HBV母婴零传播——从争议到共识
DOI: 10.12449/JCH241101
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:刘志华负责设计论文框架,起草并修改论文;侯金林负责拟定写作思路,指导撰写文章并修改及定稿。
Toward zero mother-to-child transmission of hepatitis B virus: From controversy to consensus
-
摘要: 母婴传播是HBV最主要的传播途径,预防HBV母婴传播是乙型肝炎防控的关键环节,也是2030年全球消除乙型肝炎的五大核心战略支柱之一。新生儿联合免疫和妊娠期的抗病毒干预是阻断母婴传播的关键措施,实施新生儿联合免疫和妊娠期抗病毒干预的综合策略能够加速实现消除母婴传播的目标。我国学者提出“乙型肝炎母婴零传播”的理念,并在全国范围开展了“乙肝母婴零传播工程”(“小贝壳”项目),旨在推动母婴阻断策略的实施,为我国消除病毒性肝炎打好基础。“小贝壳”项目为阻断乙型肝炎母婴传播提供了详细的实施策略、成功的实践经验及可靠的数据支持,凝聚了学术界对“乙型肝炎母婴零传播”的共识,对我国以及全球实现消除HBV母婴传播具有重要的参考价值。
-
关键词:
- 乙型肝炎病毒 /
- 传染性疾病传播, 垂直 /
- “小贝壳”项目
Abstract: Mother-to-child transmission is the major route of transmission for hepatitis B virus (HBV), and prevention of the mother-to-child transmission of HBV is the key link in the prevention and control of hepatitis B and one of the five essential core strategies for achieving the global elimination of hepatitis B by 2030. Combined immunization for neonates born to HBV-infected mothers and maternal antiviral intervention during pregnancy are important measures for blocking mother-to-child transmission, and thereby, the implementation of the comprehensive strategy of combined immunization and maternal antiviral intervention will help to accelerate the process of eliminating mother-to-child transmission. Chinese scholars have put forward the concept of “zero mother-to-child transmission of hepatitis B” and launched “Shield Program” in China, aiming to promote the implementation of the preventive strategy for mother-to-child transmission and lay a solid foundation for eliminating viral hepatitis in China. The Shield Program has provided detailed implementation strategies, successful practice experience, and reliable data for blocking the mother-to-child transmission of hepatitis B, fostering the consensus on the zero mother-to-child transmission of HBV in the academic community, and it also has an important reference value for eliminating the mother-to-child transmission of HBV in China and globally. -
[1] Working Committee of Promoting the Elimination of Viral Hepatitis of Chinese Preventive Medicine Association, Society of Prevention and Control of Infectious Diseases of Chinese Preventive Medicine Association. Expert recommendations on hepatitis B vaccination in adults[J]. J Clin Hepatol, 2024, 40( 8): 1551- 1556. DOI: 10.12449/JCH240808.中华预防医学会促进消除病毒性肝炎工作委员会, 中华预防医学会感染性疾病防控分会. 成人乙型肝炎疫苗接种专家建议[J]. 临床肝胆病杂志, 2024, 40( 8): 1551- 1556. DOI: 10.12449/JCH240808. [2] JING W, LIU J, LIU M. Eliminating mother-to-child transmission of HBV: progress and challenges in China[J]. Front Med, 2020, 14( 1): 21- 29. DOI: 10.1007/s11684-020-0744-2. [3] World Health Organization. Global hepatitis report 2024: action for access in low- and middle-income countries[R]. Geneva: World Health Organization, 2024. [4] HOU JL, WANG GQ, WANG FS, et al. Guideline of prevention and treatment for chronic hepatitis B(2015 update)[J]. J Clin Transl Hepatol, 2017, 5( 4): 297- 318. DOI: 10.14218/JCTH.2016.00019. [5] VISVANATHAN K, DUSHEIKO G, GILES M, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: Position paper produced by Australian, UK and New Zealand key opinion leaders[J]. Gut, 2016, 65( 2): 340- 350. DOI: 10.1136/gutjnl-2015-310317. [6] CHEN HL, LIN LH, HU FC, et al. Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV[J]. Gastroenterology, 2012, 142( 4): 773- 781. e 2. DOI: 10.1053/j.gastro.2011.12.035. [7] HAN GR, CAO MK, ZHAO W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55( 6): 1215- 1221. DOI: 10.1016/j.jhep.2011.02.032. [8] ZHANG H, PAN CQ, PANG Q, et al. Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice[J]. Hepatology, 2014, 60( 2): 468- 476. DOI: 10.1002/hep.27034. [9] PAN CQ, DUAN ZP, DAI EH, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374( 24): 2324- 2334. DOI: 10.1056/NEJMoa1508660. [10] ZENG QL, YU ZJ, JI FP, et al. Tenofovir alafenamide to prevent perinatal hepatitis B transmission: A multicenter, prospective, observational study[J]. Clin Infect Dis, 2021, 73( 9): e3324- e3332. DOI: 10.1093/cid/ciaa1939. [11] CUI FQ, WOODRING J, CHAN PL, et al. Considerations of antiviral treatment to interrupt mother-to-child transmission of hepatitis B virus in China[J]. Int J Epidemiol, 2018, 47( 5): 1529- 1537. DOI: 10.1093/ije/dyy077. [12] LIU ZH, LI ZD, YANG XZ, et al. Organizing an assembly to eliminate hepatitis B virus through a project zero mother-to-child transmission of hepatitis B virus[J]. Chin J Hepatol, 2019, 27( 2): 102- 105. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.006.刘志华, 李增德, 杨希忠, 等. 乙型肝炎母婴零传播工程,向消除乙型肝炎的目标迈进[J]. 中华肝脏病杂志, 2019, 27( 2): 102- 105. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.006. [13] YIN XR, LIU AH, HOU JL. Action for shield project promoting zero mother-to-child transmission of hepatitis B virus[J]. Chin J Hepatol, 2019, 27( 2): 81- 84. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.001.尹雪如, 刘志华, 侯金林. 行动起来, 全力推动乙型肝炎母婴零传播工程[J]. 中华肝脏病杂志, 2019, 27( 2): 81- 84. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.001. [14] YIN XR, LIU ZH, LIU ZH, et al. Getting to zero mother-to-child transmission of hepatitis B virus: Dream and challenge[J]. Chin J Hepatol, 2018, 26( 4): 262- 265. DOI: 10.3760/cma.j.issn.1007-3418.2018.04.006.尹雪如, 刘志华, 刘智泓, 等. 乙型肝炎病毒母婴零传播: 理想与挑战[J]. 中华肝脏病杂志, 2018, 26( 4): 262- 265. DOI: 10.3760/cma.j.issn.1007-3418.2018.04.006. [15] JOURDAIN G, NGO-GIANG-HUONG N, HARRISON L, et al. Tenofovir versus placebo to prevent perinatal transmission of hepatitis B[J]. N Engl J Med, 2018, 378( 10): 911- 923. DOI: 10.1056/NEJMoa1708131. [16] LUO KX, CHEN JJ, LI P. Hepatitis basic biology and clinical science[M]. 4th ed. Beijing: People’s Medical Publishing House, 2012.骆抗先, 陈金军, 李平. 乙型肝炎基础和临床[M]. 4版. 北京: 人民卫生出版社, 2012. [17] Antiretroviral Pregnancy Registry Steering Committee. The antiretroviral pregnancy registry interim report(1 January 1989 through 31 Jan 2023)[R/OL].[ 2024-08-29]. https://www.apregistry.com/forms/interim_report.pdf. https://www.apregistry.com/forms/interim_report.pdf [18] FUNK AL, LU Y, YOSHIDA K, et al. Efficacy and safety of antiviral prophylaxis during pregnancy to prevent mother-to-child transmission of hepatitis B virus: A systematic review and meta-analysis[J]. Lancet Infect Dis, 2021, 21( 1): 70- 84. DOI: 10.1016/S1473-3099(20)30586-7. [19] BROWN RS Jr, MCMAHON BJ, LOK ASF, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis[J]. Hepatology, 2016, 63( 1): 319- 333. DOI: 10.1002/hep.28302. [20] HU Y, XU C, XU