| Background and objectivesHepatitis B(hepatitis B for short)is a global infectious liver disease caused by hepatitis B virus(HBV)infection.The number of HBV infected people in China ranks first,and the most common form of infection is mother to child transmission.China is actively taking measures to eliminate mother to child transmission of HBV.The World Health Organization(WHO)recommends that hepatitis B exposed infants and young children should carry out post vaccination serological testing(PVST)1-2 months after completing immunization.PVST can evaluate the effect of intervention,timely identify HBV susceptible persons,timely intervene to improve the immune effect,and avoid HBV horizontal transmission infection.At present,developed countries such as Britain and the United States have policies to routinely carry out PVST testing for HBs Ag positive mothers and children.China only began to require hepatitis B exposed infants to carry out PVST in 2020.Previous studies on PVST in a few pilot areas showed that the proportion of PVST testing is not high,and there is still a gap between the proportion of PVST testing and the goal of eliminating mother to child transmission of hepatitis B≥ 80%.Previous studies have found that the main reasons for affecting PVST include:difficulty in follow-up,difficulty in venous blood collection,and lack of systematic reasons and influencing factors.In 2020,China will comprehensively promote PVST testing for infants exposed to hepatitis B.There are few relevant studies on the status quo of testing in the real world,what are the promoting factors and obstacles.This research plan is to understand the current status of PVST detection of infants exposed to hepatitis B in midwifery institutions and its possible influencing factors,so as to provide reference for formulating policies to improve the PVST detection rate,early evaluation and early intervention,and further promote the zero transmission of hepatitis B from mother to child.MethodsThis study selected infants born to HBs Ag positive mothers(hereinafter referred to as hepatitis B exposed infants)who were hospitalized in Guangdong maternal and child health Hospital from January 1,2020 to August 31,2021 as the research objects,completed relevant questionnaires and retrospective medical record information,collected basic data of hepatitis B exposed infants,feeding methods,immunization and PVST testing,as well as basic data of HBs Ag positive mothers Pregnancy data and antiviral treatment,etc.,according to whether the infants exposed to hepatitis B have detected PVST,they are divided into two groups: detected group and undetected group.According to the status of HBs Ag in the PVST outcome in the detected group,they are divided into two groups: the success group and the failure group.According to the HBs Ab titer in the PVST outcome in the successful blocking group,they are divided into two groups: immune responsive(HBs Ab titer ≥ 10 m IU/m L)and non responsive(HBs Ab titer<10m IU/m L).Chi square test or Fisher exact test were used to compare and analyze the differences between different groups.The variables with P<0.05 were included in the multivariate logistic regression model to analyze the influencing factors related to PVST detection and outcome of infants exposed to hepatitis B.Results1.PVST detection status of infants exposed to hepatitis B: Among 1376 infants exposed to hepatitis B,862 had PVST detection,514 had not,and the PVST detection rate was 62.65%.Out of 862 individuals who have undergone PVST testing,102(11.83%)were tested at 7-9 months of age,301(34.92%)were tested at 9-12 months of age,and 459(53.25%)were tested at ≥ 12 months of age.2.Factors affecting the PVST test of infants exposed to hepatitis B: 1)The main reason for not performing PVST test is that the child does not know to do PVST,the child is too young to worry about blood drawing,and does not think it is necessary to do PVST.2)The related factors of PVST detection in 1376 infants exposed to hepatitis B were analyzed.The results showed that there was a correlation between the mother’s occupation was household and unemployed,the mother was a non resident,the mother did not know PVST before the first follow-up,and the mother reached the antiviral indication and did not treat hepatitis B exposed infants.compared to freelance work,the risk of mothers of infants and young children not receiving PVST testing is reduced in the household and unemployed workers(OR=0.43,95% CI: 0.27-0.68),compared to permanent residents,the risk of mothers of infants and young children not receiving PVST testing is increased in non resident residents(OR=2.48,95% CI: 1.79-3.45),and compared to those who are aware of PVST,The risk of not knowing PVST before the initial follow-up of mothers of infants and young children is increased(OR=3.07,95%CI: 2.40-3.92),compared to not reaching the antiviral treatment indication without treatment,the risk of mothers of infants and young children reaching the antiviral treatment indication without PVST testing is increased(OR=2.05,95% CI: 1.13-3.72).3.PVST outcome of infants exposed to hepatitis B: 1)Of 862 infants exposed to hepatitis B who had undergone PVST testing,851 were successfully blocked(HBs Ag was negative),11 were failed(HBs Ag was positive),and the failure rate of mother infant blocking was 1.28%.2)Among 851 infants exposed to hepatitis B successfully blocked by mother and infant,820 were immune responsive(HBs Ab titer ≥10m IU/m L),31 were immune unresponsive(HBs Ab titer<10m IU/m L),and the immune unresponsive rate was 3.64%.4.Factors affecting the outcome of PVST in infants with hepatitis B exposure: 1)The analysis of related factors on the blocking effect of 862 mothers and infants with hepatitis B exposure showed that compared with infants with hepatitis B exposure who received the second dose of Hep B on time at the age of one month,those who did not receive the second dose of Hep B on time at the age of one month had an increased risk of maternal and infant blocking failure(OR=43.04,95% CI: 1.17-1583.91),compared with infants with hepatitis B exposure whose mothers knew about PVST before the first follow-up,There is an increased risk of mother to child blockade failure in individuals born with PVST who were not aware of it before the initial follow-up of the mother(OR=63.09,95% CI: 3.05-1306.84).2)The analysis of related factors on the immune response effect of 851 infants exposed to hepatitis B showed that compared with infants exposed to hepatitis B whose mothers were HBe Ag negative,those whose mothers were HBe Ag positive had an increased risk of immune non response(OR=4.50,95%CI=1.26-15.98).Conclusions1.The PVST detection rate of infants exposed to hepatitis B in this research institution is 62.65%.There is a correlation between the mother’s occupation is household and unemployed,the mother is a non resident,the mother is not aware of PVST before the first follow-up,and the mother’s failure to treat when reaching the antiviral indication and whether the hepatitis B exposed infants are tested for PVST.2.The main reasons for not undergoing PVST testing are not knowing what to do,the child is too young to worry about blood sampling,and there is no need to do PVST.3.Under the current comprehensive measures to eliminate mother-to-child transmission of HBV,the failure rate of HBV mother to child blockade in this research institution is 1.28%,and the immune non response rate is 3.64%.4.Failure to receive the second dose of Hep B on time at the age of 1 month,unknown knowledge of PVST before the mother’s initial follow-up,and an increased risk of mother to child blockade failure,as well as an increased risk of HBe Ag positive maternal immune unresponsiveness. |
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