深圳市宝安区乙肝联合免疫时间与乙肝母婴阻断效果

Effectiveness of combined immunization time in preventing mother-to-child transmission of hepatitis B virus in Bao'an District,Shenzhen,Guangdong

目的分析2017-2021年深圳市宝安区乙肝暴露儿童接种首剂乙肝疫苗(HepB1)和注射乙肝免疫球蛋白(HBIG)的执行情况,并探讨联合免疫执行时间对乙肝母婴传播阻断效果的影响。方法收集2017-2021年在宝安区18家助产医院分娩的HBV感染产妇及其所生儿童信息,获取乙肝暴露儿童免疫后血清学检测结果,进行统计学分析。结果共7396对HBsAg阳性产妇-乙肝暴露儿童纳入研究,HepB1及时接种率由2017年的77.74%上升至2021年的99.69%;HBIG及时注射率由2017年的76.62%上升至2021年的98.77%。乙肝母婴传播率为0.31%,免疫成功率为98.42%。在0~<6 h执行联合免疫的情况下,相较于参照组(≥12 h),乙肝母婴传播的(OR=0.11,95%CI:0.02~0.53)。此外产妇HBeAg阳性也是发生母婴传播的危险因素(OR=28.50,95%CI:6.55~123.97)。结论及早执行联合免疫是预防母婴传播的保护因素,对于HBV DNA检测和抗病毒治疗条件不成熟的地区,可考虑对乙肝暴露儿童进行极早期联合免疫(出生后6 h内),以进一步降低乙肝母婴传播风险。

Objective This study aimed to analyze the administration of the first dose of hepatitis B vaccine(HepB1)and hepatitis B immune globulin(HBIG)in children exposed to hepatitis B virus(HBV)in Bao'an District,Shenzhen.Additionally,we aimed to explore the impact of the combined immunization timing on the effectiveness of mother-to-child transmission(MTCT)blockade for hepatitis B.Methods Information on mothers infected with HBV and their children born in 18 obstetric hospitals in the Bao'an District from 2017 to 2021 was collected.Serological test results for children exposed to hepatitis B after immunization were obtained for statistical analysis.Results A total of 7396 pairs of hepatitis B surface antigen-positive mothers and hepatitis B-exposed children were included in the study.The timely HepB1 vaccination rate increased from 77.74%in 2017 to 99.69%in 2021,and the HBIG injection rate increased from 76.62%in 2017 to 98.77%in 2021.The MTCT for hepatitis B was 0.31%,with an immunization success rate of 98.42%.Compared with the reference group(≥12 hours),the odds ratio(OR)for MTCT of hepatitis B was 0.11(95%CI:0.02-0.53)when combined immunization was implemented within 0 to<6 hours.Maternal hepatitis B e-antigen positivity was also a risk factor for MTCT(OR=28.50,95%CI:6.55-123.97).Conclusions Early implementation of combined immunization is a protective factor against MTCT.In areas with limited availability of HBV DNA testing and antiviral treatment,consideration should be given to extremely early combined vaccination(within 6 hours after birth)for exposed children to further reduce the risk of MTCT for hepatitis B.