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THE EFFECT OF A NATIONWIDE PREVENTION PROGRAM FORMOTHER-TO-INFANT INFECTION BY HBV EVALUATED BY VIRAL

MARKERS IN BLOOD DONORS IN NAGASAKI PREFECTURE

Shin Chiyoda1, Hidetaka Oda1, Tamaka Kotani1, Eisuke Kusaba2and Toshiki Kusano21Nagasaki Red Cross Blood Center2Sasebo Red Cross Blood Center

Nagasaki Prefecture is a highly endemic area for hepatitis B virus�HBV. In recent years, wehave identified a decrease in the incidence of positivity for hepatitis B surface antigen�HBsAg. In1985, the Government of Japan started a nationwide prevention program for mother-to-infant infec-tion by HBV. As blood donor is acceptable from age 16, a portion of the people who owed this pro-gram became to age with approval of blood donation. We screened 291,587 serum samples from vol-untary blood donors�170,366 males and 121,221 femalesbetween 16 and 69 years of age who first vis-ited Nagasaki and Sasebo Red Cross Blood Center from June 1990 to December 2004.

The positive rate for HBsAg among blood donors by year of birth decreased from 1.67 to 01over the years 1929 to 1988�test of trend�p�0.001.

No donor born from 1986 to 1988 was positive, although a decrease in the positive rate was rec-ognized before 1985. This may be because in 1985, the Government of Japan started a preventionprogram for mother-to-infant infection by HBV. Shiraki has reported that this program was very ef-fective. The present study involving the analysis of data among blood donors provides further evi-dence for the high efficacy of this program.

HBsAg, Blood donor, Mother-to-infant infectionKey words

Japanese Journal of Transfusion Medicine, Vol. 52. No. 1 52�152�56, 2006

Table 1　Positive Rate（%）of HBsAg among Blood Donors in Nagasaki Prefecture

positive rate of HBsAgnumber of positive donorsactual number of blood donors＊

yeartotalfemalemaletotalfemalemaletotalfemalemale

1.37%1.23%1.47%28811017821,0548,95212,1021990

1.22%0.98%1.41%33112021127,22712,28014,9471991

0.75%0.62%0.83%2799218737,34114,74822,5931992

0.90%0.68%1.07%1595410517,7427,8919,8511993

0.85%0.56%1.09%117358213,8206,2747,5461994

0.67%0.49%0.82%112377516,7747,6149,1601995

0.75%0.58%0.88%1946512926,03311,29314,7401996

0.49%0.46%0.50%151599231,06712,71818,3491997

0.55%0.46%0.62%117427521,3629,19612,1661998

0.66%0.51%0.76%116387817,6947,40710,2871999

0.58%0.35%0.74%88216715,0445,9889,0562000

0.53%0.40%0.60%65184712,3624,5267,8362001

0.44%0.40%0.47%56183812,6294,5078,1222002

0.37%0.23%0.45%52114113,9444,8839,0612003

0.68%0.37%0.88%5111407,4942,9444,5502004

0.75%0.60%0.85%2,1767311,445291,587121,221170,366Total

＊donors at first visit to Nagasaki or Sasebo Blood Center

� 6����B����� �����������1986� 1��� HBe����� !"#��#$%&��'()*+� HB,-./012!34 HB5673#89(:;��< =>?@ABC;:D(AEF7GH9GIJ#����KLM(%NCFOP?QRST; 16U(V�FFW�HBs����X#YZ[\]:^J#��#_`�abc;J4defAJ44ghij�FI

���������1990� 6��� 2004� 12�NS(kl�mn

o#pRqr3st�uCFQRXv16H64U�1999� 4���d 69UNSG#wxv1,172,629yz{� 745,979y�|� 426,650yG�w}��~#�#�����#wxv291,587y�{�170,366y�|� 121,221yG��'4�����]:^�%��4# HBs�����#ij���FI��HBs� � w } d RPHAvreverse passive he-

magglutinationG�vHBs��w$��z�y�������G�HBs�xd PHAvpassive hemag-

glutinationG�vHBs�xw$��z�y�������G�HBc�xd HIvhemagglutination in-hibitionG�vHBc�xw$9��z�y�������G�9�FIHBs�����#[\d���4(-�3�

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:^­# HBe��#������Fv®ts#1¯?°±ST²³´µCF«#�¶·GINF1983��� 1985�# HBe�����d°±ST² 1986��� 1988�#¸¹º�9�FI��QRX(]�; HBs����X(]��

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Table 2　Positive Rate（%）of HBsAg among Blood Donors by Year of Birth in Nagasaki Prefecture

positive rate of HBsAgnumber of positive donorsactual number of blood donorsyear of birth totalfemalemaletotalfemalemaletotalfemalemale

