乙肝疫苗接种是根除乙型肝炎的关键措施

乙型肝炎病毒感染是全球性健康问题,据估计全世界至少有3.6亿慢性乙肝病毒感染者.目前控制乙肝病毒感染最有效的方法是用安全的乙肝疫苗免疫所有易感人群,尤其是年幼儿童.通过疫苗接种、有效的抗病毒治疗及中断传播的联合措施可使乙肝病毒感染得到控制,最终达到根除乙型肝炎的目的 .该文综述了乙肝疫苗的研发过程,阐述了其在乙肝病毒暴露前和暴露后处置中的作用,以及乙肝疫苗接种后保护力持续时间和需要加强剂量等问题.儿童计划免疫接种乙肝疫苗减少了乙肝病毒携带者、急性和慢性感染性疾病(包括肝细胞癌)的发生.同时,该文也讨论了人体清除乙肝病毒和最终根除乙型肝炎的趋向.     

乙型肝炎疫苗接种无应答解决对策

已正式批准使用的乙型肝炎（乙肝）疫苗，包括早期的血源疫苗和目前普遍使用的重组疫苗，按常规方案实施一个免疫程序后确有一定比例的接种者表面抗体（抗一HBs）滴度不能达到保护水平（即10IU／L），在健康人群中该比例波动在2％～15％之间。这些所谓无应答者对乙肝病毒（HBV）仍然易感，一旦感染仍可发病或成为病毒携带者。乙肝疫苗接种无应答是个体内、外部多种因素共同作用的结果，内部因素（包括遗传因素）决定了个体对疫苗应答能力低下，而外部因素即疫苗接种又未打破这一状态。基于原因与机制的探讨，目前主要试图通过以下3种途径来解决这一问题。     

我国乙型肝炎疫苗接种前筛检策略的优化

By means of decision tree model and cost-effectiveness analysis 15 kinds of programmes which may be used for hepatitis B virus markers screening in vaccination were evaluated. The results showed that the most cost-effective alternative was to identify the negatives for anti-HBc again after testing for anti-HBs and vaccinating all test negatives. That is to say it must not be adopted for persons to be tested for HBsAg, anti-HBs and anti-HBc before being vaccinated. Sensitivity and threshold analysis were also done to determine the effects of changes in the costs of vaccine and screening tests.     

乙肝疫苗接种前可以不筛查

乙型肝炎（乙肝）疫苗免疫是预防乙肝的关键。我国自1992年实施新生儿乙肝疫苗免疫后,一般人群乙肝病毒表面抗原（HBs Ag）携带率已由1992年9.75%降至7.18%,15岁以下儿童下降更为明显,5岁以下儿童已降至0.96%,5~14岁为2.42%。2009年我国卫生部提出对15岁以下人群实施乙肝疫苗补种并将于今年完成。     

对349例乙型肝炎疫苗接种及乙型肝炎预防知识知晓度的调查分析

自愿的基础上提倡高危人群接种乙型肝炎疫苗.     

乙型肝炎疫苗接种预防乙型肝炎和肝癌效果

目的 评价乙型肝炎(乙肝)疫苗预防乙肝和原发性肝细胞癌(肝癌)的保护效果。方法采用出生队列调查、横断面血清流行病学调查以及乙肝发病和肝癌死亡监测,对乙肝疫苗的预防效果进行评价。结果 婴儿乙肝疫苗普种后14年,接种人群HBsAg阳性率为0.7％～2.9％(平均为1.5％),保护率为83.5％～96.6％;HBV感染率为1.1％～5.1％(平均为2.2％),保护率为93.5％～98.4％。乙肝疫苗普种后15年,1～14岁年龄组乙肝发病率为1.4/10万,下降92.4％;0～19岁组肝癌死亡率为0.17/10万,下降19.23倍。结论 婴儿乙肝疫苗普种可降低急性乙肝发病率和肝癌死亡率。     

乙型肝炎疫苗接种决策分析

概述了世界范围内乙型肝炎流行的现状和分布状况，不同程度乙型肝炎流行的国家或地区引起乙肝病毒传播的主要危险因素，应重点保护的对象及控制乙型肝炎流行的预防策略，并从决策的角度阐述了经济效益分析的有关指标，如成本效益比，成本－效果比，阈值，灵敏度，名指标应用条件及其在确定乙型肝炎免疫预防策略中的应用现状，旨在为研究者筛选预防方案时提供参考。     

