乙肝疫苗免疫应答与氨基酸变异的关联性研究

目的探讨乙肝疫苗免疫应答与氨基酸变异的关联性。方法 2012年3月—2013年1月采用整群抽样的方法对新疆某县3所综合性中、小学校1 768名在校学生进行乙肝血清学检测,对HBs Ag、HBs Ab 2项指标均为阴性的469名中小学生进行免疫接种,在免疫前和免疫后1个月分别采集静脉血5 m L用于血清学相关指标检测、提取HBV-DNA、S基因扩增和测序及氨基酸序列推断。结果疫苗接种前的1 768名学生中,HBs Ab阳性1203人,阳性率为67.36%,疫苗接种后的469名学生中,HBs Ab阳性413人,阳性率为88.06%,与接种前比较差异有统计学意义(χ2=74.058,P<0.001)。HBs Ag、HBs Ab2项指标均为阴性的血清样本扩增得到40名S基因序列。40名学生中33名在强化免疫后产生抗体。40名样本中3名为ayw2血清型,5名为adrq+血清型,32名为adw2血清型。ayw2血清型中1名有碱基替换,但是编码的氨基酸是相同的,1名出现插入核苷酸C,导致移码突变。基因序列翻译成氨基酸后分别发生I110L、S113T、K122R、T126I、F134Y、T143S、K159G、K160R突变。结论新疆某县的中小学生强化免疫后表面抗体阳性率高于强化免疫前;免疫应答与否,其S基因氨基酸序列均存在一定频率的变异。     

盈江县0～5岁儿童乙型肝炎疫苗免疫效果分析

目的科学评价盈江县0～5岁儿童乙型肝炎疫苗（HepB）免疫效果，为预防控制乙肝提供科学依据。方法采用乳胶法检测完成乙肝疫苗基础免疫儿童的乙肝免疫抗体（抗-HBs），并进行统计分析。结果全县HepB年均接种率99．21％；在完成HepB全程免疫儿童采集末稍血400份，查出抗-HBs245份，阳性率61．25％，不同年龄组阳性率比较，差异有统计学意义（X^2=42．25，P〈0．001）；HepB纳入基础免疫后乙肝发病率下降了74．18％。结论HepB全程接种率较高，但抗一HBs阳性率不理想，需继续探讨影响儿童乙肝免疫效果的因素。     

大学生乙肝疫苗接种率影响因素分析

目的了解影响大学生乙肝疫苗接种率的主要因素,为大学生乙型肝炎健康教育开展及防治策略的制定提供参考依据。方法采用自制问卷和多阶段分层整体随机抽样的方法 ,对某大学本科生2135人乙肝疫苗接种率影响因素进行调查,并按性别、专业和居住地等进行统计分析。结果数据显示该校大学生乙肝疫苗接种率约53%,通过对乙肝疫苗接种行为的Logistic回归分析表明,性别、居住地和专业等因素并未影响大学生乙肝疫苗接种行为。促成大学生接种乙肝疫苗的因素包括:传播途径了解程度、疫苗重要性和必要性认识、做过乙肝检查、家人患乙肝等。结论学校应切实加强对大学生尤其是新生乙肝防治知识的健康教育,增强学生自我保护意识,使其主动接种乙肝疫苗。     

医疗保险对农村成人乙肝疫苗接种意愿的影响分析

目的：探讨农民医疗保险对其乙肝疫苗接种意愿的影响.方法问卷调查河北省12个村的4020名成人,重点分析其中未接种过乙肝疫苗的2315名调查对象的接种意愿,以医疗保险为关键变量拟合 Logistic 回归模型.结果2315名调查对象中,有接种意愿者923人(39．9％).不同医保分组人群的乙肝疫苗接种意愿差异具有统计学意义(χ2＝7．795,P ＝0．020).Logistic 回归分析结果显示,在控制性别、年龄、婚姻状况、受教育程度、收入、知识得分、距离接种机构的路程时间和自评健康条件下,医疗保险会影响乙肝疫苗接种意愿,具体来说,城镇职工医疗保险及城镇居民医疗保险参保者和在新农合基础上又购买了商业健康保险者,在将来选择接种乙肝疫苗的概率是无医保者的2．577倍(1/0．388),是新农合参保者的2．278倍(1/0．439).同时,具有统计学意义的影响因素还有年龄、受教育程度和知识得分3个变量.结论将乙肝疫苗费用纳入医疗保险支付有利于防控乙肝,并符合医疗保险发展趋势.     

