青海省孕妇乙型病毒性肝炎产前筛查及母婴传播阻断现况调查

Prenatal screening of hepatitis B and the status of preventing mother-to-child transmission of hepatitis B virus in Qinghai province

目的评价青海省孕产妇产前乙型肝炎(乙肝)病毒(HBV)标志物筛查及母婴传播阻断开展情况。方法在全省城市、农村和牧区各选择2个县(区)对14家医院的孕妇HBV标志物筛查和乙肝母婴传播阻断工作开展调查和分析,对首剂乙肝疫苗(HepB1)的未及时接种原因进行分析。结果共调查孕妇9 915名,HBV筛查率为97.75%,HBV表面抗原(HBsAg)阳性率为3.56%;9 848名住院分娩新生儿HepB1及时接种率为96.50%(9 503/9 848);345名HBsAg阳性母亲新生儿HepB1与乙肝免疫球蛋白(HBIG)联合接种率为98.55%(340/345)。上述各指标在城市、农村、牧区之间均无显著性差异。在416名未及时接种HepB1儿童中,56.97%为早产/出生低体重,30.77%为新生儿窒息,7.69%为新生儿黄疸,4.57%为家长拒绝接种。结论青海省孕产妇产前HBV标志物筛查和母婴传播阻断工作能够有效开展。需加强农村和牧区的措施落实,对医护人员需加强培训指导,合理掌握HepB禁忌证,加强早产儿/低体重儿HepB1接种。

Objective To evaluate the implementation of hepatitis B virus （HBV） prenatal screening and mother-to-child transmission interruption in Qinghai province. Methods Fourteen hospitals were selected from 6 counties that included urban, rural, and pastoral areas （2 counties in each）, to investi- gate and analyze the implementation of prenatal screening and mother-to-child transmission interruption. We identified reasons for lack of timely administration of the first dose hepatitis B vaccine （ HepB1 ）. Results Among 9 915 pregnant women, 97.75% received HBV prenatal screening, and among those screened, the HBV surface antigen （HBsAg） positive rate was 3.56%. There were 9 848 live births; 96.50% （9 503/9 848） of these newborns received a timely birth dose of HepB1. Among 345 newborns whose mothers were HBsAg positive, 98.55% （340/345） received a timely HepB1 dose and hepatitis B immunoglobulin （HBIG）. There were no significant differences in these indicators between urban, rural, and pastoral areas. Among the 416 newborns who did not receive a timely dose of HepB1, 56. 97% were premature or had low birth weight, 30.77% had newborn asphyxia, 7.69% had neonatal jaundice, and parents of 4.57% refused HepB1 for the baby. Conclusions HBV prenatal screening and mother-to- child transmission interruption were implemented well in Qinghai. We should strengthen implementation of these two strategies in rural and pastoral areas. Healthcare workers should be trained to understand HepB contraindications in order to promote HepB1 immunization of premature and low birth weight newborns.