■2020年,世界卫生组织(WHO)建议对感染乙型肝炎病毒(HBV)并伴有高病毒血症(≥200,000IU/ml)的孕妇进行围产期抗病毒预防(PAP)。当HBVDNA不可用时,也推荐乙型肝炎e抗原(HBeAg)作为替代。为决策提供信息并指导预防母婴传播战略的实施,我们进行了系统评价和荟萃分析,以估计在全球和区域一级符合PAP的HBV感染孕妇的比例.
■我们搜索了PubMed,EMBASE,Scopus,和CENTRAL涉及HBV感染孕妇的研究。我们提取了高病毒血症(≥200,000IU/ml)的女性比例,HBeAg阳性的女性比例,根据HBVDNA和HBeAg交叉分层的女性比例,以及这些产妇群体中儿童感染的风险。使用随机效应荟萃分析汇总比例。
■在6,999篇文章中,131项研究涉及71,712例HBV感染孕妇。世卫组织每个区域的研究数量为66(西太平洋),21(欧洲),17(非洲),11(美洲),九(东地中海),和七个(东南亚)。高病毒血症的总体合并比例为21.27%(95%CI17.77-25.26%),区域差异显著:西太平洋(31.56%),美洲(23.06%),东南亚(15.62%),非洲(12.45%),欧洲(9.98%),和东地中海(7.81%)。HBeAg阳性呈相似的区域变异。交叉分层后,高病毒血症和HBeAg阳性的比例,高病毒血症和HBeAg阴性,低病毒血症和HBeAg阳性,和低病毒血症和HBeAg阴性15.24%(95%CI11.12-20.53%),2.70%(95%CI1.88-3.86%),3.69%(95%CI2.86-4.75%),和75.59%(95%CI69.15-81.05%),分别。无免疫球蛋白和PAP的出生剂量疫苗接种后儿童感染的相应风险为14.86%(95%CI8.43-24.88%),6.94%(95%CI2.92-15.62%),7.14%(95%CI1.00-37.03%),和0.14%(95%CI0.02-1.00%)。
■大约20%的HBV感染孕妇有资格获得PAP。鉴于区域差异很大,每个国家都应该为HBsAg筛查量身定制策略,风险分层,和PAP在常规产前护理中的应用。
■在2020年,WHO建议对乙型肝炎表面抗原(HBsAg)检测呈阳性的孕妇进行HBVDNA检测或HBeAg以及高病毒血症(≥200,000IU/ml)或HBeAg阳性的孕妇接受PAP。有效实施新的HBVPMTCT干预措施并整合HBV筛查,风险分层,将抗病毒预防纳入常规产前护理服务,估计符合PAP的HBV感染孕妇的比例至关重要.在这篇系统综述和荟萃分析中,我们发现,大约五分之一的HBV感染的孕妇有资格根据HBVDNA检测PAP,根据HBeAg检测,类似的比例是合格的。由于资格比例以及不同测试的可用性和成本的区域差异很大,这是至关重要的每个国家优化策略,整合HBV筛查,风险分层,将PAP纳入常规产前护理服务。
■本研究已在PROSPERO注册(方案号:CRD42021266545)。
UNASSIGNED: In 2020, the World Health Organization (WHO) recommended peripartum antiviral prophylaxis (PAP) for pregnant women infected with hepatitis B virus (HBV) with high viremia (≥200,000 IU/ml). Hepatitis B e antigen (
HBeAg) was also recommended as an alternative when HBV DNA is unavailable. To inform policymaking and guide the implementation of prevention of mother-to-child transmission strategies, we conducted a systematic review and meta-analysis to estimate the proportion of HBV-infected pregnant women eligible for PAP at global and regional levels.
UNASSIGNED: We searched PubMed, EMBASE, Scopus, and CENTRAL for studies involving HBV-infected pregnant women. We extracted proportions of women with high viremia (≥200,000 IU/ml), proportions of women with positive HBeAg, proportions of women cross-stratified based on HBV DNA and
HBeAg, and the risk of child infection in these maternal groups. Proportions were pooled using random-effects meta-analysis.
UNASSIGNED: Of 6,999 articles, 131 studies involving 71,712 HBV-infected pregnant women were included. The number of studies per WHO region was 66 (Western Pacific), 21 (Europe), 17 (Africa), 11 (Americas), nine (Eastern Mediterranean), and seven (South-East Asia). The overall pooled proportion of high viremia was 21.27% (95% CI 17.77-25.26%), with significant regional variation: Western Pacific (31.56%), Americas (23.06%), Southeast Asia (15.62%), Africa (12.45%), Europe (9.98%), and Eastern Mediterranean (7.81%).
HBeAg positivity showed similar regional variation. After cross-stratification, the proportions of high viremia and positive HBeAg, high viremia and negative
HBeAg, low viremia and positive
HBeAg, and low viremia and negative
HBeAg were 15.24% (95% CI 11.12-20.53%), 2.70% (95% CI 1.88-3.86%), 3.69% (95% CI 2.86-4.75%), and 75.59% (95% CI 69.15-81.05%), respectively. The corresponding risks of child infection following birth dose vaccination without immune globulin and PAP were 14.86% (95% CI 8.43-24.88%), 6.94% (95% CI 2.92-15.62%), 7.14% (95% CI 1.00-37.03%), and 0.14% (95% CI 0.02-1.00%).
UNASSIGNED: Approximately 20% of HBV-infected pregnant women are eligible for PAP. Given significant regional variations, each country should tailor strategies for HBsAg screening, risk stratification, and PAP in routine antenatal care.
UNASSIGNED: In 2020, the WHO recommended that pregnant women who test positive for the hepatitis B surface antigen (HBsAg) undergo HBV DNA testing or HBeAg and those with high viremia (≥200,000 IU/ml) or positive
HBeAg receive PAP. To effectively implement new HBV PMTCT interventions and integrate HBV screening, risk stratification, and antiviral prophylaxis into routine antenatal care services, estimating the proportion of HBV-infected pregnant women eligible for PAP is critical. In this systematic review and meta-analysis, we found that approximately one-fifth of HBV-infected pregnant women are eligible for PAP based on HBV DNA testing, and a similar proportion is eligible based on HBeAg testing. Owing to substantial regional variations in eligibility proportions and the availability and costs of different tests, it is vital for each country to optimize strategies that integrate HBV screening, risk stratification, and PAP into routine antenatal care services.
UNASSIGNED: This study was registered with PROSPERO (Protocol No: CRD42021266545).