Analysis of 11 infants infected through mother-to-child transmission of hepatitis B virus

doi:10.3877/cma.j.issn.1674-1358.2018.03.016

Abstract

Abstract:

Objective

To investigate the causes of HBV transmission in 11 infants, and to provide clinical evidence for further HBV reduction through mother-to-child transmission.

Methods

Total of 409 infants given birth by HBV positive mothers had been observed and tracked in Beijing Ditan Hospital, Capital Medical University from December 2010 to June 2012. All the infants were given HBV immunoglobulin (HBIG) 200 IU 2 hours after birth and 15 to 30 days after birth. Meanwhile, routine HBV vaccination (recombinant yeast hepatitis B vaccine 10 μg, 0-1-6 Scheme) was given to each infant. HBV serum markers and HBV DNA were tested at birth and followed up at 1st month, 7th month until 3 years old after birth. The 409 infants were divided into three groups according to the HBV levels of their mothers: HBV negative group (< 5 × 10² copies/ml, 147 cases), HBV DNA low level group (≥ 5 × 10² - < 1 × 10⁶ copies/ml, 124 cases) and HBV DNA high level group (≥ 1 × 10⁶ copies/ml, 138 cases). The feeding method, delivery mode, mother serum HBV DNA and HBeAg level were evaluated for the impact of mother-to-child transmission by Logistic regression analysis.

Results

There were 5 HBV positive infants who got positive HBV results from the first test (one month after birth), and kept positive in the subsequent follow-up. HBV DNA levels were higher than 1 × 10⁶ copies/ml. The transmission was considered to be intrauterine infection. The other 6 infants got HBV negative results one month after birth, and HBsAb turned to be positive. But during the follow-up, 5 cases turned to be HBV positive at the 7th month after birth and one case turned positive at the 12th month after birth. The infection time implied postpartum infection. The mother-to-child transmission rates were 0, 0.81 % (1/124) and 7.25% (10/138) in HBV DNA negative group, HBV DNA low level group and HBV DNA high level group, respectively. The relative risk of HBV transmission was 8.98 times in high HBV DNA group compared with low HBV DNA group (P = 0.01). The result of Logistic regression analysis showed that HBV DNA level of mothers was the independent risk factor for mother-to-child transmission (95%CI: 1.28-6.39, P = 0.01).

Conclusions

Through strict active-passive combined immunization of HBV, there were still risks for HBV transmission from mother to child. Besides intrauterine infection, postpartum infection was also an important reason. Especially when the passive HBsAb disappeared, meanwhile the vaccine have not establish the effective immunity, the infants were still under the risk of HBV transmission.

Key words: Hepatitis virus, Hepatitis B, Mother-to-child transmission, HBV immunoglobulin, Biological marker

Xueling Wang, Gang Wan. Analysis of 11 infants infected through mother-to-child transmission of hepatitis B virus[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(03): 282-287.

