乙型肝炎疫苗免疫19年后乙型肝炎病毒感染流行规律的变化

目的探讨乙肝疫苗长期免疫地区人群HBV流行规律的变化趋势。方法整群抽样结合横断面调查，用固相放射免疫法检测研究对象血清HBV感染标志并进行分析。结果（1）平均HBsAg阳性率为7．5％，0～19岁人群HBV感染指标显著低于≥20岁人群。（2）0～19岁人群HBsAg阳性率1985年高于2005年；1985年的抗-HBs水平随着年龄增长而上升，从1～岁组的12．4％到60～岁组的53．8％，而2005年0～19岁组的抗-HBs随着年龄的增长而下降；1985年抗-HBc阳性水平随着年龄增长而上升，2005年的0～19岁组的仅为2．8％～26．8％，显著下降。结论研究人群中HBV流行规律发生显著变化，0～19岁人群的HBV感染率远低于20岁以上人群，证实乙肝疫苗预防HBV感染取得显著成果。     

中山市健康人群乙肝血清学监测情况分析

目的 了解乙肝疫苗接种效果情况，进而探讨如何更好地实行免费接种乙肝疫苗，确保接种质量。方法 随机抽取152名新生儿和1岁以上健康人群2495名，应用酶联免疫法对其血清进行HBsAg和anti．HBsAg检测。结果 152名新生儿，抗-HBs阳性141人，阳性率为92．7％。HBsAg阳性0人。2495名1岁以上健康人群，抗-HBs阳性1199人，阳性率为48．1％，HBsAg阳性259人，阳性率为10．4％。1～18岁844人，HBsAg阳性10人，阳性率为1．2％。18岁以上1651人，HBsAg阳性249人，阳性率为15．1％。结论 对新生儿及时进行乙肝疫苗全程免疫，能提高新生儿对乙肝的免疫力，预防乙肝。接种乙肝疫苗、提高接种质量能提高易感人群对乙肝的免疫力。降低人群乙肝感染率。1岁以上健康人群抗-HBs阳性率偏低，存在感染乙型肝炎病毒的危险。     

韶关市1～5岁儿童乙型肝炎血清学调查结果分析

目的了解乙肝疫苗纳入免疫规划后,韶关市1～5岁儿童乙肝病毒携带率与乙肝免疫水平,评价现阶段儿童乙肝的预防控制效果。方法从全市10个县（市、区）中采取分层整群随机抽样方法,选取2008年在幼儿园（托儿所）1～5岁儿童作为调查对象,收集血清样本采用酶联免疫吸附试验（ELISA）检测乙肝表面抗原（HBsAg）和表面抗体（抗-HBs）。结果共采集1～5岁儿童血清1485份,HBsAg阳性率为0.88%,随年龄增长有增高的趋势,男性0.93%、女性0.82%,经检验两者间差异无统计学意义（χ2=0.0586,P〉0.05）,地区间最高的是南雄市（0.97%）,最低的武江区（0.80%）,经检验两者间差异无统计学意义（χ2=0.0808,P〉0.05）;抗-HBs阳性率为65.86%,随年龄增长有下降趋势,男性65.01%、女性66.80%,经检验两者间差异无统计学意义（χ2=1.5424,P〉0.05）,地区间最高的武江区（66.27%）,最低的是乳源县（65.47%）,经检验两者间差异无统计学意义（χ2=0.0688,P〉0.05）。结论韶关市乙肝疫苗免疫规划实施后,5岁以下儿童HBsAg携带率明显降低,预防效果显著;抗-HBs阳性率偏低,加大新生儿乙肝疫苗接种剂量。     

