Analysis Of The Blocking Effect Of Combined Immunization On Mother-to-child Transmission Of Hepatitis B And Its Influencing Factors In A Hospital In Yan’an

Objective:The purpose of this study was to understand the hepatitis B virus surface antigens（HBs Ag）Blocking effect of primary and passive combination immunity in newborns with positive pregnant women;Analyze the factors affecting the block failure of infant primary and passive combined immunity,And its serum HBV surface antibodies（HBs Ab）level,In order to improve the blocking success rate and the effective joint immune response rate through the intervention of the influencing factors,Reduce the infection of hepatitis B virus（HBV）,It provides a theoretical basis for the early daily dissemination of hepatitis B to eliminate hepatitis B.Methods:From September 2019 to August 2020,155 HBs Ag positive pregnant women and 157 newborns were selected.Within 12 hours after birth,all newborns were injected with 100 IU hepatitis B immunoglobulin（HBIG）and 10μg recombinant yeast Hepatitis B vaccine（Hep B）,and then were inoculated with recombinant yeast Hep B once at the age of 1 and 6 months respectively.1-2 months after the third Hep B inoculation,the immune response of newborns was quantitatively detected by chemiluminescence method.To understand the general information of pregnant women and newborns through questionnaires,the serum markers of hepatitis B virus,including HBs Ag,HBs Ab,hepatitis B virus E antigen,hepatitis B virus E antibody and hepatitis B virus core antigen,were detected by chemiluminescence method in the peripheral blood of pregnant women one month before delivery,umbilical vein blood of newborns and peripheral vein blood of infants during follow-up from 7 months to 12 months.The quantitative determination of HBV DNA by PCR technology;Immunohistochemical Max Vision^TM combustionstaining was used to detect the expression of HBs Ag in placenta.HBs Ag positive blank section of liver puncture tissue was used as positive control,full-term placenta tissue of non-hepatitis B pregnant women was used as negative control,and Phosphate Buffer Solution（PBS）was used instead of primary antibody as blank control.Results:（1）There were 155 HBs Ag positive pregnant women,42 pregnant women who met the inclusion criteria and received full follow-up and 43 newborns（including 1pair of twins）.The quantitative analysis of HBs Ag and HBV DNA in serum of 43 infants were negative,0%（0/41）failed to block and 0%（0/29）concealed HBV infection,among which 2 cases were unresponsive 4.65%（2/43,95%Cl-1.9%～11.2%）,and 7 cases were unresponsive 16.28%（7/7）in 21 cases,the medium response was 48.84%（21/43,95%Cl 33.3%～64.4%）,and in 13 cases,the high response was 30.23%（13/43,95%Cl13.9%～41.9%）.（2）Univariate analysis showed that the infants were divided into three groups according to the quantitative level of HBe Ag:5000-10000 S/CO group,1-5000 S/CO group and<1 S/CO group.There was significant difference in the rates of low response and no response between the groups（F=9.718,P=0.006）.There were no significant differences in HBV infection of mothers before birth,complications of this pregnancy,antiviral treatment in late pregnancy,neonatal weight,the time of first injection of HBIG and Hep B,serum HBV DNA load of pregnant women,serum HBs Ag level of pregnant women and umbilical cord blood infection status of newborns（P>0.05）.（3）Multivariate Logistic regression analysis showed that the education level of pregnant women in high school OR below was an independent risk factor of low response and no response after combined immunization（OR=26.588,P=0.015）,but HBe Ag<1 S/CO was an independent protective factor（OR=0.132,P=0.016）.（4）Immunohistochemical Max Vision^TMstaining showed no positive expression of HBs Ag in placenta of pregnant women with hepatitis B.Conclusion:（1）Active and passive combined immunization can successfully block mother-to-child transimission of hepatitis B.After active and passive immunization,79.1%infants HBs Ab reach effective protection level,and 20.9%infants are in non-response and low response state.（2）Low educational background of pregnant women with hepatitis B is an independent risk factor for low response and no response after combined immunization,but negative serum HBe Ag of pregnant women is an independent protective factor.（3）The expression of HBs Ag was not detected in placenta tissue of pregnant women with hepatitis B,which suggested that placental barrier might prevent HBV from infecting placenta tissue.