乙型肝炎疫苗接种若干问题的探讨

自１９８１年美国首次使用血源性乙肝疫苗以来，已有近２０年的历史。我国比美国晚几年应用，也有十余年的经验。自疫苗问世以来，疫苗的安全性、免疫原性和保护效果已得到充分肯定，但在疫苗应用过程中，仍有一些问题不太清楚。目前亟待解决的问题有：乙肝疫苗的保护期限究竟有多长？是否需要加强接种？疫苗接种后无应答或弱应答的原因及如何处理？目前世界范围使用的乙肝疫苗主要有４种：（１）血源性疫苗：也是最早使用的疫苗，是从乙型肝炎表面抗原（ＨＢｓＡｇ）携带者的血浆中提取ＨＢｓＡｇ颗粒，经“三步灭活法”制成，至今已应用了…     

意大利大规模疫苗接种预防乙型肝炎的成本—效益分析

本对意大利采用大规模疫苗接种预防乙型肝炎的成本－效益进行了评估，对研究方法做了较详细的介绍。研究结果表明对高危人群进行疫苗接种效果较好。     

Facilitators and barriers of Hepatitis B screening and vaccination

BackgroundHepatitis B virus (HBV) infection is the most common cause of liver disease and liver cancer in Singapore, being endemic despite availability of an efficacious vaccine.ObjectiveTo assess the factors associated with HBV screening and vaccination.MethodsUsing mixed methods analysis, focus group discussions were conducted alongside a cross-sectional study amongst 784 Singapore Citizens and Permanent Residents aged 25–69 residing in Housing and Development Board (HDB) flats.ResultsAmongst the respondents, 50.6% were screened and 37.8% were vaccinated. The self-reported prevalence of HBV infection was 3.4% and that of HBsAg seropositivity among those screened was 4.3%. Routine health screening was the most common reason cited for screening (32.9%) while doctors’ recommendation was the most common reason for vaccination (42.7%). For both screening and vaccination, knowledge and cost were the top facilitators and barriers respectively. Multivariable regression models revealed the most significant predictors for not undergoing screening to be poor knowledge (p < 0.001), the presence of stigma (p = 0.040) and not being employed in a healthcare sector (p = 0.022), while factors associated with not undergoing vaccination are that of having not undergone screening (p < 0.001) and the lack of importance placed on the knowledge of the possibility of HBV being a silent killer (p = 0.006).ConclusionSeveral facilitators and barriers are seen to regulate health-seeking behaviour towards HBV infection. Public initiatives including education and financial relief targeting specific population groups should be considered to increase the uptake of HBV screening and vaccination.     

新生儿乙肝疫苗接种情况分析

目的分析新生儿乙肝疫苗接种情况并探讨乙肝疫苗接种后对新生儿的保护作用。方法选取辖区内2012年1月到2013年6月出生的新生儿1800名作为研究对象,对新生儿抽血进行“两对半”检查,并统计新生儿乙肝疫苗接种情况．接种完成后抽血检查新生儿乙肝病毒表面抗原及抗体情况,统计新生儿乙肝表面抗原阳性率及抗体保护率。以全程（三针）接种乙肝疫苗的新生儿为观察组,以人群为对照组,比较两组研究对象在乙肝表面抗原阳性率及抗体保护率之间的差异。结果新生儿乙肝疫苗接种情况非常理想,第一针及时接种率达到97．56％,全程及时接种率93．78％,全程接种率达到94．56％：新生儿HBs阳性率低于人群,且新生儿抗体保护率高达85．49％,高于人群抗体保护率,差异均具有统计学意义（P〈0．05）;疫苗接种后,不良反应少且症状轻微。结论乙肝疫苗切实发挥了对新生儿的保护作用,且安全可靠。     

新生儿乙肝疫苗接种20年后人群的HBV血清流行病学特征研究

目的了解现阶段人群乙型肝炎病毒(HBV)感染现状;评价自1985年4月开展新生儿接种乙肝疫苗免疫策略所取得的成果。方法在国家"七五"攻关课题试点区,应用整群抽样的方法,以家庭为单位,采取血清,应用固相放射免疫法(SPRIA)检测HBsAg、抗—HBs和抗—HBc。结果人群HBsAg阳性率、抗—HBs阳性率和HBV流行率经标化后分别为6.03%、37.75%和37.33%;HBsAg阳性率、HBV流行率均低于1987年同一地区的检测结果,尤以<20岁青少年降低比较明显;抗—HBs阳性率则高于1987年同一地区的检测结果,尤以<20岁青少年升高明显。结论人群乙肝流行病学特征已发生改变,新生儿乙肝疫苗接种已取得了很大的成绩。     

Hepatitis B vaccination coverage among high-risk adults 18-49 years, U.S., 2009

Background

Approximately 43,000 new hepatitis B virus (HBV) infections occurred in 2007. Although hepB vaccination has been recommended for adults at high-risk for incident HBV infection for many years, coverage remains low.

