福建省泉州市HBsAg阳性产妇所生新生儿免疫失败流行特征

目的 了解泉州市HBsAg阳性产妇所生儿童的乙肝免疫状况,评价本市乙肝母婴阻断方案的保护效果,并分析免疫失败的流行特征。方法 通过问卷调查,收集整理泉州市惠安、石狮两县HBsAg阳性产妇及其新生儿基本信息,在新生儿完成3针乙肝疫苗接种后1~2月,采集血标本并通过胶体金法检测HBsAg、抗HBs。结果 HBsAg阳性产妇所生儿童经乙肝疫苗和乙肝免疫球蛋白（HBIG）联合免疫后,其抗-HBs阳性率为93.1%,HBsAg阳性率为1.8%,免疫失败率为6.9%。新生儿乙肝免疫失败与HBsAg阳性产妇谷丙转氨酶（ALT）值和HBV-DNA值高低、产妇HBeAg阳性与否有关（P<0.05）,ALT、HBV-DNA值越高,免疫失败的概率越大,HBeAg阳性产妇所生新生儿免疫失败率高于HBeAg阴性;乙肝母婴阻断与HBsAg阳性产妇ALT值和HBV-DNA值高低有关（P<0.05）,ALT、HBV-DNA值越高,母婴阻断失败的概率越大。HBV-DNA≥10⁴ cps/mL HBsAg阳性产妇选择20 μg/mL乙肝疫苗和200 IU HBIG进行接种的率明显高于HBV-DNA<10⁴ cps/mL 产妇。结论 泉州市现行乙肝母婴阻断策略实施效果较好,建议HBeAg阳性且HBV DNA载量>6 log10 IU/mL的母亲在孕期进行干预治疗,以进一步减少免疫失败率,提高母婴阻断率。

Epidemiological characteristics of immunoprophylaxis failure in the infants born to HBsAg-positive mothers in Quanzhou,Fujian

Objective To explorethe status of hepatitis B immunization in children born to HBsAg-positive mothers in Quanzhou City, and evaluate the effects on blocking HBV maternal-neonatal transmission, and analyze the epidemiological characteristics of neonatal immunoprophylaxis failure. Methods A questionnaire survey was conducted to collect the information of HBsAg-positive mothers and their neonates in Hui'an and Shishi counties of Quanzhou City. Venous blood samples were collected from the infants after 1-2 months when they completed 3 doses of hepatitis B vaccine,and serum HBsAg, anti-HBs were detected by colloidal gold method. Results The anti-HBs positive rate and HBsAg-positive rate of infants were respectively 93.1% and 1.8%. The infants' immunoprophylaxis failure rate was 6.9 %, which was associated with ALT, HBV-DNA values and HBeAg status of mothers (P<0.05). The higher the ALT and HBV-DNA values was, the greater probability of immunoprophylaxis failure was. The neonatal immune failure rate of HBeAg-positive mothers was significantly higher than that of HBeAg-negative. Blocking mother-to-infant transmission of HBV was associated with ALT and HBV-DNA values in HBsAg-positive women (P<0.05). The higher the ALT and HBV-DNA values was, the greater probability of maternal-infant block failure. The 20 μg/mL hepatitis B vaccine and 200 IU HBIG vaccination rate in children whose mother′s HBV-DNA≥10⁴ cps/mL was significantly higher than whom of HBV-DNA<10⁴ cps/mL. Conclusion The current immunological strategy in Quanzhou has well protective efficacy for the interruption of HBV mother-to-infant transmission. It is recommended that mothers with HBeAg-positive and HBV DNA >6 log10 IU/mL should be intervented during pregnancy to further reduce the rate of immunoprophylaxis failure and increase the blockage of HBV maternal-neonatal transmission.