儿童乙型肝炎病毒感染状况临床分析

目的了解深圳市盐田区4—10岁儿童乙型肝炎病毒（HBV）感染状况及影响因素，为减少乙肝患病率提供帮助。方法所有儿童均抽空腹静脉血3ml采用酶联免疫吸附实验（ELISA法）检测HBsAg，抗-HBs，HBeAg，抗-HBe，抗-HBc谷丙转氨酶（CPT）及谷草转氨酶（ALT）。结果3455名儿童HBsAg阳性率为3．82％，HBsAg阳性儿童中，以HBsAg（＋），HBeAg（＋），抗-HBc（＋）伴GPT，ALT正常者所占比例最高，为76％。不同性别之间HBsAg阳性率比较无显著差异（P〉0．05）。6岁以下儿童HBsAg阳性率较低，6—10岁组阳性率明显升高。全程接种乙肝疫苗儿童的HBsAg阳性率明显低于未接种组，结果有显著性差异（P〈0．01）。父亲或母亲是HBsAg阳性者所占比例明显高于家庭成员中无HBsAg阳性者（132例中占105例，占79.3％）。结论儿童乙型肝炎病毒感染率较低，且年龄组越小其感染率越低，因乙肝疫苗全程免疫后抗体持续时间长，建议对儿童进行全面预防接种策略，进-步减少乙肝患病率。     

云南保山市聋哑学校乙型肝炎血清流行病学调查

目的了解保山市聋哑学校乙型病毒性肝炎（乙肝）病毒（HBV）感染状况,为聋哑学校乙肝预防控制提供科学依据。方法对在校的90名师生采集静脉血,用ELISA方法检测HBV5项血清学指标。结果 90名调查对象中,聋哑学生68人,教师22人,均无乙肝疫苗免疫史,全校HBsAb阳性率仅为23.3%。HBsAg阳性聋哑学生4人,阳性率为5.9%;HBsAg阳性教师1人,阳性率为4.5%。聋哑学生及本校教师分别有83.8%、31.8%为乙肝易感人群。聋哑学生与同年龄自然人群、本市正常学生HBsAg阳性率相近（P〉0.05）,HBsAb阳性率及HBV感染率均低于本校教师及自然人群（P〈0.05）。结论聋哑学生感染HBV机会较自然人群小,但是聋哑学生面临HBV感染的潜在威胁。     

西湖区8—15岁学生乙肝表面抗原、表面抗体检测结果分析

目的了解南昌市西湖区8～15岁学生中乙型肝炎表面抗原（HBsAg）携带及保护性抗体HBsAb（抗-HBs）产生情况。探讨预防乙肝的对策与措施。方法通过门诊采样,检测我区城乡8-15岁学生中乙肝血清标志物HBsAg、抗-HBs。结果HBsAg阳性率1．55％,性别、城乡不存在差异（P〉0．05）;抗-HBs阳性率21．5％,性别与城乡均不存在差异（P〉0．05）;于计划免疫程序外补种过至少一次乙肝疫苗与从未补种的抗-HBs阳性率存在显著差异（P〈0．01）。结论乙肝疫苗接种率的提高使乙型肝炎表面抗原携带率HBV明显减少,有必要对适龄对象进行补种。     

不同剂量乙肝疫苗与HBIG联合免疫阻断HBV母婴传播的效果对比

目的 探讨10 μg和20 μg乙肝疫苗与HBIG联合免疫阻断HBV母婴传播的效果.方法 124例HBsAg阳性孕妇所生的婴儿随机分为两组,即10 μg乙肝疫苗组和20 μg乙肝疫苗组.婴儿于出生6h内及30 d分别注射200 IU HBIG,同时分别于出生24 h内、1个月及6个月注射3次10 μg或20 μg重组酵母乙肝疫苗.检测婴儿出生时以及1岁时血清HBV标志物.结果 两组新生儿血清HBsAg、HBeAg及抗-HBe阳性率与滴度之间差别均无统计学意义（P＞0.05）.所有新生儿血清HBV DNA水平均小于检测下限（500 U/ml）.出生12个月时,所有124例婴儿血清HBsAg和HBeAg检测结果均为阴性;血清HBV DNA水平均在检测下限以下;10 μg和20 μg乙肝疫苗组血清抗-HBs阳性率分别为90.3％和96.8％,差异无统计学意义（P＞0.05）;抗-HBs水平分别为325.5±342.2 mIU/ml和463.7±353.3 mIU/ml,后者显著高于前者（P=0.01）.而且,20 μg乙肝疫苗组产生高应答抗-HBs（＞ 100 mIU/ml）的比例显著高于10μg乙肝疫苗组（P =0.035）.结论 20 μg乙肝疫苗联合HBIG方案阻断HBV母婴传播的效果优于10 μg乙肝疫苗联合HBIG方案.     

