南台灣某區域醫院台籍與外籍產婦B肝帶原狀況與嬰兒接種B肝免疫球蛋白之情形

Hepatitis B Markers in Taiwanese and New Immigrant Mothers and the Results of Their Babies Receiving Hepatitis B Immunoglobulin at a District Hospital in Southern Taiwan

10.6288/TJPH201433103009

陳秋妏(Chiou-Wen Chen)；陳志成(Solomon Chih-Cheng Chen)；陳博憲(Bor-Shyen Chen)

B型肝炎 ； 疫苗 ； 免疫球蛋白 ； 外籍母親 ； hepatitis B ； vaccine ； immunoglobulin ； new immigrant mother

台灣公共衛生雜誌

33卷3期（2014 / 06 / 15）

304 - 311

繁體中文

目標：了解台籍和外籍產婦之B肝帶原率及其嬰兒施打B肝疫苗與免疫球蛋白（HBIG）之情形。方法：本研究為回溯性病歷研究。在南台灣某區域醫院嬰兒室，回顧從2008年7月至2011年12月在該院出生嬰兒的B肝疫苗接種登錄本。在此期間產婦總數為7,931人，分別為台灣籍產婦7,205人與外籍產婦726人。如果母親是B型肝炎帶原者，就收集母親與嬰兒接種B肝疫苗和HBIG的情形。統計分析分別使用卡方檢定、t檢定和羅吉斯迴歸。結果：有720（9.1%）位母親是B型肝炎帶原，台籍與外籍母親人數分別為653（9.1%）及67（9.2%）人。HBeAg陽性人數與比率在台籍與外籍帶原母親分別為138人（21.1%）與31人（46.3%），HBeAg陽性的外籍母親主要為大陸籍24人（77.4%）與越南籍7人（22.6%）。多變項羅吉斯迴歸分析發現母親生育年齡每增長一歲，HBeAg陽性的風險降為0.87（95%信賴區間0.82-0.91，p = 0.001）；外籍母親比台籍母親有2.59倍的風險會是HBeAg陽性（95%信賴區間1.51-4.44，p ＜ 0.001）。追蹤HBeAg陽性母親所生的187位嬰兒，僅有三成嬰兒在出生滿一歲時回門診檢驗B肝血清標誌。其中有三位嬰兒HBsAg呈陽性，另有四位嬰孩的B肝表面抗原和抗體均為陰性，其中兩人追加一劑B肝疫苗後，B肝抗體轉為陽性。結論：目前外籍母親和台籍母親的B肝帶原率相當。母親生育年齡越低和外籍是母親HBeAg陽性的重要危險因子。我們建議加強衛教B肝帶原母親應帶嬰兒回診追蹤B肝血清標誌，以早期發現B肝感染情形和補接種疫苗。

Objectives: To understand the hepatitis B virus (HBV) carrier rates among Taiwanese mothers and new immigrant mothers (NIM) as well as the results of their newborns receiving hepatitis B vaccine and immunoglobulin (HBIG). Methods: This was a retrospective chart-review study of the HBV vaccination records of all babies delivered at a district hospital in southern Taiwan from July 2008 to December 2011. There were a total of 7,931 mothers of whom 7,205 were Taiwanese and 726 were NIM. If mothers were HBsAg-positive, then information about maternal HBV markers, and the use of HBIG and HBV vaccines for newborns was collected. Chisquared test, t-test and logistic regression were used for statistical analysis. Results: A total of 720 women (9.1%) were HBV carriers, and the carrier rates were 9.1% (653 mothers) for Taiwanese mothers and 9.2% (67 mothers) for NIM. Among carrier mothers, the HBeAg-positive rates were 21.1% (138) for Taiwanese mothers and 46.3% (31) for NIM including 24 from China and 7 from Vietnam. The multivariate logistic regression model found the odds ratio (OR) and 95% confidence interval (95% CI) for every increased year of maternal age was 0.87 (0.82-0.91, p = 0.001). The OR and 95%CI for NIM mothers was 2.59 (95%CI, 1.51-4.44, p ＜ 0.001) compared to Taiwanese mothers. We followed 187 babies born to HBeAg-positive HBV carrier mothers, but found that only 30% had taken their babies to have their HBV status checked. Three of these were HBsAg-positive and another 4 were negative for both HBsAg and HBeAg. Two developed a positive antibody for HBsAg after receiving one dose of HBV vaccine. Conclusions: Among HBV carrier mothers, NIM had a twofold rate of being HBeAg-positive compared to Taiwanese mothers. The younger age and NIM were two significant risk factors for mothers to be HBeAg-positive. We suggest more education and encouragement for HBV carrier mothers to have their babies checked for HBV markers in order to find HBV infections earlier and to get another booster vaccine if there is no antibody.