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References 25

[1]	Luo Z, Li L, Ruan B. Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period[J]. Int J Infect Dis,2012,16(2):e82-e88.
[2]	周乙华, 胡娅莉. 我国预防乙型肝炎病毒母婴传播的成就和挑战[J]. 中华医学杂志,2015,95(1):15-18.
[3]	汪雪玲, 李春梅, 刘敏, 等. 不同喂养方式对乙型肝炎病毒母婴传播的影响[J]. 中华围产医学杂志,2015,18(8):616-620.
[4]	鞠丽丽, 余敏敏, 季莹, 等. 乙型肝炎病毒宫内感染免疫失败机制的探讨[J]. 实用妇产科杂志,2010,26(8):625-628.
[5]	刘志勇, 王娜, 刘浩, 等. 乙肝血清学标志物定量检测与HBV DNA定量检测结果的相关性分析[J]. 国际检验医学杂志,2014,35(2):233-235.
[6]	赵燕青, 邸凤林, 钟彦伟. 乙型肝炎病毒宫内感染发生机制研究进展[J/CD]. 中华临床医师杂志:电子版,2015,9(8):133-136.
[7]	Chang MH. Hepatitis B virus infection[J]. Semin Fetal Neonatal Med,2007,12(3):160-167.
[8]	周瑾, 尹玉竹, 吴玲玲, 等. HBsAg阳性的1 355名孕妇乙型肝炎病毒母婴传播的随访调查[J]. 中华传染病杂志,2012,30(6):343-348.
[9]	王丽, 张艳琼, 王宇明, 等. 替比夫定与拉米夫定阻断中国HBV母婴传播效应及安全性Meta分析[J]. 传染病信息,2015(4):217-222.
[10]	胡玉红, 易为, 刘敏, 等. 慢性乙型肝炎妇女全孕期应用替比夫定的安全性研究[J]. 中华传染病杂志,2014,32(5):285-288.
[11]	中华医学会妇产科学分会产科学组. 乙型肝炎病毒母婴传播预防临床指南(第一版)[J]. 中华妇产科杂志,2013,48(2):151-154.
[12]	骆抗先, 陈金军, 李平编. 乙型肝炎基础和临床[M]. 4版. 北京: 人民卫生出版社,2012:205, 355.
[13]	杨绍基, 任红主编. 传染病学[M]. 7版. 北京: 人民卫生出版社,2010:25, 39.
[14]	Hu Y, Chen J, Wen J, et al. Effect of elective cesarean section on the risk of mother-to-child transmission of hepatitis B virus[J] BMC Pregnancy Childb,2013,13:119.
[15]	Zhou MF, Liu M, Wei YI, et al. Effect of delivery modes on blocking mother-to-child transmission of HBV in HBV-infected mothers with high viral load[J]. Infect Dis Informat,2016,29(2):85-88.
[16]	李金明, 张瑞. 常用乙型病毒性肝炎血清学标志物检测结果报告解释及临床应用[J]. 中华检验医学杂志,2012,35(4):296-300.
[17]	江红秀, 韩国荣, 王翠敏, 等. 乙型肝炎病毒e抗原阳性母亲所生婴儿联合免疫接种后乙型肝炎病毒血清学标志物的动态变化[J]. 中华肝脏病杂志,2011,19(11):818-822.
[18]	张藢莉, 赵隽. 乙型肝炎病毒感染孕妇的新生儿血清乙肝病毒标志物动态变化分析[J]. 中国生育健康杂志,2014,25(6):499-504.
[19]	Zhang L, Gui X, Fan J, et al. Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus[J]. J Matern Fetal Neonatal Med,2014:27(2):182-186.
[20]	白淑芬, 李萍, 陈庚, 等. 迟发表现的乙型肝炎病毒宫内感染免疫失败临床分析[J]. 中华实用诊断与治疗杂志,2012,26(6):623-624.
[21]	王建设, 朱启镕. 乙型肝炎表面抗原阳性母亲的婴儿乙型肝炎疫苗单独及与乙型肝炎免疫球蛋白联合免疫后的长期随访研究[J]. 中国计划免疫2001,7(2):96-99.
[22]	Chen HL, Lin LH, Hu FC, et al. Effects of maternal screening and Universal immunization to prevent mother-to-child transmission of HBV[J]. Gastroenterology,2012,142(4):773-781.
[23]	周冷潇, 韩涛. HBV和HCV母婴传播阻断的研究进展[J]. 临床肝胆病杂志,2016,32 (6):1207-1211.
[24]	汪海燕, 张国良, 杨桂林, 等. 《2017年世界卫生组织乙型肝炎疫苗使用指南》摘译[J]. 临床肝胆病杂志,2017,33(11):2058-2061.
[25]	庞琳, 曾慧慧, 何明. HBsAg阳性母亲所生婴儿的母婴阻断及全程接种乙型肝炎疫苗后免疫应答状态[J]. 中华传染病杂志,2010,28(7):422-425.

影响因素	OR值	P值	95%CI
分娩方式	0.82	0.760	0.24~2.86
喂养方式	1.27	0.693	0.38~4.24
Log（HBV DNA）	2.86	0.010	1.28~6.39
Log（HBeAg）	7.47	0.091	0.73~76.65

影响因素	OR值	P值	95%CI
分娩方式	0.82	0.760	0.24~2.86
喂养方式	1.27	0.693	0.38~4.24
Log（HBV DNA）	2.86	0.010	1.28~6.39
Log（HBeAg）	7.47	0.091	0.73~76.65

月龄	HBsAg（IU/ml）	抗-HBs（mIU/ml）	HBeAg（S/CO）	HBeAb（S/CO）	HBcAb（S/CO）	HBV DNA（拷贝/ml）	注射HBIG
出生时	1.36	1.42	61.34	6.59	9.52	< 5 × 10²	200 IU
1	0.21	32.07	8.71	2.19	9.82	8.70 × 10²	200 IU
3+	0.34	5.33	1.40	1.82	11.12	1.10 × 10³	200 IU
4+	0.00	96.93	0.68	1.60	10.61	< 5 × 10²	—
7	84.05	1.78	62.57	4.78	9.02	8.59 × 10⁴	200 IU
8	> 250	0.56	1255.41	43.61	8.09	0.97 × 10⁶	—
9	> 250	0.10	1763.27	46.74	4.99	0.97 ×10⁶	—

月龄	HBsAg（IU/ml）	抗-HBs（mIU/ml）	HBeAg（S/CO）	HBeAb（S/CO）	HBcAb（S/CO）	HBV DNA（拷贝/ml）	注射HBIG
出生时	1.36	1.42	61.34	6.59	9.52	< 5 × 10²	200 IU
1	0.21	32.07	8.71	2.19	9.82	8.70 × 10²	200 IU
3+	0.34	5.33	1.40	1.82	11.12	1.10 × 10³	200 IU
4+	0.00	96.93	0.68	1.60	10.61	< 5 × 10²	—
7	84.05	1.78	62.57	4.78	9.02	8.59 × 10⁴	200 IU
8	> 250	0.56	1255.41	43.61	8.09	0.97 × 10⁶	—
9	> 250	0.10	1763.27	46.74	4.99	0.97 ×10⁶	—

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