乙肝e抗原，接种疫苗较少升压婴儿的风险 产妇的病毒载量，

StephenW

HepB e-Antigen, Fewer Vaccinations Boost Baby's Risk
Maternal viral load, mother's age are additional risk factors.

   

    by Molly Walker
    Contributing Writer

Action Points

    Infants born to mothers with hepatitis B (HBV) were more likely to develop the infection themselves if their mothers had more severe forms of HBV or they received fewer than the required number of HBV vaccine doses at birth.
    Note that although only 1.1% of infants developed a HBV infection after birth, 90% of infected infants will develop chronic infections with a 25% risk of premature death due to complications of the disease.

Infants born to mothers with hepatitis B (HBV) were more likely to develop the infection themselves if their mothers had more severe forms of HBV or they received fewer than the required number of HBV vaccine doses at birth, according to data from several small publicly funded health programs.

Perinatal hepatitis B infection was associated with "maternal hepatitis B e-antigen positivity (P<0.01), maternal antibody to hepatitis B e-antigen (HBeAg) negativity (P<0.01), maternal viral load ≥2000 IU/mL (P=0.04), and infant receipt of fewer than three HepB vaccine doses (P=0.01)," reported Sarah Schillie, MD, MPH, MBA, division of viral hepatitis at the Centers for Disease Control and Prevention in Atlanta, and colleagues.
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Researchers examined data from 17,951 mothers and infants from 2007 to 2013 at five publicly funded health immunization programs with an unusually high proportion of hepatitis B surface antigen- (HBsAg) positive births (≥400 births per year). These Enhanced Perinatal Hepatitis B Prevention Program (EPHBPP) sites had 9,252 infants (51.5%) with available HBsAg testing results.

While only 1.1% of those (100 infants) developed an HBV infection after birth, the authors note that overall, 90% of infected infants will develop chronic infections with a 25% risk of premature death due to complications of the disease, they wrote in Pediatrics.

HBeAg antigen status affected infant outcomes, as mothers who were HBeAg positive or negative for anti-HBe delivered a higher percentage of infected infants (3.2%, respectively) than HBeAg-negative and anti-HBe-positive mothers, where 0% and 0.2% (one infant), respectively, became infected after birth.

A greater portion of infants who did not receive the ACIP-recommended ≥3 doses of HepB vaccine developed a perinatal HBV infection. Of those infants who received <3 vaccine doses, 6.7% (three of 45) tested positive for HBV compared with 1.1% infants (97 of 9,207) who received the recommended vaccine dosage.

Demographic characteristics such as Asian/Pacific Islander status (P<0.01) and younger maternal age (specifically <25 to 29 years, P=0.01) were also associated with a higher infection rate. However, the authors note that the majority of patients at these EPHBPP sites were of Asian/Pacific Islander descent (61.2%), and foreign-born (88.7%), and a previous study found "young infected females in East Asia" had the highest proportion of HBeAg positivity. In addition, they wrote that "HBeAg positivity" tends to decline with age, which would explain the association between maternal age and HBV-infected infants.

Limitations to the study include the fact that 48.5% (8,699) of the mother-infant pairs in the sample were not tested for infection, and the authors note their analysis only included those who completed "post-vaccination serological testing." This limited data also prevented the authors from performing a more complex analysis that could have controlled for confounding variables. The authors also note that HBeAg positivity may be overestimated, due to public health laboratory reporting requirements.

In an accompanying editorial, Ravi Jhaveri, MD, division of pediatric infectious diseases at the University of North Carolina at Chapel Hill School of Medicine said that while there is "good news" in this study, there is still more work to be done in preventing the spread of HBV to infants. He specifically mentions a program already being implemented to test women who are HBsAg-positive for the e-antigen and start them on antiviral therapy to help prevent transmission to their infants, but said that it needs additional testing.

"Further studies are important because there are tangible downstream risks to using antiviral agents during pregnancy," Jhaveri wrote.

Schillie and colleagues agreed that the study demonstrated a need for additional research on ways to minimize vertical transmission of HBV.

"The identification of women with a higher risk of perinatal HBV transmission in the context of optimal post-exposure prophylaxis suggests that interventions such as maternal antiviral therapy might further decrease or eliminate perinatal HBV infections," they concluded.

The study was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the CDC.

Schille and co-authors report they have no conflicts of interest to disclose.

Jhaveri reports he has no conflicts of interest to disclose.

    Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

StephenW

乙肝e抗原，接种疫苗较少升压婴儿的风险
产妇的病毒载量，母亲的年龄是额外的风险因素。

   

    由莫利·沃克
    特约作家

行动要点

    出生与乙型肝炎（HBV）的婴儿的母亲更容易发展感染自己，如果他们的母亲有乙肝病毒更严重的形式，或他们收到比乙肝疫苗剂量的诞生所需要的数量少。
    注意，尽管只有1.1％的婴儿开发了HBV感染在出生后，90％的受感染的婴儿会发展成慢性感染的过早死亡的25％的风险，由于该疾病的并发症。

出生与乙型肝炎（HBV）的婴儿的母亲更容易发展感染自己，如果他们的母亲有乙肝病毒更严重的形式，或他们收到比乙肝疫苗剂量的诞生所需要的数量少，据来自几个小公共资助的数据保健方案。

围产期乙肝感染与“母婴乙肝e抗原阳性（P <0.01），母源抗体对乙肝e抗原（HBeAg）阳性阴性（P <0.01），产妇的病毒载量≥2000IU /毫升（P =相关0.04），和婴儿收到少于三个乙肝疫苗剂量（P = 0.01），“报道莎拉Schillie，MD，MPH，MBA，病毒性肝炎在疾病控制中心和预防在亚特兰大，和同事分工。
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研究人员检查从17951母亲和婴儿2007年至2013年的数据，在5公费免疫规划用一个不同寻常的高比例的乙肝表面抗原（HBsAg的）阳性胎（每年≥400出生）。这些增强围产期乙肝预防计划（EPHBPP）网站有9252例（51.5％），与现有的HBsAg检测结果。

虽然只有1.1％的那些（100名婴儿）开发的HBV感染出生后，作者指出，总体而言，90％的受感染的婴儿会发展成慢性感染过早死亡的25％的风险，由于该病的并发症，他们写道：儿科。

大三阳抗原状况影响婴儿结局，因为谁是HBeAg阳性或阴性，抗-HBe交付感染的婴儿比HBeAg阴性及抗HBe阳性的母亲，其中0％和0.2％的比例更高（分别为3.2％，）的母亲（一个婴儿），分别在出生后受到感染。

婴幼儿的更大一部分谁没有收到ACIP推荐≥3剂量乙肝疫苗的研制围产期HBV感染。谁收到的婴儿<3剂疫苗，6.7％（三45）与1.1％的婴儿（9,207的97），谁收到的推荐剂量的疫苗相比，测试呈阳性乙肝病毒。

人口特征，如亚洲/太平洋岛民状态（P <0.01）和年轻的产妇年龄（特别是<25〜29岁，P = 0.01）也有较高的感染率有关。然而，作者指出，多数患者在这些EPHBPP网站是亚洲/太平洋岛民裔（61.2％），而外国出生的（88.7％），而先前的研究发现，“年轻女性感染者在东亚地区”有比例最高的HBeAg阳性。此外，他们写道，“大三阳阳性”趋于下降随着年龄的增长，这可以解释产妇年龄和HBV感染婴儿之间的关联。

限制这项研究包括的事实，样品中对母婴的48.5％（8699）的感染者没有经过测试，作者注意到他们的分析只包括那些谁完成了“疫苗接种后血清学检测。”这有限的数据也阻止了作者从执行可能已经控制了混杂变量更为复杂的分析。作者还指出，e抗原阳性可能被高估，由于公共卫生实验室的报告要求。

在随后的社论，拉维Jhaveri，MD，北卡罗来纳大学医学院教堂山中学儿科感染性疾病部门表示，虽然没有在这项研究中“好消息”，还有更多的工作需要防止做乙肝病毒的婴儿的传播。他特别提到了已在执行之中，以测试妇女谁是HBsAg阳性的e抗原，并开始他们的抗病毒治疗，以帮助防止传染给婴儿一个方案，但表示，它需要额外的测试。

“进一步的研究是很重要的，因为有在怀孕期间使用抗病毒药物的有形下游风险，”Jhaveri写道。

Schillie和同事们一致认为，研究表明需要就如何尽可能减少乙肝病毒的垂直传播更多的研究。

“妇女母婴传播的最佳暴露后预防的情况下风险较高的识别表明，干预措施，如孕产妇抗病毒治疗可能会进一步减少或消除母婴传播，”他们的结论。

这项研究是由一个任命为研究参与计划在疾病控制中心的部分资助，并通过美国能源署和疾病预防控制中心之间的间协议给予了美国橡树岭研究所科学与教育。

Schille和共同作者报告说，他们没有利益冲突的披露。

Jhaveri报告他有没有利益冲突披露。

    来自罗伯特Jasmer，医学博士助理临床教授，美国加州大学，旧金山和多萝西·卡普托，MA，BSN，RN，护士策划师