Methods

We used the 2009 National Health Interview Survey to assess self-reported HepB vaccine uptake (≥1 dose), series completion (≥3 dose), and independent predictors of vaccination among high-risk adults aged 18-49 years. High-risk adults were defined as those reporting male sex with men; injection drug use; hemophilia with receipt of clotting factors; sexually transmitted disease in prior five years; sex for money or drugs; HIV positive; sex with persons having any above risk factors; or who “felt they were at high risk for HIV”. Persons with none of the aforementioned risk factors were considered non-high risk. Bivariate analysis was conducted to assess vaccination coverage. Independent predictors of vaccine uptake and series completion were determined using a logistic regression.

Results

Overall, 7.0% adults aged 18-49 years had high-risk behaviors. Unadjusted coverage with ≥1 dose was 50.5% among high-risk compared to 40.5% among non-high-risk adults (p-values <0.001) while series completion (≥3 doses) was 41.8% and 34.2%, respectively (p-values <0.001). On multivariable analysis, ≥1 dose coverage, but not series completion, was higher (Risk Ratio 1.1, 95% CI = 1.0-1.2, p-value = 0.021) among high-risk compared to non-high risk adults. Other characteristics independently associated with a higher likelihood of HepB vaccination among persons 18-49 years included younger age groups, females, higher education, ≥2 physician contacts in the past year, ever tested for HIV, health care personnel, received influenza vaccination in the previous year, and ever received hepatitis A vaccination. Vaccine uptake with ≥1 dose increased by 5.1% (p = 0.047) among high-risk adults between 2004 and 2009.

Conclusions

A small increase in ≥1 dose HepB vaccination coverage among high-risk adults compared with non-high risk adults was documented for the first time in 2009. Higher coverage among persons 18-30 years may reflect aging of persons vaccinated when they were children and adolescents. To improve protection against hepatitis B among high-risk adults, healthcare providers should offer hepatitis B vaccination to persons at high risk and those who seek vaccination to protect themselves and facilitate timely completion of the three (3) dose HepB series.     

广东省乙型肝炎血清流行病学调查研究

目的了解广东省人群乙型肝炎（乙肝）病毒（HBV）感染现状,评价乙肝疫苗免疫策略的效果。方法采取多阶段随机抽样方法,对全省6县区3 927名1-59岁人群进行乙肝血清流行病学研究,用ELISA方法检测乙肝表面抗原（HBsAg）、乙肝表面抗体（抗-HBs）和乙肝核心抗体（抗-HBc）,并调查1-14岁儿童乙肝疫苗接种情况。结果广东省1-59岁人群HBsAg阳性率、抗-HBs阳性率、抗-HBc阳性率和HBV感染率经标化后分别为15.46%、61.51%、49.46%和66.20%。1-14岁人群HBsAg阳性率和HBV感染率明显低于15-59岁人群。1-4岁人群HBsAg阳性率和HBV感染率低于5-14岁人群,而抗-HBs阳性率高于5-14岁人群。HBsAg阳性率和HBV感染率：男性高于女性,农村高于城市,城市人群抗-HBs阳性率高于农村。1-4岁儿童乙肝疫苗接种率为91.90%,全程接种率89.01%,首针及时接种率为58.38%,明显高于5-14岁人群。结论广东省仍是乙肝高流行区;乙肝疫苗纳入儿童免疫策略效果显著,1-14岁人群HBsAg携带率和HBV感染有不同程度下降,1-4岁下降尤为明显。     

Hepatitis B vaccination strategies tailored to different endemicity levels: Some considerations

Hepatitis B is a serious public health problem. Worldwide three different levels of hepatitis B endemicity (high, intermediate and low) can be distinguished. Areas with different levels of endemicity require tailored vaccination strategies to fit the needs for individuals at risk and/or countries, depending on the infection risk per age group, vaccination rate, duration of protection after vaccination, cost effectiveness of vaccination strategies and ease of implementation in the national immunization schedules.This opinion paper evaluates these factors and proposes a combination of infant risk group and universal adolescent vaccination for low endemic countries thus targeting the different groups at risk. A universal infant vaccination schedule starting with a newborn vaccination within 24 h after birth is more appropriate in intermediate- and high-endemic regions.     