聚乙二醇干扰素α-2a联合乙肝疫苗治疗慢性乙型肝炎疗效观察

目的：探讨聚乙二醇干扰素α-2a （PEG-IFNα-2a）联合乙肝疫苗治疗慢性乙型肝炎（CHB）的临床疗效及安全性。方法随机将172例CHB患者分为观察组和对照组，每组86例。对照组应用PEG-IFNα-2a治疗，观察组应用PEG-IFNα-2a联合乙肝疫苗治疗。比较两组在治疗6 m、12 m和随访6 m时HBV DNA阴转率、HBeAg阴转率和ALT复常率。结果在治疗12 m和随访6 m时，观察组HBV DNA阴转率、HBeAg阴转率和ALT复常率分别为81.4%、53.5%和82.6%，和93.0%、64.0%和95.3%，均显著高于对照组水平（67.4%、38.7%和68.6%，和75.6%、46.5%和77.9%，P〈0.05）；在治疗6 m、12 m和随访6 m时，观察组ALT和AST水平分别为（93.5±43.1） U/L和（86.0±50.6） U/L、（40.8±25.1） U/L和（50.7±28.6） U/L、（36.5±11.3） U/L和（43.2±15.7）U/L，均显著低于对照组（116.4±58.6） U/L和（105.3±52.8） U/L、（50.6±26.2） U/L和（59.5±25.4） U/L、（46.0±24.4）U/L和（52.6±23.9） U/L，P〈0.05。结论 PEG-IFNα-2a联合乙肝疫苗治疗CHB可有效地提高干扰素的临床疗效。     

无锡某社区14岁以下儿童乙肝疫苗接种及乙肝病毒感染情况调查分析

目的了解儿童乙肝疫苗接种及乙肝病毒（HBV）感染情况,为制定或调整乙肝疫苗接种策略提供依据。方法随机选取无锡市某社区534名1-14岁常住儿童作为调查对象,对其进行乙肝疫苗接种情况问卷调查,并通过酶联免疫吸附法（ELISA）检测血清中乙肝病毒表面抗原（HBsAg）、乙肝病毒表面抗体（抗-HBs）和乙肝病毒核心抗体（抗-HBc）三项指标。结果该社区1-14岁儿童乙肝疫苗接种率和首针及时接种率分别为97.75%和91.57%,6岁以下两组儿童乙肝疫苗接种率和首针及时接种率差异无统计学意义（P〉0.05）,7-14岁儿童乙肝疫苗接种率和首针及时接种率均低于1-6岁儿童（P〈0.01）;HBV感染率随年龄增长呈递增趋势,1-6岁儿童HBV感染率低于7-14岁儿童（P〈0.05）。结论近年来无锡市儿童乙型肝炎防治效果显著,加强儿童乙肝疫苗接种工作,特别是提高疫苗接种率对于防治HBV感染意义重大。     

中国东中西部地区乙型病毒性肝炎流行现状

目的了解中国东、中、西部地区乙型病毒性肝炎(乙肝)流行现状。方法利用2002年中国居民营养与健康状况调查保留的血清开展乙肝病毒感染血清学检测。结果①中国东、中、西部地区全人群乙肝病毒表面抗原(HBsAg)标化阳性率分别9.20%、7.24%、8.24%。东部地区城市、农村全人群HBsAg阳性率分别为4.29%、11.79%;中部地区城市、农村全人群HBsAg阳性率分别为4.41%、7.84%;西部地区城市、农村全人群HBsAg阳性率分别为4.53%、9.05%。②东、中、西部地区<15岁儿童HBsAg阳性率分别为6.46%、4.47%、5.48%。东部地区城市、农村<15岁儿童HBsAg阳性率分别为2.29%、12.39%;中部地区城市、农村<15岁儿童HBsAg阳性率分别为1.61%、6.82%;西部地区城市、农村<15岁儿童HBsAg阳性率分别为2.57%、7.35%。结论中国东、中、西部地区全人群HBsAg阳性率均有不同程度下降,<15岁儿童下降最明显。表明中国自1992年将乙肝疫苗纳入儿童计划免疫管理效果显著。     

Hepatitis B vaccine alone may be enough for preventing hepatitis B virus transmission in neonates of HBsAg (+)/HBeAg (−) mothers

