8个省(自治区)乙型肝炎病毒表面抗原阳性产妇筛查及新生儿免疫预防措施的调查

Survey on Hepatitis B Virus Surface Antigen Screening among Pregnant Women and Prevention Measures for Newborns in 8 Provinces or Autonomous Regions,China

目的评价乙型肝炎(乙肝)病毒表面抗原[Hepatitis B Virus(HBV)Surface Antigen,HBs Ag]阳性产妇筛查及新生儿母婴阻断措施开展情况。方法在云南、湖南、广西、安徽、甘肃、贵州、内蒙古、四川8个省(自治区,下同),选取2010年新生儿乙肝疫苗(Hepatitis B Vaccine,Hep B)及时接种率(Timely Birth Dose Rate,TBD)<75%的设区的市(地区、州),以2011年产前筛查出的HBs Ag阳性住院分娩产妇及其新生儿为观察对象,开展流行病学调查,了解产妇HBV血清学标志物筛查情况,孕期是否采取阻断措施,新生儿首剂(First Dose)Hep B(Hep B1)及乙肝免疫球蛋白(Hepatitis B Immunogloblin,HBIG)接种情况等。产妇在分娩前采集静脉血5毫升(ml),在省级疾病预防控制中心(Center for Disease Prevention and Control,CDC)实验室采用酶联免疫吸附试验(Enzyme-linked Immunosorbent Assay,ELISA)对HBs Ag、乙肝病毒e抗原(HBV e Antigen,HBe Ag)和抗乙肝病毒e抗原抗体(Antibody to HBe Ag,Anti-HBe)进行复核检测。结果调查地区医疗机构产妇HBV血清学标志物筛查多采用国产ELISA试剂。经省级CDC实验室复核检测,初筛HBs Ag阳性产妇HBs Ag、HBe Ag、Anti-HBe复核一致率分别为95.93%、83.28%、75.44%。调查9999名HBs Ag阳性产妇的新生儿全部接种了Hep B1,79.58%的新生儿接种10微克(μg)重组Hep B(酵母);TBD为97.05%,早产儿、低体重儿TBD低于足月儿(χ2=80.72,P<0.05)、正常体重儿(χ2=175.16,P<0.05),差异均有统计学意义;婴儿Hep B1和HBIG联合接种率为67.17%,产妇HBe Ag阳性、阴性或未检测者,其新生儿联合接种Hep B和HBIG的比例差异无统计学意义(χ2=0.72,P>0.05)。结论需继续加强HBs Ag阳性母亲的早产儿、低体重儿Hep B1及时接种,以及HBs Ag和HBe Ag双阳性产妇的新生儿Hep B1和HBIG联合接种。

Objective To evaluate Hepatitis B Virus （HBV） surface antigen （HBsAg） screening of pregnant women and implementation of the prevention of mothertochild transmission strategy in babies born to HBsAg positive mothers. Method In 2011, we conducted an epidemiology survey of HBsAg pos itive pregnant women in hospitals and their newborns. The setting was prefectures where coverage of the timely birth dose （TBD） of hepatitis B vaccine （HepB） was reported in 2010 to be less than 75% in 8 provinces （Yunnan, Hunan, Guangxi, Anhui, Gansu, Guizhou, Inner Mongolia, and Siehuan）. The survey content included hospital screening results for maternal HBV serologic markers, the preventionstrategy used during pregnancy, vaccination with the first dose of HepB （HepB1） vaccine, and administration of hepatitis B immunogloblin （HBIG） to newborns. We collected 5ml blood from pregnant woman who screened positive for HBsAg in the hospital prior to delivery. HBsAg, HBV e Antigen （HBeAg）, and antibody to HBeAg （antiHBe） were determined in provincialcenters for disease control and prevention （CDC） laboratories by enzymelinked immunosorbent assay （ELISA）. Results ELISA was the major laboratory method used in the hospitals to screen pregnant women for HBsAg. The concordance rates of HBsAg, HBeAg and AntiHBe were 95.93%, 83.28%, and 75.44% between the initial screenings and the confirmed results, respectively. We surveyed 9,999 pairs of HBsAg positive pregnant women and their newborn infants. All infants had been vaccinated with HepB vaccine, and 79.58% had been vaccinated with 10~xg HepB made by recombinant deoxyribonucle ic acid techniques in yeast. The overall rate for the TBD of HepB was 97.05%. For premature and low birth weight infants, the TBD rates were statistically significantly lower than for fullterm and normal birth weight infants （X2 = 80. 72 ,P 〈 0. 05 ;X2 = 175.16, P 〈 0. 05 ）. Vaccination with HepB1 in combination with HBIG administration was 67.17%, and the use of HepB in combination with HGIB was not related to whether the pregnant women＇ s HBeAg status was negative or unknown （X2 = 0. 72, P 〉 0. 05 ）. Con clusion It is necessary to improve use of the TBD of HepB vaccine for premature and low birth weight infants, and to strengthen use of combined HepB1 vaccination and HBIG administration for newborns of pregnant women who are positive for both HBsAg and HBeAg.