乙肝疫苗全程及规范接种对HBV母婴阻断效果的影响

目的 分析儿童乙肝疫苗（HepB）全程接种及规范接种在乙肝母婴阻断中的作用。方法 采用队列研究的方法，以2017年佛山市HBsAg阳性产妇及其所分娩活产儿为对象，通过回顾性病历采集、儿童预防接种信息检索、儿童乙肝两对半检查结果的前瞻性跟踪管理等方法，采集母婴阻断结果及相关的影响因素。结果 本研究共追踪到母婴阻断结果的儿童5 615人，阻断成功率99.4%，失败率为0.6%；儿童出生后1年内乙肝疫苗的全程接种率为96.7%，其中三针规范（按照“0/1/6”完成）接种率为65.9 %；单因素及多因素分析结果均显示产妇HBeAg阳性（OR = 6.76,95%CI:3.22～14.19）、HepB未全程接种（OR = 2.86,95%CI:1.02～8.07）、HepB未规范接种（OR = 2.33,95%CI:1.12～4.85）是母婴阻断失败的危险因素。结论 加强HBV感染产妇分娩儿童预防接种的管理，提高儿童乙肝疫苗1年内全程及规范接种率，实施HBeAg阳性孕妇孕期抗病毒治疗，是实现全市乙肝母婴零传播的关键。

Preventive effect of full and standardized hepatitis B vaccination on mother-to-infant transmission

To analyze the effect of standardized three-dose coverage of HepB vaccine on preventing mother-tochild hepatitis B virus (HBV) transmission. Methods Mothers with HBV infection and their newborns in Foshan in 2017 were enrolled in this cohort study. Maternal and child information, children’s vaccination information, results of HBV examination were collected from the medical case management system to investigate the mother-to-infant HBV transmission prevention and the influencing factors. Results A total of 5 615 children were followed up in this study. The successful blocking rate was 99.4% and failure rate was 0.6%. The full vaccination rate within 1 year after birth was 96.7%, and the standardized vaccination rate of three doses (completed at the age of 0/1/6) was 65.9%. The results of both univariate and multivariate analyses showed HBeAg positivity in mothers (OR=6.76, 95%CI: 3.22-14.19), failure of full vaccination of HepB (OR=2.86, 95%CI: 1.02-8.07), and failure of standardized vaccination of HepB (OR=2.33, 95%CI: 1.12-4.85) were risk factors for failed prevention of mother-to-infant transmission. Conclusion Strengthening the vaccination management of children delivered by HBV-infected mothers, increasing the rate of full and standardized vaccination of children with hepatitis B vaccine within 1 year, and implementing antiviral treatment during pregnancy for HBeAg -positive pregnant women are the keys to achieve zero mother-to-infant transmission in Foshan city.