青海省不同地区乙型肝炎病毒母婴阻断以及婴儿免疫后血清检测研究

Study on mother to child blocking of hepatitis B virus and serum analysis for infants after immunization in different areas of Qinghai province

目的评价青海省乙肝母婴阻断工作现况,掌握乙肝病毒表面抗原(hepatitis B surface antigen,HBsAg)阳性母亲所生婴儿乙肝疫苗免疫后血清学检测情况.方法对2016年5月1日至2017年4月30日期间在青海省内住院分娩的所有孕妇开展乙肝表面抗原筛查,乙肝表面抗原阳性的孕妇所生新生儿,出生后12 h内免费注射乙肝免疫球蛋白,并按照0、1、6月免疫程序接种3剂次乙肝疫苗(10μg重组汉逊酵母),全程免疫后1~3个月采集指尖血快速筛查,乙型肝炎病毒表面抗原阳性者,采集静脉血进行乙肝抗原定量检测.结果 60027名孕妇参与HBsAg筛查,其中乙肝表面抗原阳性孕妇1912名,阳性率为3.19%.调查活产儿57557名,24 h乙肝疫苗接种率为97.11%.HBsAg阳性产妇的活产儿12 h乙肝疫苗接种率94.78%,乙型肝炎免疫球蛋白注射率97.15%.864名新生儿完成随访,45名HBsAg(+),阳性率为5.21%.结论青海省育龄期妇女仍有一定比例乙肝感染者,乙肝疫苗和乙肝免疫球蛋白联合阻断效果好,对于阳性产妇和儿童仍需加强乙肝疫苗以及乙肝免疫球蛋白注射.

Objective To evaluate the status of mother to child blocking of hepatitis B virus and to understand post-vaccination serological status among infants of hepatitis B surface antigen (HBsAg) positive mothers in multi-ethnic areas of Qinghai province. Methods From May 1, 2016 to April 30, 2017, all pregnant women who delivered newborns in hospitals within Qinghai province were screened for HBsAg. Free injections of hepatitis B immunoglobulin (HBIG, 100 units) were provided for newborns of HBsAg positive mothers within 12 hours after birth. Three doses of hepatitis B vaccine (10 μg recombinant Hanson yeast) were inoculated according to the immunization procedure of 0, 1 and 6 months. After the whole course of immunization, fingertip blood samples were collected monthly (1-3 months) for rapid screening of HBsAg. Venous blood samples were collected from patient with positive results for quantitative detection of hepatitis B antigen. Results A total of 60 027 pregnant women in Qinghai province participated in the screening test, and 1 912 pregnant women were HBsAg positive. The positive rate was 3.19%. A total of 57 557 liveborn infants were surveyed. The vaccination rate of hepatitis B vaccine within 24 hours was 97.11%. Among liveborn infants of HBsAg positive mothers, the vaccination rate of hepatitis B vaccine and injection rate of HBIG within 12 hours after delivery were 94.78% and 97.15%, respectively. For 864 newborns who finished follow-up survey, 45 were HBsAg positve and the positive rate was 5.21%. Conclusions A certain proportion of women of childbearing age were infected with hepatitis B in Qinghai province. Statisfactory results of blocking by hepatitis B vaccine and HBIG were obtaiend. Injection of hepatitis B vaccine and HBIG for HBsAg positive mothers and children should be strengthened.