Medscape:预防围产期乙肝传播

StephenW

Prevention of Perinatal Hepatitis B Transmission

Hello. I am Sarah Schillie, a physician in the Division of Viral Hepatitis at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. I am happy to speak with you today as part of the CDC Expert Commentary Series on Medscape.

Today I will be discussing the results of a study in the journal Pediatrics[1] that examined outcomes of infants born to women infected with hepatitis B virus (HBV). Perinatal exposure is an important mode of HBV transmission, resulting in chronic disease in approximately 90% of infected infants. Immunoprophylaxis consisting of HBV vaccine and HBV immune globulin given within 12 hours of birth, and completion of the three-dose HBV vaccine series, are the cornerstones of perinatal HBV infection prevention. Immunoprophylaxis for infants born to hepatitis B surface antigen-positive mothers reduces up to 95% of perinatal HBV infections.

However, despite recommended immunoprophylaxis, the study showed that perinatal HBV transmission still occurs in approximately 1% of vaccinated infants born to infected mothers. Infection occurs more commonly among infants born to mothers who are younger, who are Asian/Pacific Islander, who are HBV e-antigen positive, or who have high viral loads, as well as among infants who receive fewer than three HBV vaccine doses.

Perinatal HBV transmission may be further reduced by identifying pregnant women at the greatest risk of transmitting the virus to their infants and providing these women with antiviral therapy prior to delivery. Those at most risk include mothers with high viral loads or who are HBV e-antigen positive.

Preventing perinatal HBV transmission is a critical part of the national strategy to eliminate HBV infection in the United States. It's important for healthcare providers to understand that HBV in pregnant women poses a serious risk for chronic HBV infection, liver failure, and hepatocellular carcinoma in their infants. Following national guidelines that include the universal screening of pregnant women for HBV during pregnancy, case management of mothers with HBV and their infants, provision of timely immunoprophylaxis consisting of HBV vaccine and HBV immune globulin for infants born to infected mothers, as well as routine vaccination of all infants with the HBV vaccine series with the first dose administered shortly after birth, are of paramount importance.

Web Resources

Hepatitis B Perinatal Transmission

Sarah Schillie, MD, MPH, MBA, is a medical epidemiologist with the CDC's Division of Viral Hepatitis, Vaccine Research and Policy Unit. She is a graduate of the University of Missouri School of Medicine and Columbia University's Mailman School of Public Health. Her areas of professional interest include perinatal hepatitis B infection, occupational risk for bloodborne pathogen transmission, and infection control in healthcare settings.

StephenW

预防围产期乙肝传播

您好。我是莎拉Schillie，病毒性肝炎司医师在美国疾病控制和预防中心（CDC）在佐治亚州亚特兰大市。我很高兴今天跟大家讲的疾病预防控制中心专家短评系列在Medscape表示的一部分。

今天，我将讨论在儿科杂志上的一项研究结果[1]，审查出生于感染乙肝病毒（HBV）的女性婴儿的结果。围产期曝光是乙肝病毒传播的重要模式，从而导致慢性疾病感染婴儿的约90％。免疫预防，包括乙肝疫苗和出生后12​​小时内给予乙肝免疫球蛋白，和三个剂量乙肝疫苗系列完成，是围产期HBV感染预防的基石。免疫预防出生于乙肝表面抗原阳性母亲所生的婴儿减少了高达95％的母婴传播。

然而，尽管推荐的免疫预防的研究表明，母婴传播仍然发生在出生到受感染母亲的婴儿接种约1％。发生感染较为普遍的母亲所生谁是年轻，谁是亚洲/太平洋岛民，谁是乙肝病毒e抗原阳性，或谁拥有高病毒载量，以及谁收到少于三个乙肝疫苗剂量的婴儿在婴儿当中。

母婴传播可通过识别孕妇将病毒传染给婴儿，并在交付之前向这些妇女提供抗病毒治疗的最大风险进一步降低。那些面临最大风险包括具有高病毒载量或谁的母亲是乙肝病毒e抗原阳性。

预防母婴传播是国家战略，以消除HBV感染在美国的一个关键部分。重要的是为医疗保健提供要明白，乙肝孕妇构成严重危险慢性HBV感染，肝衰竭，并且在他们的婴儿肝细胞癌。按照国家指导原则，包括孕妇乙肝病毒在怀孕期间的普遍筛查，乙肝病毒及其婴儿的母亲的案件管理，提供及时的免疫预防，包括乙肝疫苗和乙肝免疫球蛋白的出生感染的母亲，婴儿以及常规接种与乙肝疫苗系列出生后不久给予首次剂量所有的婴儿，是最为重要的。

网络资源

乙肝母婴传播

莎拉Schillie，医学博士，公共卫生硕士，工商管理硕士，是病毒性肝炎，疫苗研究和政策股的疾病预防控制中心的科医学流行病学家。她是医学密苏里学校和公共卫生的哥伦比亚大学梅尔曼学院的大学毕业生。她的专业领域包括围产期乙肝感染，职业风险的血源性病原体传播，并在医疗机构感染控制。