广州市应用乙型肝炎疫苗免疫22年人群血清学效果研究

目的评价广州市长期应用乙型肝炎疫苗（hepatitis B vaccine,HepB）对乙型肝炎（乙肝）免疫防病效果。方法在广州市全市12个区、县级市按照多阶段分层整群抽样法,以家庭为单位对1～59岁人群进行横断面调查分析,包括检测HBsAg、抗-HBs,对HepB接种史及主要乙肝感染危险因素进行问卷调查,评估人群HepB接种率,分析和比较不同年龄组、不同家庭感染状况下接种与未接种HepB人群乙型肝炎病毒感染指标,评价HepB免疫防病效果。结果 1～16岁年龄组乙肝疫苗全程接种率为88.11%（2535/2877）,17～59岁人群有乙肝疫苗免疫史为20.75%（470/2113）。在推行新生儿HepB接种纳入计划免疫管理后出生的1～16岁人群,HBsAg阳性率为1.29%,而出生时尚未开展HepB接种的20～59岁人群HBsAg阳性率为13.72%。1～16岁人群中有HepB接种史人群HBsAg阳性率0.99%,无接种史人群为5.56%,疫苗保护率为82.19%。20～59岁人群接种HepB,基本都不是在新生儿时期,疫苗保护率为52.01%。新生儿接种HepB,母婴乙肝传播阻断率为94.16%,并能有效阻断家庭内水平传播。结论长期实施新生儿接种HepB能控制、消除受种人群乙肝病毒感染,非新生儿人群接种HepB也能显著降低乙肝病毒感染率。     

广州市从业人员HBV及ALT检测结果分析

目的了解广州市从业人员乙型肝炎病毒（HBV）及丙氨酸氨基转移酶（ALT）的检测情况,为制定防控措施提供科学依据。方法对2009年在广州市疾病预防控制中心健康体检的从业人员的血清标本进行乙型肝炎病毒表面抗原（HBsAg）、乙型肝炎病毒e抗原（HBeAg）、ALT检测。结果从业人员的HBsAg阳性率为4.51%（10368/229738）,HBeAg阳性率为1.30%（2998/229738）,ALT异常率为0.92%（2125/229738）;30～岁组HBsAg阳性率最高（5.15%）,〈30岁组HBeAg阳性率最高（1.61%）;不同年龄组间的HBsAg和HBeAg阳性率比较差异有统计学意义（P〈0.001）;男性的HBsAg、HBeAg阳性率及ALT异常率比女性高,差异均有统计学意义（P〈0.001）。结论广州市从业人员HBV感染状况较我国一般人群携带率低,实行预防性健康体检、健康教育和疫苗接种等措施可逐步降低HBV感染。     

