中断母婴传播乙型肝炎病毒的管理算法。

StephenW

Clin Gastroenterol Hepatol. 2018 Oct 9. pii: S1542-3565(18)31090-5. doi: 10.1016/j.cgh.2018.10.007. [Epub ahead of print]
Management Algorithm for Interrupting Mother to Child Transmission of Hepatitis B Virus.
Hou J1, Cui F2, Ding Y3, Dou X3, Duan Z4, Han G5, Jia J6, Mao Q7, Li J8, Li Z9, Liu Z10, Wei L11, Xie Q12, Yang X9, Zhang H13, Zhuang H8.
Author information

1
    Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address: [email protected].
2
    School of Public Health, Peking University, Beijing, China.
3
    Department of Infectious Diseases, Shengjing Hospital, China Medical University, Shenyang, China.
4
    Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
5
    Department of Gynecology and Obstetrics, The Second Affiliated Hospital of the Southeast University, Nanjing, China.
6
    Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
7
    Department of Infectious Diseases, Southwest Hospital, Army Medical University, Chongqing, China.
8
    School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
9
    China Foundation for Hepatitis Prevention and Control, Beijing, China.
10
    Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
11
    Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China.
12
    Department of Infectious Diseases, Ruijin Hospital, Shanghai, China.
13
    Department of Gynecology and Obstetrics, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Abstract

In areas where hepatitis B virus (HBV) is endemic, mother to child transmission (MTCT) is the major route of infection of children. Blocking MTCT of HBV would therefore reduce its prevalence. The China Foundation of Hepatitis Prevention and Control organized a team of specialists in infectious diseases, hepatology, immunology, obstetrics, and public health to develop an algorithm for interrupting MTCT of HBV, based on the most recent hepatitis B guidelines and latest evidence. This algorithm comprises 10 steps and has been adopted in clinical practice in China. Four aspects (screening, antiviral intervention during pregnancy, immunoprophylaxis, and post-vaccination serologic testing) are the core components of preventing MTCT. Although the combination of passive and active immunization in newborns of HBsAg-positive mothers reduces MTCT of HBV, this immunoprophylaxis cannot completely eradicate MTCT. In the past decade, administration of antiviral agents to pregnant women has been shown to be safe and effective in reducing MTCT of HBV in combination with immunoprophylaxis. Aiming to achieve zero MTCT, this algorithm recommends the use of antivirals during pregnancy by women with high viral loads. Preventing MTCT is key to achieving the goal of eliminating HBV as a public health threat by 2030. Implementation and enhancement of the standardized algorithm for pregnant women with chronic HBV infection and their infants is urgently needed to prevent MTCT.
KEYWORDS:

CFHPC; antiviral therapy; neonate; vaccine

PMID:
    30312789
DOI:
    10.1016/j.cgh.2018.10.007

StephenW

Clin Gastroenterol Hepatol。 2018年10月9日.pii：S1542-3565（18）31090-5。 doi：10.1016 / j.cgh.2018.10.007。 [提前打印]
中断母婴传播乙型肝炎病毒的管理算法。
侯J1，崔F2，丁Y3，窦X3，段Z4，韩G5，贾J6，毛Q7，李J8，李Z9，刘Z10，魏立11，谢Q12，杨X9，张H13，庄H8。
作者信息

1
    南方医科大学南方医院感染科，广州电子地址：[email protected]。
2
    北京大学公共卫生学院，北京，中国。
3
    中国医科大学附属盛京医院感染科，沉阳
4
    首都医科大学附属北京佑安医院人工肝中心，北京，中国。
五
    东南大学第二附属医院妇产科，南京
6
    首都医科大学附属北京友谊医院肝脏研究中心，中国北京。
7
    中国重庆市陆军医科大学西南医院感染科
8
    北京大学医学部基础医学院，北京，中国。
9
    中国肝炎预防控制基金会，中国北京。
10
    南方医科大学南方医院感染科，广州
11
    北京大学人民医院北京大学肝病研究所，北京，中国。
12
    上海瑞金医院感染科，上海
13
    首都医科大学附属北京佑安医院妇产科，北京

抽象

在乙型肝炎病毒（HBV）流行的地区，母婴传播（MTCT）是儿童感染的主要途径。因此阻断HBV的MTCT会降低其患病率。根据最新的乙型肝炎指南和最新证据，中国肝炎预防和控制基金会组建了一个传染病，肝病学，免疫学，产科和公共卫生专家团队，制定了一项中断HBV MTCT的算法。该算法包含10个步骤，已在中国临床实践中得到应用。四个方面（筛查，怀孕期间的抗病毒干预，免疫预防和疫苗接种后血清学检测）是预防MTCT的核心组成部分。虽然HBsAg阳性母亲的新生儿被动和主动免疫相结合可降低HBV的MTCT，但这种免疫预防不能完全根除MTCT。在过去的十年中，已经证明向孕妇施用抗病毒剂在减少HBV的MTCT和免疫预防方面是安全有效的。为了实现零MTCT，该算法推荐在病毒载量高的女性怀孕期间使用抗病毒药物。预防MTCT是实现到2030年消除HBV作为公共卫生威胁的目标的关键。迫切需要实施和加强慢性HBV感染孕妇及其婴儿的标准化算法以预防MTCT。
关键词：

CFHPC;抗病毒治疗;新生儿;疫苗

结论：
    30312789
DOI：
    10.1016 / j.cgh.2018.10.007