Universal screening for hepatitis B among pregnant women led to 96% vaccination coverage among newborns of HBsAg positive mothers in Denmark

In Denmark selective screening programs of pregnant women for hepatitis B missed 30-50% of high-risk groups and in late 2005 a universal screening of pregnant women for HBsAg was implemented.During a 2-year period a prospective enhanced surveillance of the universal screening was performed to examine the effectiveness of universal HBV-screening of pregnant women and HBV-immunizations of their newborn, and to provide a prevalence-estimate for HBV in Denmark. On a opt out basis all women in Denmark attending antenatal care were tested for hepatitis B serology. Vaccination data of the newborns and households of HBsAg positive pregnant women were assembled.Among 140,376 HBsAg tests of pregnant women, 371 (0.26%) were positive. The prevalence among women of Danish origin was 0.012% and 2.74% among foreign born women, highest for women from Southeast Asia (14.5%). Genotype C was the most prevalent (37%) and 13% had a HBVDNA ≥10⁸ IU/ml. The prevalence estimate of chronic hepatitis B in Denmark was 0.2-0.3% in the general population.Among children born within the project period, 96% received vaccination at birth compared to 50% of siblings born prior to universal screening. During 3 years of passive follow-up two transmissions (0.5%) have been notified. Among children born of the positive mothers prior to the trial-period 7.3% had been notified.Thus the prevalence of HBV positive mothers has more than doubled in Denmark over the last 40 years, but among women of Danish origin it has decreased 10-fold. By replacing selective screening with universal, identification of newborns in need of HBV-immunization was increased from 50% to almost complete coverage, and also identifies mothers with high viral load for evaluation of pre-term treatment to interrupt in utero transmission.     

Long-term immunity to hepatitis B following vaccination in infancy: Real-world data analysis

BackgroundHepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infections and their sequelae. However, whether vaccination at birth provides lifelong protection is unclear.ObjectiveTo assess long-term immunity following neonatal HBV immunization in a large population-based cohort.MethodsUsing the database of a 2 million member sick fund in Israel, we identified all subjects born after introduction of universal HBV vaccination in Israel (January 1992 through December 2014), that were tested for hepatitis B surface antibody (anti-HBs Ab's). Years since vaccination were categorized into 5-year groups and linear trends in the seroprevalence of HBV immunity were calculated. Anamnestic response and presence of Hepatitis B surface antigen (HBs Ag) were assessed.ResultsIncluded were 20,634 tested individuals. Mean (±SD) age at testing was 14.8 (±5.4) years. Mean anti-HBs Ab levels declined with time to 16.39 mIU/ml in the 15–20 year group (P < 0.001). The proportion of negative results increased gradually (P < 0.001) to 66.7% after 15 years. Anamnestic response assessment showed that 604 of 644 seronegative subjects (93.8%, 95% CI: 91.6–95.5%) became seropositive after a booster dose. HBs Ag was identified in 91 of the 20,634 (4.4 per 1000 study participants).ConclusionsFollowing vaccination, anti-HB's Ab's progressively decline, with only a third of the population retaining protective levels after 15 years. In adolescence, anamnestic response shows that nearly all revaccinated adolescents exhibit immunity. A low rate of Hepatitis B infection was demonstrated despite vaccination of nearly all newborns.     

Prevalence of hepatitis B markers in the population of catalonia (Spain). Rationale for universal vaccination of adolescents

The prevalence of hepatitis B markers was determined in a representative sample of the general population of Catalonia (Spain). HBsAg was found in 0.5% of children (less than 15 years of age) and in 1.7% of adults (more than 15 years of age), and anti HBs in 1.6% and 18%, respecitvely. Age-specific prevalence for both markers showed a low risk for hepatitis B before puberty, and a progressive rise since adolescence, suggesting that perinatal transmission and horizontal transmission in children are relatively uncommon in Spain. Prevalence of hepatitis B markers was significantly higher among subjects with low education level, residing in an urban area and born outside Catalonia, but in the stratified analysis, a statistical significant difference was only maintained in the prevalence of HBV markers between those who live in urban and rural areas, and between those who were born outside Catalonia and in Catalonia. These data may be used as a basis for a strategy of hepatitis B prevention in Spain which include universal vaccination of adolescents, passive-active immunization of newborns to HBsAg positive mothers and vaccination of susceptible adults subjects from high-risk groups.Preventive Medicine Unit.Liver Unit.Corresponding author.     