辽河油田兴隆台区十五个二级单位体检职工HBV-M状况分析

目的评估2009年1月～2009年12月间在辽河油田二院体检的辽河油田职工乙肝病毒感染率情况,为制定乙肝防治规划提供科学依据。方法对辽河油田参加体检职工抽样调查15个二级单位3000名职工的HBV-M及肝功能情况,按2005年《慢性乙型肝炎防治指南》的要求进行评估。结果抽样调查的3000人中：HBV-M组合模式共有11种,显示人群中HBV感染呈多样性。全阴模式所占比例最大,占1467人（48.9%）;其次是恢复期模式组的单项抗-HBs阳性模式所占比例1026人（34.2%）;在感染期模式组中,以＂HBsAg、抗HBc和抗HBe阳性所占比例最大＂居该组之首位,占114人（3.8%）。具有强传染性的＂HBsAg、抗HBc和HBeAg阳性（4人）＂、＂HBsAg和HBeAg阳性（4人）＂模式共占2.6‰;HBsAg和抗HBc阳性6人（2‰）占感染期模式组比例较大,其余恢复期单一抗HBc阳性66人（2.2%）,抗HBs和抗HBc阳性225人（7.5%）,抗HBs、抗HBc和抗HBe阳性49人（1.6%）,抗HBc和抗HBe阳性18人（6‰）,抗HBs和抗HBe阳性15人（5‰）所占比例较少。3000人中乙肝表面抗原携带率4.26%。不同二级单位存在一定差异：128名乙肝病毒感染者中122人肝功异常,38人需住院治疗。油建一公司感染率最高为5.6‰,渤海物业和消防队感染率较低为1.33‰。不同性别存在一定差异：男性HBV感染者占总人数的3.06%,男性HBV感染者占男性总人数的5.07%,女性HBV感染者占总人数的1.2%,女性HBV感染者占女性总人数的3.03%。曾感染HBV者1399人,占总人数的46.6%,均低于全国HBV感染流行水平。结论辽河油田HBV感染率低,乙型肝炎预防的措施有效,应继续加大对乙肝疫苗规范接种及接种后随访管理工作,降低乙肝病毒感染水平。     

基因重组干扰素治疗急性乙型肝炎疗效观察

目的　以基因重组干扰素治疗急性乙型肝炎病人,观察其减少急性乙肝转慢率的效果。方法　用基因重组α干扰素（３００ 万Ｕ,肌内注射,隔日１ 次,１２ 周为一个疗程） 治疗１９ 名急性乙肝病人,对治疗后未产生抗ＨＢｓ 者,加用乙肝疫苗（３０ μｇ,肌内注射,每周注射１ 次,连用３ 周）;对照组为病情相似的１５ 例病人,服用一般保肝药物。结果　治疗组１８ 例（９５－０％ ,１８１９）ＨＢｓＡｇ 阴转,但均未产生抗ＨＢｓ,再用乙肝疫苗后,１７ 例（９４－０％ ,１７１９） 产生抗ＨＢｓ。２４～２４０ 周随访期间,１８ 例ＨＢｓＡｇ 阴转者无复发;１ 例ＨＢｓＡｇ 未阴转者,至随访结束时仍为阳性。对照组８ 例（５３－０ ％ ,８１５）ＨＢｓＡｇ 阴转,同时,８７－５ ％（７８）的病例产生抗ＨＢｓ,另７ 例ＨＢｓＡｇ 未阴转者,在２４ ～２４０ 周的随访期间,仅１ 例ＨＢｓＡｇ阴转,余６ 例ＨＢｓＡｇ 持续阳性。结论　对于急性乙型肝炎发病８ 周后ＨＢｓＡｇ 仍未阴转者,采用干扰素合用乙肝疫苗,对防止转慢及ＨＢｓＡｇ 阴转后抗ＨＢｓ 的产生可能有一定作用     

Cell-mediated immunity to hepatitis B surface antigen in man.