B, et al. Safety and efficacy of telbivudine in late pregnancy to prevent mother-to-child transmission of hepatitis B virus: A multicenter prospective cohort study[J]. J Viral Hepat, 2018, 25( 4): 429- 437. DOI: 10.1111/jvh.12834. [21] GREENUP AJ, TAN PK, NGUYEN V, et al. Efficacy and safety of tenofovir disoproxil fumarate in pregnancy to prevent perinatal transmission of hepatitis B virus[J]. J Hepatol, 2014, 61( 3): 502- 507. DOI: 10.1016/j.jhep.2014.04.038. [22] PAN CQ, DAI EH, DUAN ZP, et al. Long-term safety of infants from mothers with chronic hepatitis B treated with tenofovir disoproxil in China[J]. Gut, 2022, 71( 4): 798- 806. DOI: 10.1136/gutjnl-2020-322719. [23] FAN L, OWUSU-EDUSEI K Jr, SCHILLIE SF, et al. Cost-effectiveness of active-passive prophylaxis and antiviral prophylaxis during pregnancy to prevent perinatal hepatitis B virus infection[J]. Hepatology, 2016, 63( 5): 1471- 1480. DOI: 10.1002/hep.28310. [24] NAYAGAM S, de VILLIERS MJ, SHIMAKAWA Y, et al. Impact and cost-effectiveness of hepatitis B virus prophylaxis in pregnancy: A dynamic simulation modelling study[J]. Lancet Gastroenterol Hepatol, 2023, 8( 7): 635- 645. DOI: 10.1016/S2468-1253(23)00074-2. [25] ZHENG H, NAYAGAM S, CHAN PL, et al. Progress towards elimination of mother-to-child transmission of hepatitis B virus infection in China: A modelling analysis[J]. Bull World Health Organ, 2021, 99( 1): 10- 18. DOI: 10.2471/BLT.19.248146. [26] Chinese Foundation for Hepatitis Prevention and Control; Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Management algorithm for interrupting mother-to-child transmission of hepatitis B virus(2021)[J]. J Clin Hepatol, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007.中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会. 阻断乙型肝炎病毒母婴传播临床管理流程(2021年)[J]. 临床肝胆病杂志, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007. [27] HOU JL, CUI FQ, DING Y, et al. Management algorithm for interrupting mother-to-child transmission of hepatitis B virus[J]. Clin Gastroenterol Hepatol, 2019, 17( 10): 1929- 1936. e 1. DOI: 10.1016/j.cgh.2018.10.007. [28] YIN XR, HAN GR, ZHANG H, et al. A real-world prospective study of mother-to-child transmission of HBV in China using a mobile health application(shield 01)[J]. J Clin Transl Hepatol, 2020, 8( 1): 1- 8. DOI: 10.14218/JCTH.2019.00057. [29] YIN XR, WANG W, CHEN H, et al. Real-world implementation of a multilevel interventions program to prevent mother-to-child transmission of HBV in China[J]. Nat Med, 2024, 30( 2): 455- 462. DOI: 10.1038/s41591-023-02782-x. [30] World Health Organization. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy[R]. Geneva: World Health Organization, 2020. [31] Office of the National Health Commission. Notice on printing and distributing work specifications for prevention of mother to child transmission of AIDS, Syphilis and hepatitis B(2020 Edition)[EB/OL].( 2020-11-12)[ 2024-08-29]. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml国家卫生健康委办公厅. 关于印发预防艾滋病、梅毒和乙肝母婴传播工作规范(2020年版)的通知[EB/OL].( 2020-11-12)[ 2024-08-29]. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml. http://www.nhc.gov.cn/fys/s3581/202011/fc7b46b2b48b45a69bd390ae3a62d065.shtml
本文二维码
计量
- 文章访问数: 120
- HTML全文浏览量: 1852
- PDF下载量: 95
- 被引次数: 0