Hepatitis B immunity in adolescents and necessity for boost vaccination: 23 years after nationwide hepatitis B virus vaccination program in Taiwan

The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15–18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984–1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.     

替比夫定联合乙肝免疫球蛋白对乙肝病毒母婴传播的阻断效果

目的探讨替比夫定联合乙肝免疫球蛋白对乙肝病毒母婴传播的阻断效果。方法选择2017年1月至2018年7月我院收治的乙型肝炎病毒表面抗原阳性的产妇130例,随机分为两组各65例。对照组单用乙肝免疫球蛋白治疗,观察组在对照组基础上加用替比夫定治疗。比较两组产妇治疗前后的乙肝病毒脱氧核糖核酸(HBV-DNA)水平,以及新生儿出生12个月后乙肝标志物阳性率。结果治疗后,观察组产妇的HBV-DNA水平显著低于对照组(P<0.05)。观察组新生儿出生12个月后的乙肝表面抗原(HBsAg)、乙肝病毒脱氧核糖核酸(HBV-DNA)阳性率均显著低于对照组(P<0.05)。结论替比夫定联合乙肝免疫球蛋白可有效降低产妇血清中HBV DNA的承载量,降低新生儿乙肝标志物阳性率,提高乙肝病毒母婴传播的阻断效果。     

Seroepidemiological study of hepatitis B virus markers in Japan

BackgroundIn Japan, since 1986, selective vaccination has been implemented as a hepatitis B prevention strategy. The target of vaccination is the infant born to a hepatitis B surface antigen (HBsAg)-positive mother. The current Japanese hepatitis B prevention strategy focuses on reducing the number of HBV carriers but overlooks the risk to susceptible populations. We conducted a nationwide HBV seroepidemiological study to explore the next hepatitis B control strategy.MethodsWe used sera derived from healthy individuals collected nationwide from 2005 through 2011 to investigate the HBsAg seroprevalence among children aged 4–9 years and 10–15 years (3000 samples) and hepatitis B core antibody (HBcAb) seroprevalence among people 10–39 years of age (600 samples).FindingsAmong sera from 3000 children, 5 (0.17%) specimens were HBsAg-positive. There was no significant difference in HBsAg prevalence between age groups. Among 600 samples, 15 (2.5%) were HBcAb-positive. Out of 15 samples, 4 were from teenagers. Both HBsAg- and HBcAb-positive sera were found mainly in the Southern area of Japan.ConclusionThe prevalence of HBsAg among children was 0.17% in the present study. This is higher than the prevalence reported in previous studies performed in the local area or in blood donors. The prevalence of HBcAb is also higher than we estimated. One of the reasons for this discrepancy from previous studies may be due to the small sample size and the impact of HBV high-endemic areas included in the present nationwide study. Nevertheless, our findings revealed that the opportunities for acquiring HBV infection in the susceptible population were more frequent than we thought, especially in some localities. Hepatitis B vaccination should be introduced into the routine child immunization program for susceptible populations, and the selective vaccination program should be continued for high-risk children.     

广东省乙型肝炎血清流行病学调查研究

目的了解广东省人群乙型肝炎（乙肝）病毒（HBV）感染现状,评价乙肝疫苗免疫策略的效果。方法采取多阶段随机抽样方法,对全省6县区3 927名1-59岁人群进行乙肝血清流行病学研究,用ELISA方法检测乙肝表面抗原（HBsAg）、乙肝表面抗体（抗-HBs）和乙肝核心抗体（抗-HBc）,并调查1-14岁儿童乙肝疫苗接种情况。结果广东省1-59岁人群HBsAg阳性率、抗-HBs阳性率、抗-HBc阳性率和HBV感染率经标化后分别为15.46%、61.51%、49.46%和66.20%。1-14岁人群HBsAg阳性率和HBV感染率明显低于15-59岁人群。1-4岁人群HBsAg阳性率和HBV感染率低于5-14岁人群,而抗-HBs阳性率高于5-14岁人群。HBsAg阳性率和HBV感染率：男性高于女性,农村高于城市,城市人群抗-HBs阳性率高于农村。1-4岁儿童乙肝疫苗接种率为91.90%,全程接种率89.01%,首针及时接种率为58.38%,明显高于5-14岁人群。结论广东省仍是乙肝高流行区;乙肝疫苗纳入儿童免疫策略效果显著,1-14岁人群HBsAg携带率和HBV感染有不同程度下降,1-4岁下降尤为明显。     

