A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population

AIM:To examine the determinants of maternal-neonatal transmission of hepatitis B virus(HBV) METHODS:A nested case-control study was conducted in Changsha,Hunan,People's Republic of China from January 1,2005 to September 31,2006 To avoid potential maternal blood contamination,we collected vein blood of newborns immediately after birth and before initial hepatitis B vaccination to determine the HBV infection status of the newborn For each HBsAg-positive infant,one HBsAg-negative infant born to an HBsAg-positive mother was matched by hospital at birth(same),gender(same),and date of birth(within 1 mo) A faceto-face interview was conducted to collect clinical and epidemiological data Conditional logistic regression analysis was used to estimate the independent effects of various determinants on maternal-neonatal transmission of HBV RESULTS:A total of 141 HBsAg-positive infants and 141 individually matched HBsAg-negative infants were included in the final analysis Maternal first-degree family history of HBV infection,intrahepatic cholestasis,and premature rupture of membranes were risk factors for perinatal transmission of HBV,whereas systematic treatment and HBV immunoglobulin injections for mothers with HBV infection were protective factors for maternal-neonatal transmission of HBV,after adjustment for potential confounding factors CONCLUSION:For HBsAg-positive mothers,systematic treatment,HBV immunoglobulin administration,and controlling intrahepatic cholestasis and pregnancy complications may reduce the incidence of perinatal transmission of HBV.

2004年加拿大预防血透病人医院血流感染的成本-效益分析

目的:血液透析相关的血流感染是一个严重的公共健康问题,因为加拿大的血液透析病人从1996年到2005翻了一番。本研究目的在于确定加拿大医院血流感染的成本,估算在综合性医院中建立感染控制项目的成本,并进行成本-效益分析。材料与方法:用加拿大医院感染监测项目的数据来估算医院血流感染的发生率。用加拿大健康信息所数据来估算2004年加拿大平均一次血流感染住院的额外成本。建立和维护一个感染控制项目的成本用美国疾病预防与控制中心1985年的成本换算为2004年的加拿大成本来估算。假设感染控制项目能降低医院血流感染病例的20%～30%。结果:2004年的加拿大15278名血液透析病人中估计共有2524人发生血流感染。全年用于治疗血流感染的成本估计为4901万加元。医院血流感染预防和人力资源的总投资成本为815万加元。建立医院感染控制项目后能带来1452万加元的医疗成本节约。效益成本比在1.0:1到1.8:1之间。结论:本研究提供的证据表明,如果医院感染控制项目能降低20%～30%的感染,该项目的经济效益将远超过增加的成本。医院感染控制项目将带来双重效益:节约货币成本的同时改善医疗质量。