Background and aimTo prospectively evaluate the efficacy of vaccine alone compared with vaccine plus HBIG for preventing HBV transmission in neonates of HBsAg (+)/HBeAg (−) mothers.MethodsCombined immunization is currently recommended for neonates of HBsAg (+) mothers in China. As a result, a randomized design is infeasible due to ethical reasons. In practice, Guangxi Zhuang Autonomous Region and Jiangsu Province implement vaccine alone and vaccine plus HBIG strategies for neonates born to HBsAg (+)/HBeAg (−) mothers, respectively. We alternatively enrolled neonates of HBsAg (+)/HBeAg (−) mothers from these two regions. Three doses of a recombinant yeast-derived hepatitis B vaccine were given at 0, 1 and 6 months with or without HBIG at birth.ResultsAt 7 months, sera were collected from 132 neonates in Guangxi Zhuang Autonomous Region and 752 neonates in Jiangsu Province. Baseline characteristics of both mothers and neonates were comparable in the two regions. No differences were revealed regarding the occurrence of perinatal HBV transmission with or without HBIG at birth [0.1% (1/752) vs. 0.0% (0/132), p = 1.000]. The anti-HBs response rates were 97.7% (129/132) and 98.5% (740/751) for the neonates with vaccine alone and with HBIG (p = 0.758), respectively. Vaccine alone induced a significantly higher anti-HBs GMC as compared to vaccine plus HBIG at 7 months of age (1555.3 mIU/mL vs. 654.9 mIU/mL, p < 0.0001). At 12 months of age, protective levels of anti-HBs remained in 97.4% (596/612) and 98.3% (118/120) of the neonates receiving and not receiving HBIG, respectively (p = 0.771). The neonates receiving combined prophylaxis had a markedly lower anti-HBs GMC (210.7 mIU/mL vs. 297.0 mIU/mL, p = 0.011). Horizontal HBV transmission occurred in none of the successfully immunized neonates for both compared groups at 12 months of age.ConclusionsVaccine alone may be enough for preventing HBV transmission in neonates of HBsAg (+)/HBeAg (−) mothers.     

Immune response to hepatitis B vaccination among people with inflammatory bowel diseases: A systematic review and meta-analysis

IntroductionThe response rate to hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) is low and varies markedly. We performed a systematic review and meta-analysis to determine the response rate to HBV vaccination and identified the factors predictive of an immune response.MethodsWe searched PubMed, Cochrane Library, and Embase databases, and reviewed the titles and abstracts of studies on the efficacy of HBV vaccination in IBD patients performed through July 2016. Anti-HBs levels > 10 IU/L was considered to be an effective immune response. The primary outcome measure was the response rate to HBV vaccination after series completion, and the secondary outcome was identification of factors at baseline predictive of an immune response.ResultsThirteen studies including 1688 patients were eligible for inclusion. Based on a random-effects model, the pooled rate of a response to HBV vaccination among patients with IBD was 61% (95% confidence interval [CI]: 53–69). Young age (mean difference [MD]: −5.7; 95% CI: −8.46, −2.95) and vaccination during disease remission (relative risk [RR]: 1.62; 95% CI: 1.15–2.29) were associated with a positive response to HBV vaccination. In addition, no immunosuppressive therapy was predictive of an immune response compared to immunomodulatory (RR: 1.33; 95% CI: 1.08–1.63) or anti-tumor necrosis factor-α (anti-TNF-α) (RR: 1.57; 95% CI: 1.19–2.08) therapy.ConclusionsBased on this meta-analysis, only three of five IBD patients will show a serological response to HBV vaccination. Vaccination should be performed at the time of IBD diagnosis, during disease remission, or before starting immunosuppressive therapy.     

Improving hepatitis B birth dose coverage through village health volunteer training and pregnant women education

Hepatitis B is highly endemic in the Republic of Kiribati, while the coverage of timely birth dose vaccination, the primary method shown to prevent mother-to-child transmission of hepatitis B virus, was only 66% in 2014. Children born at home are especially at high risk, as they have limited access to timely birth dose (i.e. within 24 h) vaccination. To improve birth dose coverage, a project to improve linkages between village health volunteers and health workers and educate pregnant women on hepatitis B vaccination was carried out in 16 communities with low birth dose coverage in Kiribati from November 2014 to May 2015. After project completion, the coverage of timely birth dose administration increased significantly both in the densely populated capital region of South Tarawa (from 89% to 95%, p = 0.001) and the Outer Islands (from 57% to 83%, p < 0.001). The coverage of timely birth dose administration among infants born at home increased significantly from 70% to 84% in South Tarawa (p = 0.001) and from 49% to 75% in the Outer Islands (p < 0.001). Timely birth dose was associated with being born in a hospital, being born during the study period and caregivers having developed an antenatal birth dose plan. The project demonstrates a successful model for improving hepatitis B vaccine birth dose coverage that could be adopted in other areas in Kiribati as well as other similar settings.