Materno-fetal transmission of hepatitis B virus in Ivory Coast. Plea for mass vaccination

BACKGROUND: Hepatitis B is a major public health problem in the developing countries of Africa and Asia because the prevalence of HBs antigen carriers is high. In Ivory Coast, the prevalence of HBs antigen carriers is more than 8% (6 to 29%). In these countries, in which hepatitis B is highly endemic, most infections with hepatitis B virus (HBV) occur during early childhood. The chronic carriage of HBV was found to be common in children, who played a key role in maintaining the high level of endemicity in these areas. Vaccines against HBV are effective and their introduction as part of the Expanded Program of Immunization (EPI), as recommended by the WHO, is feasible. OBJECTIVE: The aim of this study was to evaluate the prevalence of HBs antigen in pregnant women and to determine the rate of maternal transmission of HBV to the fetus, to demonstrate the importance of HBs antigen screening during pregnancy and the immunization of babies in the Ivory Coast. PATIENTS AND METHODS: Between August 1995 and February 1996, 395 women in the last three months of pregnancy (age 25 +/- 6.9 years) were screened for HBs antigen. Those testing positive were also screened for HBe antigen. Transmission of HBV in utero was studied with 322 mothers and their offspring. HBs antigen was assayed in the cord blood of the offspring of HBs antigen-positive mothers. If the test for HBs antigen was positive, HBe antigen was also assayed. Second-generation ELISA tests (MONOLISA HBs Ag and MONOLISA HBe Ag from Sanofi Pasteur) were used. Babies from HBs antigen-positive mothers were vaccinated at birth with three doses of GenHevac B.     

衡阳市居民乙型病毒性肝炎HBsAg携带率及抗-HBs流行率调查

目的了解并评价衡阳市居民乙肝病毒表面抗原（hepatitisBsurfaceantigens,HBsAg）携带率和抗体流行情况。方法于2012年6～7月采用多阶段随机抽样方法,抽取石鼓区、常宁市2个县（市区）7个乡7个村1044名1—59岁人群,进行问卷调查和血标本采集,由湖南省疾病预防控制中心统一检测HBsAg、乙型肝炎表面抗体（抗．HBs）2项指标。结果衡阳市居民乙肝HBsAg携带率为6．13％,10岁以下儿童已降至1．21％,HBsAg携带率随着年龄的增加而增长,农民HBsAg携带率高于其它职业人群。不同性别、地区、文化程度人群间无差异。衡阳市居民乙肝抗一HBs阳性率为54．21％,不同性别、年龄、地区、职业、文化程度人群间均无差异。结论衡阳市乙肝防治已达到卫生部〈〈2006—2010年全国乙型病毒性肝炎防治规划》中提出的总体目标,但乙肝防治任务依然艰巨,仍需加强新生儿乙肝疫苗接种策略,做好围产期母婴阻断;进一步加强成人健康教育与健康促进,提倡知情自愿自费接种乙肝疫苗。     

Trend in incidence of hepatitis B virus infection during a decade of universal childhood hepatitis B vaccination in Saudi Arabia

Since 1990, the national strategy to eliminate hepatitis B virus (HBV) infection in Saudi Arabia has included universal administration of HBV vaccine to all infants. From 1990 to 1995 this vaccine was also routinely administered to children at school entry. The prevalence of hepatitis B surface antigen (HBsAg) among children before this programme was reported to be 6.7%. The objective of this study was to describe the trend in incidence of HBV infection over a decade of surveillance following the introduction of this programme. From January 1990 to December 1999 a total of 30,784 cases of HBV infection (positive for HBsAg) were reported. The total number of HBV infections among children <15 years of age was 4180 cases, with a prevalence of 0.05%. The total number of HBV infections among adults was 26,604 cases, with a prevalence of 0.22%. The prevalence varied by region, ranging from 0.03% to 0.72% with a mean prevalence of 0.15%. There was a clear decline in incidence among children whereas the incidence in adults slightly rose, perhaps owing to population growth estimated to be 3.3% annually. This study showed that the universal childhood HBV vaccination programme had an enormous positive impact on HBsAg seroprevalence among children in Saudi Arabia.     

Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992–2015

In 2016, the Immunization Technical Advisory Group of the South-East Asia Region (SEAR) endorsed a regional goal to achieve ≤1% prevalence of hepatitis B surface antigen (HBsAg) among 5-year-old children by 2020. Chronic hepatitis B virus (HBV) infection is largely preventable with a birth dose of hepatitis B vaccine (HepB-BD) followed by two to three additional doses. We reviewed the progress towards hepatitis B control through vaccination in SEAR during 1992–2015. We summarized hepatitis B vaccination data and reviewed the literature to determine the prevalence of chronic HBV infection pre- and post-vaccine introduction. We used a mathematical model to determine post-vaccine prevalence of HBsAg among 5 year olds in countries lacking national serosurvey data and estimated the impact of vaccination on disease burden. Regional coverage with three doses of hepatitis B vaccine (HepB3) increased from 56% in 2011 to 87% in 2015. By 2016, 7 of 11 countries had introduced universal HepB-BD. Regional HepB-BD coverage increased from 9% in 2011 to 34% in 2015. In 2015, estimated HBsAg among 5 year olds was 1.1% with variability among countries. Myanmar (3.8%), Timor-Leste (2.7%), Indonesia (1.8%), and India (1%) had the highest prevalence of HBsAg. During 1992–2015, vaccination prevented approximately 16 million chronic HBV infections and 2.6 million related deaths. In 2015, around 197,640 perinatal HBV infections occurred in SEAR with majority occurring in India (62%), Bangladesh (24%), and Myanmar (8%). Myanmar had the highest rate of perinatal chronic HBV infections at 16 per 1000 live births. Despite significant progress in the control of HBV, SEAR needs to secure political commitment for elimination and consider additional strategies, such as promoting health facility births, universal birth dose administration, developing strong coordination between health sectors, and using alternative vaccine delivery methods, to improve HepB-BD coverage and subsequently achieve HBV control and elimination.     

Hepatitis B surface antigen seroprevalence among children in the Philippines, 2018

The World Health Organization Western Pacific Region (WPR) set a hepatitis B virus (HBV) control target to achieve HBV surface antigen (HBsAg) prevalence of <1% among children aged 5 years by 2017. The estimated HBsAg prevalence in the Philippines among adults was 16.7% during the pre-vaccine era. We estimated the HBsAg seroprevalence among children aged 5–7 years to measure the impact of vaccination.We conducted a household serosurvey, using a three-stage cluster survey methodology (provinces, clusters, and households). We estimated HBsAg prevalence using a rapid, point-of-care HBsAg test and calculated vaccination coverage by reviewing vaccination records or by caregiver recall. A questionnaire was administered to assess demographic variables for the child and family. We assessed the association between chronic HBV infection, vaccination coverage, and demographic variables, accounting for the complex survey design.Of the 2178 children tested, HBsAg was detected in 15 children [0.8%, 95% confidence interval (CI): 0.4, 1.7]. Only two of the HBsAg-positive children had been fully vaccinated against HBV. Based on documented vaccination or caregiver recall for the survey population, hepatitis B vaccine birth dose (HepB-BD) coverage was 53%, and the third dose hepatitis B vaccination (HepB3) coverage was 73 percent. Among the 1362 children with documented HepB-BD, timely HepB-BD coverage (given within 24 h of birth) was 43%; children born outside a health facility were less likely to receive a timely HepB-BD than those born in a health facility (adjusted odds ratio 0.10, 95% CI: 0.04, 0.23).HBsAg prevalence among children in the Philippines has decreased compared to the prevalence among adults in the pre-vaccination era. Strategies to further reduce HBsAg prevalence include ensuring that all children, whether born in health facilities or at home, receive a timely HepB-BD, and increasing HepB-BD and HepB3 coverage to reach the WPR goals of ≥95% coverage.     

