Outcomes of the national programme on prevention of mother-to-child transmission of hepatitis B virus in China, 2016–2017

Abstract

Background In addition to providing free hepatitis B vaccine (HBvacc) series to all infants in China since 2005, the national programme on prevention of mother-to-child transmission (PMTCT) of hepatitis B virus (HBV) started providing free hepatitis B immunoglobulin for all new-borns born to hepatitis B surface-antigen (HBsAg) positive mothers in 2010. However, few studies have evaluated the effectiveness of the PMTCT programme. Therefore, we aimed to investigate the outcomes of the programme and identify associated factors. Method Using a cross-sectional study design, we collected data on 4112 pairs of HBsAg-positive mothers and their children aged 7–22 months in four representative provinces through interviews and medical record review. We tested HBsAg and hepatitis B surface antibody (anti-HBs) of children by enzyme-linked immunosorbent assay at designated maternal and child hospital laboratories. We used logistic regression to analyse factors associated with child HBsAg and anti-HBs positivity. Results Thirty-five children were HBsAg positive, indicating the mother-to-child transmission (MTCT) rate was 0.9% (0.6–1.1%). The anti-HBs positive rate was 96.8% (96.3-97.4%). Children receiving HBvacc between 12 and 24 h of birth were 2.9 times more likely to be infected than those vaccinated in less than 12 h (adjusted odds ratio [a OR ] = 2.9, 95% confidence interval [ CI ]: 1.4–6.3, P = 0.01). Maternal hepatitis B e-antigen (HBeAg) positivity was associated with higher MTCT rate (a OR = 79.1, 95% CI : 10.8–580.2, P < 0.001) and lower anti-HBs positive rate (a OR = 0.4, 95% CI : 0.3–0.6, P < 0.001). Children with low birth weight (LBW) were 60% less likely to be anti-HBs positive than those with normal birth weight (a OR = 0.4, 95% CI : 0.2–0.8, P = 0.01). Conclusions The MTCT rate was lower than the 2030 WHO elimination goal, which implies the programme is on track to achieve this target. As earlier HBvacc birth dose (HBvcc-BD) was associated with lower MTCT rate, we suggest that the PMTCT programme work with the Expanded Programme on Immunization (EPI) to modify the current recommendation for early HBvcc-BD to a requirement. Our finding that LBW was associated with lower anti-HBs positivity points to the need for further studies to understand factors associated with these risks and opportunities for program strengthening. The programme needs to ensure providing essential test to identify HBeAg-positive mothers and their infants and provide them with appropriate medical care and follow-up. Electronic supplementary material The online version of this article (10.1...

Response to the comment on “Mother‐to‐child transmission of hepatitis B virus after amniocentesis: A retrospective matched cohort study”

“…Like previous reports, our study also demonstrated that maternal high HBV DNA levels and hepatitis B e antigen (HBeAg) positivity were risk factors for MTCT . After ruling out all cases with antiviral, the MTCT rate among HBeAg‐positive mothers without amniocentesis was 2.14% (3/140) (Table S1), which was a relatively moderate transmission rate compared with recently reported 1.28% (2/156), 2.04% (3/147), 2.70% (33/1221), 3.20% (12/374), and 6.82% (6/88, with maternal HBV DNA > 2 × 10 6 IU/mL) . Meanwhile, the MTCT rate among HBeAg‐positive mothers underwent amniocentesis was 11.11% (4/36) (Table S1), which was obviously higher than above reported results.…”

Hepatitis B virus infection among 90 million pregnant women in 2853 Chinese counties, 2015-2020: a national observational study

“…We used data from the Management Information System of the National Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Programme (iPMTCT Programme) from 2015 to 2020 in mainland China. The National iPMTCT Programme, funded by the Government of China, was started in 2011 in 1156 (41%) county-level administrative units (briefly, counties) and expanded to all the 2856 counties nationwide by 2015 [ 16 , 17 ]. All the health-care facilities providing midwifery and antenatal care services were required to participated in the programme [18] .…”

Influencing factors and necessity of post‐vaccination serologic testing follow‐up for HBsAg‐positive mothers and their infants: A 5‐year prospective study in Zhejiang Province, China (2016–2020)

“…8 There are 16-18 million mothers giving birth each year in China, nearly 6% of whom have chronic HBV infections, and onethird of them having a high HBV load. 9,10 One to 9% of infants born to HBV-carrying mothers may be infected with HBV, despite receiving HBIG plus HBV vaccine in the immediate neonatal period. 11 Furthermore, the risk of developing chronic HBV infection is strongly associated with the age of exposure.…”