The risk factors of transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China
The risk factors of transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China
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西北发展中地区乙肝病毒感染母亲暴露儿童实施常规免疫后传播的危险因素
DOI：
10.1016/j.vaccine.2012.09.031
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发表时间：
2012-11-19
期刊：
影响因子：
5.5
通讯作者：
Fan, Daiming
中科院分区：
文献类型：
--
作者：
Li, Fan;Wang, Qixia;Fan, Daiming
我们的目的是评估中国西北发展中地区乙肝病毒感染母亲暴露儿童实施常规免疫后乙肝病毒传播的现状和可能的危险因素。 2010年，中国甘肃省武威市最终招募了221名HBsAg携带者母亲及其所生的247名儿童。从这些HBsAg携带者母亲及其孩子身上采集了血清样本。检测到 HBsAg 或 HBV DNA 的儿童被视为 HBV 感染。采用条件logistic回归模型识别HBV母婴传播的潜在危险因素。 HBsAg携带者母亲所生的247名儿童中，HBsAg阳性8名（3.24%），HBV DNA阳性15名（6.07%）。乙型肝炎母婴传播率为7.29%（18/247）。单因素分析和多因素分析显示，母亲HBV DNA阳性（OR = 4.83，95% CI：1.38-16.98，p = 0.0140）、早产后第一剂乙肝疫苗延迟注射（OR = 9.73，95% CI：1.78-53.21，p = 0.0087）和漏用乙肝疫苗（OR = 8.29，95% CI：1.42-48.23，p = 0.0186）与 HBV 母婴传播风险增加显着相关。出生后同时接种乙型肝炎疫苗和乙型肝炎免疫球蛋白的儿童的乙型肝炎病毒感染率（2.56%, 4/156）低于单独接种乙型肝炎疫苗的儿童（11.39%, 9/79）（chi(2) = 7.83, p = 0.0052）。综上所述，西北地区乙型肝炎母婴传播率仍然较高。除母体HBV DNA阳性和出生后未接种乙肝疫苗外，早产后延迟注射首剂乙肝疫苗也是乙肝母婴传播的可能独立危险因素。乙肝防治指南应明确，所有新生儿，包括早产儿，均需在出生后24小时内注射乙肝疫苗。 (C) 2012 Elsevier Ltd. 保留所有权利。
We aimed to evaluate the present situation and possible risk factors of HBV transmission after the implementation of the routine immunization among children exposed to HBV infected mothers in a developing area in northwest China. Two hundred and twenty one HBsAg carrier mothers and 247 children born to them were finally recruited in Wuwei city, Gangsu province, China in 2010. Serum samples were taken from those HBsAg carrier mothers and their children. Children who had detectable HBsAg or HBV DNA were considered to be HBV infection. Conditional logistic regression model was used to identify potential risk factors of HBV mother-to-child transmission. Of the 247 children born to HBsAg carrier mothers, 8 (3.24%) were HBsAg positive, 15 (6.07%) were HBV DNA positive. The rate of HBV mother-to-child transmission was 7.29% (18/247). The univariate analysis and multivariate analysis showed that maternal HBV DNA positive (OR = 4.83, 95% CI: 1.38-16.98, p = 0.0140), the delayed injection of the first dose of HBV vaccine after premature birth (OR = 9.73,95% CI: 1.78-53.21, p = 0.0087) and the missing use of HBV vaccine (OR = 8.29, 95% CI: 1.42-48.23, p = 0.0186) were significantly associated with an increased risk for HBV mother-to-child transmission. The rate of HBV infection of the children received HBV vaccine and HBIG together after birth (2.56%, 4/156) was lower than those children received HBV vaccine alone (11.39%, 9/79) (chi(2) = 7.83, p = 0.0052). In conclusion, the rate of mother-to-child transmission of HBV was still high in the northwest of China. Besides the positivity of maternal HBV DNA and the missing of HBV vaccination after birth, the delayed injection of the first dose of HBV vaccine after premature birth was also a possible independent risk factor for HBV mother-to-child transmission. The HBV prevention and treatment guidelines should make it clear that all of the new born infants need to receive HBV vaccine injection after birth in 24 h, including the premature infants. (C) 2012 Elsevier Ltd. All rights reserved.