The long-term efficacy, 13–23 years,of a plasma-derived hepatitis B vaccine in highly endemic areas in China

ObjectiveTo evaluate the long-term effectiveness of the plasma-derived hepatitis B vaccine that has been applied widely in five areas of China where HBV prevalence was highly endemic.MethodA cross-sectional investigation was conducted in 2009 at five HBV surveillance sites around China. The target study subjects of 6772 were born between 1986 and 1996 and received plasma-derived HBV vaccine. Serum samples were collected to test for HBV markers using the microparticle enzyme immunoassay.ResultsThe number of participants enrolled was 6772. The average hepatitis B surface antigen (HBsAg) prevalence was 2.01%. The birth dose group included 5052 children. In this group, the average positive rates of HBsAg and hepatitis B core antibody (anti-HBc) were 1.58% and 6.39%, respectively, and these values declined gradually from 1986 to 1996. The positive rates of anti-hepatitis B surface antibody (HBs) and the geometric mean concentration (GMC) of anti-HBs-positive subjects were 41.69% and 115.8 mIU/ml.ConclusionThe long-term effectiveness of the plasma-derived hepatitis B vaccine still provided protection 13–23 years after vaccination. It seems that a booster dose is not necessary. Enhancing the rate of the birth dose within 24 h is one of the most important measures to prevent and control HBV infection.     

衢州市乙型肝炎血清流行病学调查

目的为掌握衢州市乙型肝炎病毒(HBV)流行现状和人群免疫水平,评价我市儿童乙肝疫苗预防接种效果,为制订乙肝预防控制策略提供依据。方法按照多阶段随机抽样的方法抽取1~59岁自然人群623人,进行问卷调查,采集静脉血3mL,应用酶联免疫吸附试验检测HBV血清学指标。结果衢州市1~59岁人群HBsAg阳性率、抗-HBs阳性率和抗-HBc阳性率分别为5.78%、46.23%和24.56%;1~14岁人群HBsAg阳性率和抗-HBc阳性率低于15~59岁人群。1~4岁、5~9岁和10~14岁人群乙肝疫苗全程接种率为96.61%、97.30%和91.46%;首针及时接种率分别为91.53%、72.97%和34.15%;有乙肝疫苗免疫史人群HBsAg阳性率(0.89%)低于无乙肝疫苗免疫史人群(11.64%)。结论衢州市人群HBsAg阳性率特别是15岁以下年龄组已控制在较低水平,乙肝疫苗的广泛接种取得明显成效,但15~59岁人群HBsAg阳性率仍处于较高水平。     

上海市599名15岁以下儿童乙型肝炎感染危险因素的研究

目的 研究影响上海市15岁以下儿童感染乙型肝炎(乙肝)病毒(HBV)的危险因素,为提高儿童乙肝免疫预防效果提供依据.方法 以2006年全国乙肝血清流行病学调查上海现场的599名1～15岁儿童为研究对象,按是否感染HBV分为研究组和对照组,进行单因素分析并拟合多因素logistic回归模型,探讨影响儿童感染HBV的危险因素.结果 全部调查对象中感染HBV的儿童共有15例,感染率为2.50%.经综合考虑单因素分析和多因素分析,母亲怀孕时HBsAg状况、乙肝疫苗接种史、出生地点是影响儿童感染HBV的危险因素(P＜0.05),OR值分别为母亲HBsAg阳性者5.338,未接种乙肝疫苗者42.118,在家出生者12.239.结论 进一步降低上海市儿童HBV感染率,免疫预防的干预重点应为外来流动孕产妇和HBsAg阳性孕产妇,并应改进乡镇级医院新生儿乙肝免疫预防条件.     

