Investigation On The Willingness Of HBsAg Positive Mothers For Their Children Participating In PVST And Analysis Of The PVST Results In Six Provinces In China

Object:1.To explore the willingness of hepatitis B virus(HBV)surface antigen(HB sAg)positive mothers on the post-vaccination serological testing(PVST)for their children and analyze the influencing factors.2.Based on the PVST results of HBV exposed children,to evaluate the effectiveness of the HBV mother-to-child transmission prevention strategies in China;3.To evaluate the feasibility and scientific nature of using rapid test as an alternative in PVST laboratory testing.Method:1.The survey about HBsAg positive mothers’ willingness on PVST for their children:Using convenience sampling method,we selected Fujian province and Zhejiang province from east regions,Jiangxi province and Henan province from middle regions,and Gansu province and Shaanxi province from west regions as our study sites.In each province,we selected 1-2 districts or counties to carry out the field work,and totally we selected 13 districts(counties).In each district(county),we selected one community health service center or township hospital to enroll the target subjects for a face-to-face interview with unique questionnaire.The target population was women screened for HBsAg positive in pregnancy and delivered within March 1,2019-December 31,2019.In the questionnaire,we collected the general demographic information,some HBV infection related information and the information about their HBV related knowledge and the attitude on PVST for their children.We utilized descriptive statistics for demographic data.We used the Chi-square test(or Fisher’s exact probability method)to compare the difference between proportions,and we developed a logistic regression model to estimate the factors that affected HBsAg-positive mothers’ willingness to conduct PVST monitoring on their children.2.Analysis of PVST of the high-risk children from HBsAg positive mothers:Using convenient sampling method,we selected Fujian province,Jiangxi province and Gansu province as our study sites.In each province,we selected one or two counties to conduct PVST surveillance work.All the HBsAg positive mothers and their children who were delivered from July 1,2018 to June 30,2019 in the study county were enrolled in our PVST study.In this study,we collected the information on mother’s age,parity,education,mothers’ HBV infected status,region,infant birthdate,infant hepatitis B vaccination(HepB)information,date of PVST completion,reasons for not completing PVST,et.We utilized descriptive statistics for demographic data.We collected infants’blood samples one or two months later after the third dose HepB vaccination,and used ELISA method or rapid testing to test HBsAg and anti-HBs.We used the Chi-square test(or Fisher’s exact probability method)to compare the difference between proportions,and we developed a logistic regression model to estimate the factors influencing HBsAg-positive mothers’ compliance with PVST for their children.Kappa consistency test and kappa hypothesis test were used to compare the consistency between rapid test and ELISA test.Results:1.The survey about HBsAg positive mothers’ willingness on PVST for their children:Among the 1183 HBV HBsAg positive mothers,1055(89.18%)of them expressed their willingness on PVST for their children,and 128(10.82%)refused PVST.For the refused reasons,we found 53.91%(69)of mothers were because they were worried about their infants too young to collect venous blood,28.13%(36)were for the inconvenience of transportation,22.66%(36)of mothers chose to have PVST independent,and 19.53%(28)of mothers considered the PVST was unnecessary.And the High PVST willingness rates were more likely to be from Zhejiang(OR=3.19,95%CI:1.47-6.93),Fujian(OR=1.86,95%CI:1.03-3.36)and Jiangxi(OR=8.28,95%CI:3.10-22.11),Henan(OR=4.91,95%CI:2.41-10.02),Gansu(OR=1.51,95%CI:1.97-10.32),local residents(OR=1.68,95%CI:1.77-6.22),from the mothers with no HBV treated in pregnancy(OR=1.62,95%CI:1.07-2.66),from the mothers with higher scores on HBV knowledge(OR=4.71,95%CI:1.99-11.14),and from the mothers with higher PVST awareness(OR=4.54,95%CI:2.58-7.99)2.Analysis of PVST of the high-risk children from HBsAg positive mothers:We enrolled 1,044 target children with mother HBsAg positive,and 74.32%(776)of them received PVST.Based on ELISA testing results,a total of 97.64%(538/551)of children were protected,0.91%(5/551)of children were HBV infected,and 1.45%(8/551)of children were susceptible to HBV who need revaccinate another full-series three doses HepB.Among those 268 children without PVST,29.48%(79)were because of the difficulties of blood sample collecting,18.28%(50)were due to incorrect contact information,and 11.57%(31)transferred out.We found that the high PVST rates were more likely to be from Jiangxi(OR=5.55,95%CI:3.05-10.07),Gansu(OR=2.82,95%CI:1.78-4.47),and from mothers with more knowledge on HBV before pregnancy(OR=1.71,95%CI:1.24-2.37).We found that the consistency was weak between the rapid test results using finger or earlobe blood and the ELISA testing results using venous blood for HBsAg and Anti-HBs.And the combined testing with rapid test screening followed by ELLISA confirming would have the feasibility for PVST field work.Conclusion:HBV HBsAg positive mothers have high compliance with the PVST for their children,but the compliance exists differences in provinces.The prevention rate for mother-to-children transmission of HBV is 97.64%in China with our status quo strategies,and 1.45%of the HBV exposed children are still susceptible to HBV and need to be revaccinated.The factors that affect HBsAg positive mothers’ agreement on PVST for their children are including blood samples collected difficulties for young children,and concerning about the exposure of their privacy.Providing rapid test service using finger or earlobe blood as an additional choice for the mothers who refuse PVST because of venous blood collecting would improve the PVST compliancy.Although the consistency is weak between rapid test results and ELISA testing results,it would have the feasibility for PVST field work using the combined testing with rapid test screening followed by ELLISA confirming.