1. 內政部戶政司：人口資料庫：出生數按生母原屬國籍分。台北：內政部戶政司，2013。Department of Household Registration, Ministry of the Interior, R.O.C. (Taiwan). Number of births by mother's nationality. Taipei: Department of Household Registration, Ministry of the Interior, R.O.C. (Taiwan), 2013.
2. Beasley, RP.(2009).Rocks along the road to the control of HBV and HCC.Ann Epidemiol,19,231-4.
3. Chang, MH(2009).Cancer prevention by vaccination against hepatitis B.Recent Results Cancer Res,181,85-94.
4. Chang, MH.(2007).Hepatitis B virus infection.Semin Fetal Neonatal Med,12,160-7.
5. Chen, SC,Toy, M,Yeh, JM,Wang, JD,Resch, S.(2013).Cost-effectiveness of augmenting universal hepatitis B vaccination with immunoglobin treatment.Pediatrics,131,e1135-43.
6. Cheung, KW,Seto, MT,Wong, SF.(2013).Towards complete eradication of hepatitis B infection from perinatal transmission: review of the mechanisms of in utero infection and the use of antiviral treatment during pregnancy.Eur J Obstet Gynecol Reprod Biol,169,17-23.
7. Giles, ML,Grace, R,Tai, A,Michalak, K,Walker, SP.(2013).Prevention of mother-to-child transmission of hepatitis B virus (HBV) during pregnancy and the puerperium: current standards of care.Aust N Z J Obstet Gynaecol,53,231-5.
8. Liang, TJ.(2009).Hepatitis B: the virus and disease.Hepatology,49(5 Suppl),S13-21.
9. Liang, X,Bi, S,Yang, W(2009).Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China.J Infect Dis,200,39-47.
10. Liaw, YF,Brunetto, MR,Hadziyannis, S.(2010).The natural history of chronic HBV infection and geographical differences.Antivir Ther,15(Suppl 3),25-33.
11. McMahon, BJ,Bruden, DL,Petersen, KM(2005).Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up.Ann Intern Med,142,333-41.
12. Merican, I,Guan, R,Amarapuka, D(2000).Chronic hepatitis B virus infection in Asian countries.J Gastroenterol Hepatol,15,1356-61.
13. Ni, YH,Chang, MH,Huang, LM(2001).Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination.Ann Intern Med,135,796-800.
14. Pan, CQ,Duan, ZP,Bhamidimarri, KR(2012).An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus.Clin Gastroenterol Hepatol,10,452-9.
15. Piratvisuth, T.(2013).Optimal management of HBV infection during pregnancy.Liver Int,33(Suppl 1),188-94.
16. Shao, ZJ,Zhang, L,Xu, JQ(2011).Mother-to-infant transmission of hepatitis B virus: a Chinese experience.J Med Virol,83,791-5.
17. Shi, Z,Li, X,Ma, L,Yang, Y.(2010).Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis.Int J Infect Dis,14,e622-34.
18. Tong, CY,Robson, C,Wu, Y(2013).Post-vaccination serological test results of infants at risk of perinatal transmission of hepatitis B using an intensified follow-up programme in a London centre.Vaccine,31,3174-8.
19. Wait, S,Chen, DS.(2012).Towards the eradication of hepatitis B in Taiwan.Kaohsiung J Med Sci,28,1-9.
20. Wu, TW,Lin, HH,Wang, LY.(2013).Chronic hepatitis B infection in adolescents who received primary infantile vaccination.Hepatology,57,37-45.
21. Xu, WM,Cui, YT,Wang, L(2009).Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study.J Viral Hepat,16,94-103.
22. Yin, Y,Wu, L,Zhang, J,Zhou, J,Zhang, P,Hou, H.(2013).Identification of risk factors associated with immunoprophylaxis failure to prevent the vertical transmission of hepatitis B virus.J Infect,66,447-52.
23. 林志陵、高嘉宏(2008)。肝癌的流行病學。中華民國癌症醫學會雜誌，24，277-81。
24. 張平、陸偉、李順天、尤煒、張玉榮、陳靜(2012)。人乙型肝炎免疫球蛋白定量清除新生兒乙型肝炎病毒表面抗原的研究。中華肝臟病雜誌，20，17-9。
25. 張美惠(2011)。肝癌之預防。聲洋防癌之聲，132，49-51。
26. 蔣安仁、沈國壽、尹西雲、吳虹、鄧秀珍(2006)。大陸與外籍新娘生育健康問題及就醫需求評估。96年度台灣婦產科年會暨擴大學術研討會，台南=Tainan:

1. 楊舜婷、陳志成、林嘉玲、林怡岑(2014)。台灣新生兒B型肝炎疫苗政策之直接成本分析。臺灣公共衛生雜誌，33(6)，674-680。