蓬莱市农村人群乙肝疫苗接种和乙肝病毒感染相关性

目的分析评价乙肝疫苗免疫接种对蓬莱市农村居民乙肝病毒(HBV)感染变化的影响。方法采用多阶段整群抽样方法,对蓬莱市农村1～59岁常住人口共629人进行乙肝血清流行病学调查和乙肝疫苗接种率调查,采用ELISA法检测HB-sAg、抗-HBs、抗-HBc等乙肝标志物。结果 629名调查对象HBV感染率为22.26%,HBsAg、抗-HBs、抗-HBc阳性率分别为2.70%、62.32%、18.44%。乙肝疫苗接种率由1992年以前出生人群的18.89%提高到2002-2006年出生人群的100.00%,HBV感染率由42.11%降为1.31%;有乙肝免疫史的人群HBV感染率和HBsAg、抗-HBc阳性率均低于无乙肝疫苗免疫史人群,抗-HBs阳性率明显高于无乙肝疫苗免疫史人群,乙肝疫苗保护率为85.63%。结论从1992年使用乙肝疫苗以来,不仅有效的减少了乙肝病毒携带状态,且乙肝疫苗保护率达到较好的效果,进一步说明接种乙肝疫苗可有效防止乙肝病毒的感染。     

The end of the Australia antigen? An ecological study of the impact of universal newborn hepatitis B vaccination two decades on

Background

A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced.

Methods

A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs.

Findings

Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43–0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11–0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women.

Interpretation

The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.     

“a”决定簇变异对慢性乙型肝炎患者HBsAg与HBsAb表达的影响

目的研究＂a＂决定簇变异对慢性乙型肝炎患者乙型肝炎表面抗原（HBsAg）与表面抗体（HBsAb）表达的影响。方法收集HBsAg阳性持续6个月以上的CHB患者866例，其中789例（91．1％）仅HBsAg阳性，77例（8．9％）患者血清HBsAg与HB-sAb均阳性。从77例血清HBsAg与HBsAb双阳患者中，选择14例血清HBsAg与HBsAb双阳患者为Ⅰ组。789例HBsAg阳性患者中随机选择12例HBsAg单独阳患者为Ⅱ组对照。对HBsAg编码基因进行扩增和克隆，每例样本至少克隆15个后进行测序分析。结果Ⅰ组患者S蛋白氨基酸残基改变数量为Ⅱ组患者的2．7倍[9．52变化量／100残基vs2．43变化量／100残基（9．52％VS2．43％），P〈0．01]，且绝大多数发生在主亲水区（MHR）“a”决定簇。MHR区至少出现2残基改变的在Ⅰ组有10例（71％），Ⅱ组3例（25％）。Ⅰ组患者S蛋白残基改变常见位点为s145、s129、s126、s144和s123。这些S基因位点突变，最终形成病毒的免疫逃逸。结论CHB患者HBsAg和HBsAb共存可能与“a”决定簇变异率升高相关。“a”决定簇变异可能为乙型肝炎病毒免疫逃逸突变的一种选择。HBV免疫逃逸对疫苗接种免疫效应、临床疾病诊断和治疗策略革新等有影响。     

妊娠合并乙肝病毒感染的临床分析

目的 探讨妊娠合并乙肝病毒感染对妊娠生化指标及妊娠结局的影响.方法 回顾性对比分析642例妊娠合并乙肝病毒感染(乙肝组)和642例妊娠无乙肝病毒感染(aY-常妊娠组)的常规生化指标及妊娠结局.结果 (1)乙肝组TP,ALB显著低于正常妊娠组;TB,DB,ALT,AST,GGT,TBA,GCT显著高于正常妊娠组:ALP与正常妊娠组无差别. (2)妊娠合并乙肝病毒感染和正常妊娠母体的并发症分别为:IGT 10.8％,6.2％:GDM 10.3％,4.8％;PIH 5.3％,1.1％;产后出血11.5％,4.0％;蛋白尿17.9％,7.5％;尿WBC阳性25.5％.7-8％;尿RBC阳性21.8,6.9％;血清总胆红素升高5.8％,0.6％;肝酶升高21.8％,2.8％. (3)妊娠合并乙肝病毒感染和正常妊娠新生儿并发症的发生率分别为:早产9.7％,2.7％;黄疸32.1％,8.3％;肺炎5.6％,1.9％:小样儿3.6％,1.2％;窒息4.1％,1.2％.结论 妊娠合并乙肝病毒感染妊娠母体和新生儿各类并发症的发生率明显高于正常妊娠孕妇,临床应加强对妊娠合并乙肝病毒感染的母婴监测,减少并发症的发生,提高母婴健康.