An aqueous preparation of hepatitis B virus (HBV) vaccine was used as an intradermal skin test antigen to assess delayed hypersensitivity to hepatitis B surface antigen (HBsAg). Thirty-five persons were tested including 10 individuals seronegative for all HBV markers, 10 positive for HBsAg (chronic carriers) and 15 positive for antibody to HBsAg (anti-HBs), five of whom had received the HBV vaccine. All patients were also studied for lymphocyte blastogenic responses to phytohaemagglutinin, concanavalin A, pokeweed mitogen and purified HBsAg. Only one individual had a positive delayed skin test reaction to HBsAg. This person had received the HBV vaccine and had high titres of anti-HBs in serum. However, neither this individual nor any other subject exhibited a positive lymphocyte blastogenic response to HBsAg in vitro. Thus, delayed hypersensitivity skin test reactivity to HBsAg was not detected after natural infection with HBV and was rarely present in hyperimmunized individuals. In vitro assays of immune responsiveness failed to demonstrate cellular immunity to HBsAg even in hyperimmunized persons. These studies provide no evidence that cell-mediated immunity to HBsAg plays a role in the immunopathogenesis of acute or chronic type B hepatitis.     

HBV and HCV infection in Japanese dental care workers

Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in dental care workers. To determine the best way to protect these workers, our study examined viral hepatitis infection in dental care workers in regions with a high prevalence of HCV infections in Japan. In total, 141 dental care workers (including dentists, dental hygienists and dental assistants) were enrolled. After a questionnaire to elicit demographic information was administered by an oral surgeon, hepatitis B surface antigen (HBsAg), antibody to HBs (anti-HBs), antibody to hepatitis B core antigen (anti-HBc) and antibody to HCV (anti-HCV) were measured. When necessary, HBeAg, anti-HBe, levels of HBV DNA, anti-HBc IgM and HCV RNA in serum were measured. Of the dental care workers included, 68 (48.2%) had been immunized with a HBV vaccine. Only 9 wore a new pair of gloves for each new patient being treated, 36 changed to a new pair only after the old gloves were torn and 24 did not wear any gloves at all. No one was positive for HBsAg or anti-HCV, though 73 (51.8%) and 17 (12.1%) workers were respectively positive for anti-HBs and anti-HBc. The positive rate of anti-HBc varied directly with worker age and experience. Of the 68 workers immunized with HBV vaccine, 51 (75%) were positive for anti-HBs. Of the 63 workers who were not so immunized, 17 (27%) were positive for anti-HBs and 15 of these were also positive for anti-HBc. Immunized workers were more protected against HBV infection than non-immunized workers, indicating that HBV vaccine was a useful measure for protection against the infection. The anti-HBc positive rate was significantly higher among dental care workers than general blood donors, suggesting that frequency of exposure to HBV was greater in dental care workers. HBV vaccination should be made compulsory for all dental care workers who handle sharp instruments.     

Significance of isolated anti-HBc seropositivity by ELISA: implications and the role of radioimmunoassay.

Hepatitis B virus (HBV) surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) are excellent markers for HBV infection and its immunity. The significance of isolated antibody to HBV core antigen (anti-HBc) seropositivity is not certain. To elucidate this, sera from 638 Chinese adult subjects, aged 18-52 years, seronegative for both HBsAg and anti-HBs, were tested for anti-HBc. Fifty-one (8%) were found to have an isolated anti-HBc seropositivity by ELISA, and all were negative for IgM-anti-HBc. The anti-HBc persisted in all subjects who attended follow-up for hepatitis B vaccination (n = 48) for a period of 8 months. These 48 subjects received 3 doses of hepatitis B vaccine (HB-VAX, 10 micrograms or 20 micrograms) at 0, 1, and 6 months: 72.9% developed a primary anti-HBs response (suggestive of a false-positive anti-HBc seropositivity), 4.2% developed an anamnestic or secondary anti-HBs response, and 22.9% did not develop an anti-HBs response. Increasing the cutoff point of the ELISA or reconfirmation with radioimmunoassay (RIA) reduced only a minor half of the false positives. This low specificity of anti-HBc ELISA/RIA, together with the high rate of anti-HBs response to hepatitis B vaccine, indicates that subjects with isolated anti-HBc seropositivity should be included in vaccination programs.     