聊城市乙肝疫苗接种实施前后居民血清乙肝病毒感染指标检测分析

[目的]了解聊城市实施乙肝疫苗免疫接种工作对提高居民乙肝免疫水平的效果。[方法]在聊城市实施乙肝疫苗免疫接种工作前(2009年7月)和实施后(2010年5月)分别抽取部分1～55岁常住居民,检测血清乙肝病毒感染的5项指标。[结果]接种工作开展前调查2 526人,开展后调查2 491人。抗-HBs阳性率,开展前为39.07%,开展后为69.93%(P<0.01);HBsAg阳性率,开展前为2.89%,开展后为2.65%(P>0.05);抗-HBc阳性率,开展前为35.11%,开展后为33.68%(P>0.05);HBeAg阳性率,开展前为0.83%,开展后为0.68%(P>0.05);抗-HBe阳性率,开展前为9.66%,开展后为8.79%(P>0.05)。[结论]对易感人群开展乙肝疫苗预防接种工作后,抗-HBs阳性率明显提高。     

2012年潍坊市住院分娩产妇HBsAg与新生儿首针乙肝疫苗接种情况调查

目的了解潍坊市住院分娩产妇乙肝病毒表面抗原（HBsAg）检测及其所生新生儿首针乙肝疫苗及时接种情况,为进一步完善新生儿乙肝免疫预防策略提供依据。方法采取回顾性调查的方法,对2012年潍坊市各级医疗机构孕产妇HBsAg检测和新生儿首针乙肝疫苗接种情况进行调查。结果调查潍坊市2012年各级医疗机构住院分娩产妇103236名,新生儿103226名,其中本市新生儿87825名,外地新生儿15401名。产妇HBsAg检查率为97．24％,各县（市、区）为96．15％～98．53％;已检查者阳性率为2．97％,各县（市、区）为2．17％～5．14％。新生儿首针乙肝及时接种率为96．69％,各县（市、区）为92．81％～98。15％。乙肝疫苗及时接种率,本地新生儿为97．10％,外地新生儿为94。40％（P〈0．01）。2173名未及时接种乙肝疫苗的新生儿中,未及时接种原因为患病占83．16％,早产、难产的占6．07％,低体重儿占8．61％,家长拒绝占o．46％,新生儿窒息占0．37％,新生儿畸形占0．51％,其他占0．83％。结论潍坊市2012年各级医院对住院的孕产妇产前HBsAg筛查率较高,其所生的新生儿24h内乙肝疫苗及时接种率较高。     

上海等四城市城区和郊区新生儿乙型肝炎疫苗免疫效果调查

为了解乙型肝炎（乙肝）疫苗的免疫后效果,于1997年9～12月在上海、成都、兰州、肝春4个城市,采用整群随机抽样法抽取城区和郊区3～4岁儿童1271人调查,结果表明：1993～1994年新生儿乙肝疫苗接种丰城区为92.14％,明显高于郊区的76.97％。HBsAg阳性率降至2.28％,抗-HBS阳性率平均为71.28％．城区儿童未发现HBsAg阳性者,郊区儿童HBSAg阳性率为3.36％说明郊区是HBSAg阳性者的主要来源．此结果表明,我国乙肝疫苗免疫效果显著,但在郊区乙肝疫苗免疫工作有待加强。     

郓城县全面实施儿童乙型肝炎疫苗免疫接种的效果分析

[目的]评价郓城县全面实施儿童乙型肝炎免疫接种的效果。[方法]2007年10～12月,在郓城县县城内抽取幼儿园、小学、初中各2所,对部分2～14岁儿童进行调查。[结果]调查3819人,完成全程以上接种(包括全程接种后进行1～2次加强免疫)乙肝疫苗的占91.10%,单纯HBsAg阳性检出率为0.84%,乙肝患病率为0.47%。全程以上接种率有随着年龄的增长而降低的趋势(P0.01);单纯HBsAg阳性率,2～10岁、11～12岁、13～14岁分别为0.41%、1.43%、6.00%(P0.01);乙肝患病率2～10岁为0.10%,11～14岁为1.64%(P0.01)。全面实施乙肝免疫后与实施前出生的,完成全程以上乙肝疫苗接种者所占比例分别为91.49%、62.00%(P0.01),单项HBsAg阳性的分别占0.63%、6.00%(P0.01),乙肝患病率分别为0.35%、3.33%(直接概率P=1.00)。[结论]全面实施乙肝疫苗接种可以降低儿童乙肝病毒感染率与乙肝发病率。