A Study On Prevent Mother-to-child Transmission And Post Vaccination Serological Test Of Children Born To HBsAg Positive Mothers In Qinghai Province

Background:Alarge number of people infected with Hepatitis B virus(HBV)before the application of hepatitis B vaccine(HepB)in china,the chronic HBV infection accounted about 10%in china.Mother to ch:ild transmission is the main route of transmission of hepatitis B(HB),about 30-50%person’s HBV infected from mother to child transmission.Therefore,to carry out HBV mother to child blocking strategy and protect more children from HBV infection is the important focus of prevention and control of hepatitis B in china at present.Baby born to HBsAg positive mother’s post vaccination serological test(PVST),refers to this part of the high-risk neonates in 1-6 months after immunization with 3 needles hepatitis B vaccine,intravenous blood samples were collected for detection of HBV markers,determine whether vaccination has a protective effect.The PVST conventional development has very strong practical significance:first,from the policy level,can effectively evaluate the PMTCT strategies,adjust strategies and problems which found in the process of implementation intime;secondly,from the individual and household level,can determine whether vaccination is successful,for those children susceptibility and vaccination failure without infection with HBV,can be vaccinated with hepatitis B vaccine again as soon as possible,to further reduce the risk of HBV infection,WHO Western Pacific region proposed to eliminate the vertical transmission of hepatitis B as the next control objectives,considered to carry out PVST work in the year 2017 in those countries the prevalence rate of HBsAg<1%in children aged<5 years following the national promotion.China as a model for the prevention and control of hepatitis B,the conventional PVST will play an important role in the promotion of PVST strategy in the western pacific region.At present,China has not yet carry out PVST requirements.This study aims to understand the status of maternal and child block of children born to HBsAg positive mothers in Qinghai Province,to understand the children’s PVST status by the survey,investigate the awareness and willingness on PVST of parents.Investigate the obstetricians and vaccination doctors,analyze the factors that affect the PVST promotion strategy,provide a reference for future development of PVST promotion strategy in Qinghai province.Object:Investigate and understand the hospital and midwifery institutions to carry out the hepatitis B screening of pregnant women and hepatitis B maternal and child blocking work.To evaluate the PVST development situation of infants born to HBsAg positive mothers in Qinghai province;analysis the difference between different ethnic groups and different regions,HBsAg positive mothers PVST implementation;analysis the factors influencing HBsAg positive mothers PVST development;understand the obstetrician’s awareness on HBsAg positive mother infant PVST.Provide the basis for popularizing PVSTMethods:According to the regional and demographic characteristics,we divided the province into three categories:urban,rural and pastoral areas.In various regions,in accordance with the uniform inclusion criteria,select 2 counties(districts)to carry out on-site investigation.In each district(county)to select the maximum number of hospital births in 2 hospitals in 2015,To evaluate the status of maternal HBsAg screening and maternal and child block,In HBsAg positive mother delivery babies delivery during the January 1,2015 to December 31,2015,we carry out a questionnaire survey by telephone survey;if unable to contact,according to home address,we take home survey.The survey includes the basic information of the baby(date of birth,birth hospital,gender,nationality,family income,education,mother’s occupation,the distance from the hospital,the main mode of transport,etc.),whether had PVST after(1-6)month to complete the 3 doses of hepatitis B vaccine immunization(7-12 months),testing sites,test results,etc.);the reasons of does not detect,take questionnaire survey in medical personnel and vaccination doctors of knowledge,attitude and behavior on HBsAg positive mother’s children PVST.Results:In this study,a total of 9915 pregnant women were investigated.The screening rate of HBV markers was 97.75%,and the positive rate of HBsAg was 3.56%.The screening rate of urban,rural and pastoral areas was about 100%,96.07%and 94.36%respectively.A total of 9848 newborns during the period of 2015 in the hospital,and the rate of HepBl vaccination in time was about 95.78%.HBsAg positive maternal newborn 345,HepB1 timely vaccination rate was 98.55%,HBIG vaccination rate was 98.55%.There was no significant difference in HepBl vaccination rate and HBIG vaccination rate between different regions and different ethnic groups.HBsAg positive mother’s children PVST,a total of 276 valid questionnaires were completed,Only 35 Children in the age of 12 month to go to the medical institutions to do the hepatitis B markers detection,accounting for 12.68%,22 people to do the test in the city hospital.The reasons to do test was the parents want to know the effect of hepatitis B vaccination,and spontaneously to the hospital for testing(94.29%);2 children take the detection because of other disease to the hospital(5.71%).Logistic regression analysis showed that birth hospital and mother’s occupation were the influencing factors of PVST detection rate.The higher the birth hospital level and occupation level,the higher the PVST detection rate.241 people do not take PVST detection after 3 doses of hepatitis B vaccine within six months,investigate the reasons,the parents said they did not receive the doctor’s inform 47.72%(115/241),32.78%(79/241)to worry about the cost fee,no need to detection(do not know the risk)11.62%(28/241),the child is too small to collect blood 7.88%(19/241).Detection site selection,251(90.10%)parents choose to take their children to the hospital to do the test,.If the test is take for free,75.36%(208/276)willing to do the detection for children;if at their own expense,24.64%(68/276)willing to do the detection.We investigated 154 hospital obstetrics and vaccination doctors,the survey results show that the doctors lack of awareness on PVST,only 56(36.36%)doctors said they had told HBsAg positive mothers and parents to carry out detection for children in12 months age,only 19(12.34%)person choose to inform.Conclusions:1.The hepatitis B screening rate of pregnant women is high in Qinghai province,but there is still a gap in rural and pastoral area.2.The coveragerate of HepB1 and HBIG in children with HBsAg positive mothers in the survey area were maintained at a high level,but after the completion of hepatitis B vaccine immunization,the PVST rate was low in 12 months age.3.The parents did not receive the doctor’s inform,worried about the cost fee are the main reasons for did not carry out PVST for HBsAg positive mothers’children.4.The awareness rate of HBsAg positive mothers’children PVST was low among obstetricians and vaccination physicians.