0.77%1.65%0.00%2202601211391929

0.62%0.70%0.55%2113241421821930

1.67%0.61%2.36%7164181642541931

0.51%0.39%0.59%3125932553381932

0.96%0.66%1.17%7257293014281933

0.82%1.10%0.61%7438533644891934

0.56%0.00%0.96%6061,0694436261935

0.72%0.71%0.73%9451,2485646841936

1.17%1.44%0.96%17981,4536238301937

0.86%0.45%1.18%133101,5126638491938

0.66%0.86%0.51%11651,6666959711939

0.94%1.10%0.83%199102,0238211,2021940

1.47%1.57%1.40%3315182,2449571,2871941

0.90%0.73%1.01%217142,3429611,3811942

0.76%0.39%1.02%194152,5121,0351,4771943

1.03%0.74%1.22%288202,7291,0851,6441944

1.02%0.85%1.11%227152,1668201,3461945

1.30%0.86%1.57%369272,7691,0441,7251946

1.26%0.83%1.50%5613434,4291,5622,8671947

1.17%1.24%1.13%5421334,6211,6982,9231948

1.01%0.72%1.16%5213395,1721,8083,3641949

1.33%0.87%1.57%6314494,7341,6173,1171950

0.95%0.60%1.12%4610364,8651,6593,2061951

1.24%1.10%1.32%6018424,8221,6433,1791952

0.92%0.74%1.01%4512334,8921,6223,2701953

1.22%1.04%1.30%6117445,0131,6343,3791954

0.94%0.58%1.10%469374,9091,5543,3551955

1.25%0.88%1.43%6114474,8781,6003,2781956

1.19%1.02%1.28%5817414,8621,6693,1931957

0.74%0.46%0.88%398315,2651,7463,5191958

1.02%0.77%1.15%5414405,3061,8273,4791959

1.05%0.63%1.27%5812465,5151,8923,6231960

0.89%0.75%0.96%4914355,4981,8553,6431961

0.97%0.88%1.02%5417375,5681,9303,6381962

0.88%0.67%1.00%5014365,7072,0983,6091963

0.71%0.67%0.74%4215275,8792,2273,6521964

0.63%0.52%0.71%4013276,3082,4963,8121965

0.92%0.69%1.07%4614325,0222,0402,9821966

0.65%0.33%0.88%4710377,2373,0194,2181967

0.76%0.53%0.94%5416387,0743,0304,0441968

0.77%0.66%0.86%6123387,9123,4964,4161969

0.70%0.61%0.78%5723348,1113,7414,3701970

0.72%0.83%0.62%6435298,9044,2254,6791971

0.73%0.63%0.82%83335011,3155,2146,1011972

0.77%0.48%1.03%100297112,9696,1016,8681973

0.73%0.87%0.61%97534413,2596,0657,1941974

0.54%0.54%0.54%64293511,8085,3816,4271975

0.48%0.42%0.53%49212810,2724,9675,3051976

0.44%0.31%0.55%4214289,6544,5535,1011977

0.42%0.39%0.45%4018229,4894,5804,9091978

0.45%0.37%0.53%3915248,5764,0804,4961979

0.24%0.30%0.18%181177,5923,6883,9041980

0.39%0.43%0.35%2614126,7093,2333,4761981

0.34%0.34%0.35%209115,8472,6653,1821982

0.21%0.15%0.26%10374,7642,0192,7451983

0.18%0.18%0.17%7343,9841,6412,3431984

0.07%0.09%0.05%2113,0701,1661,9041985

0.00%0.00%0.00%0001,8906961,1941986

0.00%0.00%0.00%0007633164471987

0.00%0.00%0.00%0002131101031988

0.75%0.60%0.85%2,1767311,445291,587121,221170,366Total

54 Japanese Journal of Transfusion Medicine, Vol. 52. No. 1

Table 3　Program for the Prevention of mother-to- infant infection by HBV in Nagasaki

198819871986198519841983Year

18,23318,96219,94620,36621,34521,657（A） Numbers of birth

17,17618,18719,301（B） Pregnant women examined for HBsAg

383311374（C） HBsAg―positive

328321351（D） Pregnant women examined for HBeAg

827886（E） HBeAg―positive

7571116（F） Infants treated by prevention program

0.410.370.58（G） Rate of infants treated（%）；（F） / （A）×100

0.5570.4160.4750.483#0.483#0.483#（H） Positive rate of HBeAg（%）；［E/ ｛B× （D/C）｝］×100

2137631,8903,0703,9844,764（I） Blood donors

139131721（J） Prospectivde HBsAg―positive donors；（I） × （H） /100×0.9＊

0002710（K） Actual HBs Ag―positive donors

（J）is number of infants who would have become HBs Ag carriers, if infants were not treated by prevention program.＊；0.9 mean that 90% of infants who were born from HBe Ag―positive mothers, become HBs Ag carriers

#：the mean of the positive rate of HBeAg from 1986 to 1988

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1986��[ 1988�3W1���� �[�./ �M'L�F[�����0\�� 1985� 6��[��Z���B�����wx��T�� ¡3�EL+t`�E0Table 33�¢wx��T�� �£¤Z��\¥¦§Z, HBs�24�¨ HBe�2./l�-C©p�0�¢wx��T�� �£¤Z��ªbcd8«W¬��­® 2¯°�±��90&�$¦§Z,�\� 3²³Z��HBe�2./ �® 805�±���´ HBe�2./l� 0.416&�[0.557&�(��0\�µZ,�¶�T�C>g��·¸PQRS¹lC 90&+UE+�1,000'3 4a5'�PQRS+�)�1986a1988�3W1�� 2,866'�� ��® 135PQRS�ºWUE\+�¶»Z�E0p�p��¼3�M'./ L�F[�����0\�3�)¶�T�3���½¾�χ2I¿ÀPÁ0.001�3nop�\+������0p�p�ÂÃ+�� ���ÄÅÆ��[./l�MÇUE+�È[É�1983a1985� HBe�2./lC 1986a1988�./l+*ÊËÌ+Í¿UE+�1983a1985�W1��� ./ � 515+¶ÎZ�E���¼3� 195Ï��0\���ÄÅÆ�3�EÐ+jk�\Ѹ��� ÄÅ./ CÒÓUE+���T�CÔ[����·¸1986a1988�./ � 135��H 55+�E\+�¶»Z�E0p�p�./ �M'L�F

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56 Japanese Journal of Transfusion Medicine, Vol. 52. No. 1