Impact of the thimerosal controversy on hepatitis B vaccine coverage of infants born to women of unknown hepatitis B surface antigen status in Michigan
Impact of the thimerosal controversy on hepatitis B vaccine coverage of infants born to women of unknown hepatitis B surface antigen status in Michigan
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DOI：
10.1542/peds.111.6.e645
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发表时间：
2003-06-01
期刊：
影响因子：
8
通讯作者：
Stoltman, G
中科院分区：
文献类型：
--
作者：
Biroscak, BJ;Fiore, AE;Stoltman, G
客观的。建议所有婴儿接种乙型肝炎疫苗，该系列疫苗可在分娩入院期间开始。对于乙型肝炎表面抗原（HBsAg）阳性的女性或HBsAg状态未知的女性所生的婴儿，应在出生后12小时内开始接种疫苗，以预防围产期和幼儿期乙型肝炎病毒感染。由于担心含有硫柳汞的疫苗会导致汞暴露，美国公共卫生服务署 (USPHS) 和美国儿科学会 (AAP) 于 1999 年 7 月建议将第一剂乙型肝炎疫苗推迟到 2 - 6 个月大时接种，但仅限于 HBsAg 阴性妇女所生的婴儿。为了评估 HBsAg 状态未知的妇女所生婴儿的出生剂量疫苗覆盖率的影响，我们测量了 1999 年 7 月前后的覆盖率。方法。通过审查 1) 1999 年 4 月 1 日（建议变更之前 [T1]）期间出生的婴儿的新生儿筛查卡，确定了 HBsAg 状态未知或缺失的妇女所生的密歇根州婴儿样本； 2) 1999年7月15日至9月15日（推荐变更后立即[T2]）； 3) 2000 年 3 月至 4 月（建议恢复 1999 年之前的做法后 6 个月[T3]）。我们通过审查婴儿和孕产妇医院记录来验证孕产妇 HBsAg 筛查和新生儿乙型肝炎疫苗接种。结果。在这 3 个时间段内，新生儿筛查卡上 HBsAg 状况显示为未知或缺失的妇女所生的 1201 名婴儿中，根据医疗记录审查确定，有 216 名 (18%) 是在分娩时状况确实不明的妇女所生。在 T1 期间，这 216 名婴儿中有 53% 在出院前接种了乙型肝炎疫苗，而在 T2 期间出生的婴儿中这一比例为 7%，在 T3 期间出生的婴儿中这一比例为 57%。在 T1 期间，19% 的婴儿在出生后 12 小时内接种了乙型肝炎疫苗，而在 T2 期间出生的婴儿中这一比例为 1%，在 T3 期间出生的婴儿中这一比例为 14%。结论。在 1999 年 7 月 USPHS/AAP 联合声明发布之前，密歇根州对于分娩时 HBsAg 状况未知的妇女所生婴儿的乙型肝炎疫苗出生剂量覆盖率已经很低，但在 USPHS/AAP 联合声明发布后的 2 个月内显着下降。针对低风险儿童的既定疫苗接种建议的突然变化可能会导致高风险儿童的覆盖率下降。增加出生时乙型肝炎疫苗的覆盖率对于降低 HBsAg 状况未知的妇女所生婴儿的围产期感染风险是必要的。
Objective. Hepatitis B vaccine is recommended for all infants, and the series may be started during the delivery admission. For infants who are born either to women who are positive for hepatitis B surface antigen ( HBsAg) or to women whose HBsAg status is unknown, vaccination should be started within 12 hours of birth to prevent perinatal and early childhood hepatitis B virus infection. Because of concerns about mercury exposures from vaccines that contain thimerosal, the United States Public Health Service ( USPHS) and the American Academy of Pediatrics (AAP) recommended in July 1999 that the first dose of hepatitis B vaccine be deferred until 2 - 6 months of age but only for infants who are born to HBsAg-negative women. To assess the impact on birth-dose vaccine coverage for infants who are born to women with unknown HBsAg status, we measured coverage before and after July 1999.Methods. A sample of Michigan infants who were born to women whose HBsAg status was either unknown or missing were identified by reviewing newborn screening cards for infants who were born during 1) March April 1999 ( before recommendation changes [T1]); 2) July 15 - September 15, 1999 ( immediately after recommendation changes [T2]); and 3) March - April 2000 ( 6 months after resumption of pre-1999 practices were recommended [T3]). We verified maternal HBsAg screening and newborn hepatitis B vaccination by reviewing infant and maternal hospital records.Results. Of 1201 infants who were born to women whose HBsAg status was indicated as unknown or missing on the newborn screening card during the 3 time periods, 216 (18%) were born to women whose status was truly unknown at the time of delivery, as determined by medical record review. During T1, 53% of these 216 infants received hepatitis B vaccine before hospital discharge, compared with 7% of infants who were born during T2 and 57% of infants who were born during T3. During T1, 19% of these infants received hepatitis B vaccine within 12 hours of birth compared with 1% of infants who were born during T2 and 14% of infants who were born during T3.Conclusions. Hepatitis B vaccine birth-dose coverage for infants who were born to women whose HBsAg status was unknown at the time of delivery was already low in Michigan before the July 1999 USPHS/AAP Joint Statement but decreased significantly during the 2 months after the USPHS/AAP Joint Statement. Abrupt changes in established vaccination recommendations for lower risk children may lead to decreased coverage among higher risk children. Increases in hepatitis B vaccine coverage at birth are necessary to reduce the risk of perinatal infection for infants who are born to women with unknown HBsAg status.