Occult hepatitis B virus infection in patients with leprosy

Leprosy patients may present with immune system impairment and have a higher hepatitis B virus (HBV) seroprevalence, justifying the investigation of occult HBV infection in these individuals. The aim of this study was to verify the frequency and the clinical factors associated with occult HBV infection in leprosy patients. Between 2015 and 2016, leprosy patients from a reference center in Brazil were interviewed to assess clinical data. Blood samples were collected for the screening of HBV serological markers using enzyme-linked immunosorbent assay. Patients with negative hepatitis B surface antigen (HBsAg) that had positive anti-HBc and/or anti-HBs were selected for HBV DNA detection using real-time polymerase chain reaction. SPSS was used for data analysis. Among 114 selected patients, six were identified with occult infection (5.3%) and five of them with multibacillary leprosy. Three patients with occult infection had a history of a type 2 reaction (P = 0.072; OR, 4.97; 95% CI, 0.87-28.52). Only two patients with occult infection had isolated anti-HBc, while three had isolated anti-HBs, including those with the highest HBV DNA titers. In conclusion, in leprosy patients with negative HBsAg and positive anti-HBc and/or anti-HBs, occult HBV infection occurs in 5.3% and can be found even in patients with isolated anti-HBs.     

广州某高等医学院校研究生乙肝疫苗接种情况调查

目的了解广州某高等医学院校研究生乙肝疫苗接种情况，为乙肝防治工作提供依据。方法对广州某高等医学院校2006年入学的1139名研究生进行入学体检现况调查，采集血标本用ELISA法检测乙型肝炎表面抗原（HBsAg）和表面抗体（HBsAb）。同时发放乙肝疫苗接种情况调查表，调查乙肝疫苗接种的年代、次数，是否加强接种及时间。用SAS统计软件包对结果进行X^2检验分析。结果广州某高等医学院校06级研究生HBsAg阳性率为2．90％，曾注射乙肝疫苗组，HBsAg阳性率显著低于从未注射疫苗组（1．15％ vs． 21．69％，P〈0．0001），而HBsAb阳性率则显著高于从未注射疫苗组（81．54％ vs．44．58％，P〈0．0001）。有17．31％曾接种乙肝疫苗者未能达到预期预防效果。不同年龄研究生乙肝疫苗接种效果有差异（P=0．0462），随着年龄的增加，HBsAb阳性率有下降趋势。女性乙肝疫苗接种效果较男性好（80．0％ vs．84．87％，P=0．0468）。接种年限在3年内者，HBsAb阳性率较其他年限高（0—3年 vs．4—6年，P=0．0089；0—3年 vs．7—9年，P=0．0172；0—3年 vs．〉9年，P=0，0474）。注射大于3针（即加强接种）免疫效果较注射3针者好，差异有统计学意义（P=0．0093）。结论随着年龄的增加，乙肝疫苗接种效果（HBsAb阳性率）逐渐降低。男性群体较女性群体更易成为乙型肝炎病毒的易感人群。对接种年限大于3年者，可进行抗-HBs监测，及时进行加强免疫。     

Acute hepatitis B viral infection in a patient with anti-HBs.

We report a patient with antibody to hepatitis B surface antigen (anti-HBs) but no antibodies to other hepatitis B virus components, who developed acute symptomatic type B hepatitis. The possible explanations for this unusual serological pattern are 1) the antibody-positive status, which developed against only a subdeterminant of hepatitis B surface antigen (HBsAg), arose naturally or as the result of cross-reaction with a variety of antigens; and 2) seroconversion to anti-HBs occurred in response to surface antigen of a mutant strain of hepatitis B virus (HBV). This anti-HBs positivity, in the absence of antibody to hepatitis B core antigen, does not provide natural immunization against HBV infection, and so is not protective. Individuals who are positive to anti-HBs antibody alone which is not elicited by HBV vaccine, should be vaccinated against possible HBV infection.