/42). This could indicate an important nonparenteral transmission of HBV in schools. The prevalence of HBeAg in HBsAg positive women was 64.3% (9/14). Based on historical data on perinatal HBV transmission, this would lead to a HBV carriership in 2.4 to 3.5% of all newborns. Possible strategies of prevention of HBV infection in newborns are briefly discussed.     

Seroprevalence of HBV (anti-HBc,HBsAg and anti-HBs) and HDV infections among 9006 women at delivery*

Abstract: Serum samples from 9006 women, who delivered in Switzerland in 1990 and 1991, were collected around the country. Of these women, 62.7% were Swiss and 37.3% originated from foreign countries. Samples were first screened for anti-HBc and those found positive were further tested for HBsAg, anti-HBs and anti-HDV Anti-HBc was found in 640 of the 9006 women (overall prevalence, 7.1%; Swiss, 3.3%; foreigners, 13.5%). Of these 640 positive samples, 61 (9.5%) were positive for HBsAg (without anti-HBs), 467 (73.0%) positive for anti-HBs (without HBsAg) and 8 (1.3%) positive for both HBsAg and anti-HBs. The remaining 104 were thus anti-HBc positive without HBsAg or anti-HBs. These 104 specimens with the so-called “isolated anti-HBc” reactivity represented 1.2% of the whole population or 16.3% of the 640 anti-HBc positive mothers. All were HBV DNA negative (PCR). Anti-HDV antibody was found in only five women. HBsAg was seen in 38 of the cord-blood samples from the anti-HBc positive mothers. In this large sampling, we observed a relatively high seroprevalence of HBV infection. Cases with isolated anti-HBc reactivity, being HBV DNA negative by PCR, were probably non-infectious at the time of blood collection.