针对新生儿HBV检测的CDC指南更新防止错误分类

StephenW

Updated CDC guidelines for neonatal HBV testing prevent misclassification      
                      June 28, 2017      
                                             

PHILADELPHIA — Shortening the time frame in which an infant receives post-vaccination serologic testing for hepatitis B from 9 to 18 months to 9 to 12 months may increase adherence for testing in accordance with CDC guidelines and lessen the time in which nonresponders may come into close contact with the infection, according to a recent presentation at the annual meeting of the American Association of Nurse Practitioners.

“If the mother tests negative for hepatitis B earlier in her pregnancy but comes into contact and picks up the infection later, we absolutely want to make sure that the baby is vaccinated,” Mary Koslap-Petraco, DNP, PNP-BC, CPNP, FAANP, from Stony Brook University School of Nursing, told Infectious Diseases in Children. “It will dramatically decrease the chance that they will go on to be a hepatitis B carrier.”

This recommendation for a shorter duration for testing by the CDC was due to the discontinuation of Hib/HepB vaccine. This is especially important because perinatal hepatitis B causes a chronic infection in 90% of infants infected through delivery or while in utero. According Koslap-Petraco, nearly 25% of infants who acquire the infection perinatally will have an increased risk of premature death from liver cancer.

To evaluate the updated CDC guidelines regarding hepatitis B vaccination, which recommended shortening the interval for post-vaccination serologic testing (PVST) from 9 to 18 months to 9 to 12 months, Koslap-Petraco and colleagues determined how a busy practice may be able to implement this recommendation.

According to Koslap-Petraco and colleagues, the updated guideline may conserve case management services and other public health resources. When infants are tested at increasing intervals after their last vaccine, they may also be misclassified as non-responders because of lower levels of anti-HB. This can result in unnecessary revaccination. The researchers claim that the decreased time frame suggested by the CDC will reduce the chance of misclassification and prevent revaccination in infants who do not need it.

“That birth dose [of the vaccine] is so important. Make sure that baby gets that,” Koslap-Petraco said. “If they’re born to a positive mother, then of course the birth dose and the additional HepB [should be given] within 12 hours of birth. We want to make sure all babies get the birth dose and finish the series on time at 6 months of age.” — by Katherine Bortz

Reference:
Koslap-Petraco M, et al. Hepatitis B in newborns: The updated Centers for Disease Control and Prevention guidelines and how to implement them in your busy practice. Presented at: American Association of Nurse Practitioners National Conference; June 20-25, 2017; Philadelphia.

StephenW

针对新生儿HBV检测的CDC指南更新防止错误分类
2017年6月28日

PHILADELPHIA - 缩短婴儿从9至18个月至9至12个月接种乙型肝炎接种后血清学检测的时间范围可能会增加遵照CDC指南进行测试的依从性，并减少无应答者可能接近的时间根据最近在美国护士执业者协会年会上的介绍，接触感染。

PNP-BC，CPNP，DNP，美国国家科学院院士Mary Koslap-Petraco，“如果母亲在怀孕早些时候检测出乙型肝炎阴性，接下来感染后，我们绝对要确保婴儿接种疫苗，来自石溪大学护理学院的FAANP告诉儿童传染病。 “这将大大减少他们继续成为乙型肝炎携带者的机会。”

CDC提出的测试时间较短的建议是由于Hib / HepB疫苗的停用。这是特别重要的，因为围产期乙型肝炎在通过分娩感染或在子宫内感染的90％的婴儿中引起慢性感染。据Koslap-Petraco介绍，近25％接受围生期感染的婴儿会有增加肝癌过早死亡的风险。

为了评估更新的CDC乙型肝炎疫苗接种指南，该建议将疫苗接种后血清学检测（PVST）的间隔时间缩短为9至18个月至9至12个月，Koslap-Petraco及其同事确定了一项繁忙的做法可能如何实施这个建议。

据Koslap-Petraco及其同事说，更新的指导方针可能会保护病例管理服务和其他公共卫生资源。当婴儿在最后一次疫苗后以更长的时间间隔进行测试时，由于抗HB水平较低，它们也可能被错误分类为无应答者。这可能导致不必要的再次接种。研究人员声称，CDC建议的时间减少将减少错误分类的机会，并防止不需要婴儿的再次接种。

“疫苗的出生剂量如此重要。确保宝宝得到这个，“Koslap-Petraco说。 “如果他们出生于积极的母亲，那么当然是在出生后12小时内出生剂量和额外的HepB [应该给予]。我们希望确保所有的婴儿都能获得出生剂量，并在6个月大的时间内完成系列作品。“ - 由Katherine Bortz

参考：
Koslap-Petraco M，et al。新生儿乙型肝炎：更新的疾病控制和预防中心指南以及如何在繁忙的实践中实施。主持人：美国护士执业者全国会议; 2017年6月20日至25日费城