测试乙型肝炎疫苗反应早些时候的婴幼儿，疾病预防控制中

StephenW

Medscape Medical News
Test Hepatitis B Vaccine Response Earlier in Infants, CDC Says

Pam Harrison
October 09, 2015


Physicians should request postvaccination serologic testing (PVST) for infants born to hepatitis B–infected mothers between 9 and 12 months of age, the Centers for Disease Control and Prevention says in an updated recommendation.

The recommendation, published in the October 9 issue of the Morbidity and Mortality Weekly Report, shortens the interval between vaccination and PVST. Previously, the recommended timing was from 9 to 18 months of age.

Sarah Schillie, MD, from the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues note that infants born to hepatitis B–infected mothers should receive postexposure prophylaxis within 12 hours of birth, including hepatitis B (HepB) vaccine and hepatitis B immune globulin. The prophylaxis has been shown to reduce infants' risk for perinatal hepatitis B (HBV) infection.

The updated recommendations state that PVST, including tests for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs), should be performed between the ages of 9 and12 months, or 1 to 2 months after the vaccine series is completed.

"This recommendation was prompted by the discontinuation of the Hib/HepB vaccine (Comvax) and new data from the Enhanced Perinatal Hepatitis B Prevention Program supporting PVST 1–2 months after receipt of the last HepB vaccine dose, and at age ≥9 months," the authors write.

For infants born to HBsAg-positive mothers who are HBsAg negative and have an adequate response to the vaccine, PVST will show anti-HBs levels ≥10 mIU/mL. In contrast, infants whose anti-HBs levels are below 10 mIU/mL require revaccination with a second 3-dose HepB vaccine series. These infants should also be retested for anti-HBs 1–2 months after completing the vaccine series.

The authors note that PVST before the age of 9 months should be avoided, as earlier testing could detect the anti-HBs from hepatitis B immune globulin administered at birth.

"For most infants born to HBsAg-positive mothers, PVST at age 9–12 months provides opportunities for testing at two well-child visits," the authors note. "An added benefit of a shortened interval to PVST is a reduction in the period during which nonresponders are at risk for transmission from close contacts with HBV infection," they add, and it "might also increase adherence with recommendations for timely completion of PVST and conserve public health resources."

"Postvaccination seroprotection is achieved in 98% of healthy full-term infants who received a 3-dose or 4-dose HepB vaccine series, although it is lower among infants with birthweights <4.4 lbs."

Morb Mortal Wkly Rep. 2015;64:1118-1120. Full text

StephenW

WebMD医学新闻
测试乙型肝炎疫苗反应早些时候的婴幼儿，疾病预防控制中心说

帕姆·哈里森
2015年10月9号


医生应要求接种后血清学检测（PVST）出生于乙肝病毒的母亲9至12个月以下的婴儿之间，美国疾病控制和预防说，在一个更​​新的建议。

该建议，发表在10月9日出版的发病率和死亡率周报，缩短了疫苗接种和PVST之间的时间间隔。此前，推荐的时间是从9到18个月的年龄。

莎拉Schillie医师，病毒性肝炎司，国家中心的艾滋病毒/艾滋病，病毒性肝炎，性病和结核病预防，美国疾病控制和预防，亚特兰大，佐治亚和同事指出，出生于肝炎婴儿B-感染母亲应出生后12​​小时，包括乙型肝炎（乙肝）疫苗和乙肝免疫球蛋白内收到暴露后预防。预防已证明减少婴儿的风险围产期乙型肝炎（HBV）感染。

更新的建议指出PVST，包括测试乙肝表面抗原（HBsAg）和抗体对HBsAg（抗-HBs），应的9 AND12个月，或1至2个月的年龄之间进行的疫苗系列完成后。

“这个建议得到提示的Hib疫苗/乙肝疫苗（Comvax）从加强围产期预防乙型肝炎程序支持PVST收到最后一份乙肝疫苗剂量后1-2个月，并且在岁≥9个月停产和新的数据， “作者写道。

对于非婚生谁是HBsAg阴性，并有对疫苗的充分反应HBsAg阳性母亲的新生儿，PVST将呈现抗-HBs水平≥10MIU /毫升。与此相反，婴儿的抗-HBs水平低于10 MIU /毫升需要复种与第二3剂乙肝疫苗系列。这些婴儿也应在完成系列疫苗后重新检测抗-HBs 1-2个月。

作者指出，应避免的9月龄之前PVST，如先前测试可能从乙肝免疫球蛋白给药在出生检测抗HBs。

“对于大多数所生婴儿乙肝表面抗原阳性母亲，PVST年龄在9-12个月内提供两个健康儿童访问进行测试的机会，”作者指出。 “缩短间隔PVST的一个好处是在此期间减少了在此期间，无应答者是在危险中从与HBV感染，密切接触传播”他们补充说，它“还可能增加与及时完成PVST和建议，坚持节约卫生资源。“

“疫苗接种后血清保护是在98％的谁收到了3剂量或4剂量HepB是系列健康足月婴儿实现的，虽然它是用出生体重婴儿<4.4英镑之间低”。

MORB凡人Wkly众议员2015; 64：1118年至1120年。全文