Residual risk of mother-to-child transmission of hepatitis B virus infection despite timely birth-dose vaccination in Cameroon (ANRS 12303): a single-centre, longitudinal observational study
Residual risk of mother-to-child transmission of hepatitis B virus infection despite timely birth-dose vaccination in Cameroon (ANRS 12303): a single-centre, longitudinal observational study
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DOI：
10.1016/s2214-109x(22)00026-2
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发表时间：
2022-03-15
影响因子：
34.3
通讯作者：
Lunel-Fabiani, Francoise
中科院分区：
文献类型：
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作者：
Shimakawa, Yusuke;Veillon, Pascal;Lunel-Fabiani, Francoise
背景在撒哈拉以南非洲地区，出生时接种B型肝炎病毒（HBV）疫苗的效果仍不理想。关于非洲国家是否应侧重于增加疫苗覆盖率或制定纳入额外措施的战略，如对高危孕妇进行围产期抗病毒预防，证据很少。为了更好地告知决策者，我们估计母婴传播的剩余风险，尽管HBV出生剂量疫苗在Camero.Methods我们做了一个单中心，纵向观察研究。孕妇在托孔贝雷区医院（喀麦隆托孔贝雷区）接受HBV表面抗原（HBsAg）系统筛查。在2009-16年出生的HBsAg阳性母亲的儿童接受了HBV出生剂量疫苗和随后在6周，10周和14周接种的三剂五价疫苗，并在2015-17年进行了前瞻性随访。在儿童中，获得毛细血管血用于HBsAg快速检测和干血斑定量HBV DNA浓度。还从HBsAg阳性儿童中收集静脉血。结果2009年1月31日至2016年12月31日，在33309名孕妇中，有22243人（66.8%）接受了产前HBV筛查，其中3901人（17.5%）HBsAg阳性。2004年（51.4%），3901名HBsAg阳性母亲所生的儿童接受了HBV出生剂量疫苗，其中1800名（89.8%）还完成了三剂五价疫苗。总的来说，目前的分析包括607名儿童谁进行了后续血清调查。在出生后24小时内接种出生剂量疫苗的儿童中，HBsAg的患病率为5.6%，出生后24-47小时接种的儿童为7.0%，出生后48-96小时接种的儿童为16.7%（p趋势=0.083）。39名感染儿童中有35名（89.7%）的母亲为HBV e抗原阳性，且HBV DNA含量高达5.3 log 10 IU/mL或以上。HBV全基因组测序证实感染的母亲-儿童对的高同一性比例为99.97-100%.Interpretation我们记录了母亲-儿童传播的重大风险，尽管及时管理的HBV出生剂量疫苗在出生后24小时内。为了达到世卫组织的消除目标，在非洲部分地区可能需要围产期抗病毒预防，此外还需要增加HBV出生剂量疫苗的覆盖面。版权所有（c）2022作者。爱思唯尔有限公司出版
Background In sub-Saharan Africa, administration of hepatitis B virus (HBV) birth-dose vaccines remains suboptimal. Evidence is scarce on whether African countries should focus on increasing vaccine coverage or developing strategies incorporating additional measures, such as peripartum antiviral prophylaxis to pregnant women at high risk. To better inform decision makers, we estimated the residual risk of mother-to-child transmission despite HBV birth- dose vaccine in Cameroon.Methods We did a single-centre, longitudinal observational study. Pregnant women were systematically screened for HBV surface antigen (HBsAg) at Tokombere District Hospital (Tokombere district, Cameroon). Children born to HBsAg-positive mothers in 2009-16 who received the HBV birth-dose vaccine and three subsequent doses of pentavalent vaccine at 6, 10, and 14 weeks were followed up prospectively in 2015-17. In children, capillary blood was obtained for HBsAg rapid test and dried blood spots to quantify HBV DNA concentrations. Venous blood was also collected from HBsAg-positive children. Mother-to-child transmission was confirmed by whole-genome sequencing.Findings Between Jan 31, 2009, and Dec 31, 2016, 22 243 (66.8%) of 33 309 pregnant women accepted antenatal HBV screening, of whom 3901 (17.5%) were HBsAg positive. 2004 (51.4%) of 3901 children who were born to HBsAg-positive mothers received the HBV birth-dose vaccine, of whom 1800 (89.8%) also completed the three-dose pentavalent vaccine. In total, the current analysis included 607 children who had a follow-up serosurvey. The prevalence of HBsAg was 5.6% in children who received the birth-dose vaccine in less than 24 h, 7.0% in those who received it 24-47 h after birth, and 16.7% in those who received it 48-96 h after birth (p trend=0.083). 35 (89.7%) of 39 infected children were born to mothers positive for HBV e antigen with high HBV DNA of 5.3 log 10 IU/mL or more. Whole-genome sequencing of HBV in infected mother-child pairs confirmed high identity proportions of 99.97-100%.Interpretation We documented a substantial risk of mother-to-child transmission despite timely administration of the HBV birth-dose vaccine within 24 h after birth. To reach WHO's elimination targets, peripartum antiviral prophylaxis might be required in parts of Africa, in addition to increasing coverage of the HBV birth-dose vaccine. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.