Age- and sex-related study of hepatitis B virus chronic carrier state in infants from an endemic area (Senegal)

This report concerns hepatitis B virus (HBV) infections observed in 155 infants from Senegal, studied with a view to determining the factors involved in development of the chronic carrier state. A chronic carrier state was observed in 50.3% of the infants. This study confirms that the risk of chronic carriage is linked to age. This risk declines very rapidly with age, falling from 82% in infants under 6 months old, to 15% in children between the ages of 2 and 3 years. Spontaneous elimination of hepatitis B surface antigen (HBsAg) is uncommon in HBsAg carriers during childhood. The difference observed in chronic carriage between males and females is due to a difference in susceptibility of the two sexes to the development of the chronic carrier state: HBV infections (before 2 years of age) lead to a chronic carriage in 77% of males as against 50% of females. These conclusions are important in view of the immunisation programs being carried out against hepatitis B virus in endemic areas. For a maximum efficacy, vaccination must be carried out at birth, or shortly afterwards.     

Hepatitis B infection is highly endemic in Uganda: findings from a national serosurvey

Background

Infant immunization against hepatitis B began in Uganda in 2002.

Objective

To determine the baseline prevalence of hepatitis B virus (HBV) infection and explore risk factors.

Methods

A hepatitis B prevalence study was nested in the 2005 national HIV/AIDS serobehavioural survey. Demographic characteristics and risk factors were explored by questionnaire. One third of blood specimens (n=5875) from adults aged 15 to 59 years were tested for hepatitis B core antibodies (HBcAb); positive specimens were tested for hepatitis B surface antigen (HBsAg).

Results

HBcAb was present in 52.3% (95% CI: 51.0–53.6) of adults, and HBsAg in 10.3% (9.5–11.1). By 15–19 years of age, 40.0% had been infected with HBV. Prevalence of both markers was significantly higher across northern Uganda, in rural areas, among the poor and least educated, and in uncircumcised men. Other independent predictors of infection were age, ethnic group, occupation, number of sex partners, and HIV and HSV-2 status.

Conclusion

Hepatitis B virus infection is highly endemic in Uganda, with transmission occurring in childhood and adulthood. More than 1.4 million adults are chronically infected and some communities disproportionately affected. The hepatitis B infant immunization programme should be sustained and catch-up vaccination considered for older children.     

Field evaluation of the efficacy and immunogenicity of recombinant hepatitis B vaccine without HBIG in newborn Vietnamese infants

A study involving more than 2,000 infants was conducted in Vietnam to assess the field effectiveness and immunogenicity of recombinant hepatitis B vaccine given at birth, 1 month, 2 months, without concomitant hepatitis B immune globulin (HBIG). All received a 5 microg dose of H-B-VAX II at birth. Infants born to non-carrier mothers (Group 1; N = 1798) then received 2.5 microg doses at 1 and 2 months of age, while infants of HBeAg-negative (Group 2; N = 125) or HBeAg-positive (Group 3; N = 88) carrier mothers received 5 microg doses. No Group 1 or 2 vaccinees were infected. In Group 3, 12 (14.6%) of 82 infants did become infected (estimated efficacy 84%). 98.0-98.6% of uninfected infants who were tested for anti-HBs developed a seroprotective concentration > or = 10 IU/L. In hyperendemic Vietnam, where routine maternal screening and passive-active prophylaxis of high-risk infants with vaccine plus HBIG is not feasible, administration of vaccine alone to all newborns may control effectively HBV infection.     

2007年广州部分大学生乙肝疫苗接种与乙肝相关知识态度调查

目的了解大学生乙肝疫苗（HBV）接种情况和大学生对乙型肝炎的认知程度，为制定更好的免疫接种计划提供更为可靠的依据。方法2007年，在广州市抽取4所高等学校的部分大学生进行调查。结果调查191人，HBV接种率为76．44％，其中全程接种的为64．92％。HBV接种率及全程接种率，不同年龄学生间有显著性差异（P〈0．05），不同家庭经济收入的学生有差异（P〈0．05）。有乙肝疫苗接种史者、全程接种者对乙肝是否经日常生活接触传播的知晓率仅为56．16％、60．48％．经唾液传播的知晓率仅为41．78％、45．16％；97．4％的被调查者表示会劝亲人或朋友去接种乙肝疫苗，93．7％的被调查者表示会愿意接受乙肝病人或乙肝携带者赠送的礼物。20．9％的被调查者表示会回避与乙肝病人或乙肝携带者交往，同时86．9％的被调查者也表示不介意与乙肝携带者一起工作或学习。结论广州市大学生HBV接种率较商，对乙肝知识的知晓率较高，对乙肝病人多有正确的态度，但在某些方面存在误区？     

Hepatitis B vaccine in the prevention of perinatally transmitted hepatitis B virus infection: final report on a West Midlands pilot study

A four-dose vaccination schedule was used to interrupt perinatal transmission of hepatitis B virus from carrier mothers to their babies. Of 49 babies immunised and successfully followed up, 43 (88%) became immune: 15 out of 21 (71%) of babies born to HBeAg + mothers became immune, the other 6 becoming the only carrier babies in the study. Without immunisation a carrier rate in excess of 70% would have been expected in this high-risk group. Vaccine alone, given in a rapid immunisation schedule, protected the majority of babies at risk. In those babies in whom the carrier state occurred in spite of immunisation, infection may have taken place in utero, or the infant may have failed to produce adequate antibody in response to the vaccine.     

Comparative evaluation of the immunogenicity of yeast-derived (recombinant) and plasma-derived hepatitis B vaccine in infants.

The immunogenicity of plasma-derived (HB Vax,MSD) and recombinant hepatitis B virus (Engerix B, SK&F) vaccines was evaluated in infants born to hepatitis B virus carrier mothers. The vaccination was carried out at 1 day, 1 month, and 6 months of age using 10 micrograms of the vaccine given intramuscularly. A total of 83/88 (94.3%) and 74/79 (93.6%) of the infants receiving the plasma-derived vaccine and yeast-derived vaccine showed antibody to hepatitis B surface antigen (anti-HBs). None of the maternal factors studied apart from the HBeAg positivity corellated with vaccine failure. The yeast-derived vaccine gives marginally lower antibody titre than the plasma-derived vaccine. The group-specific anti-"a" antibody was less than 10% of the total anti-HBsAg titre. It was observed that the vaccine alone without prior administration of hepatitis B immunoglobulin is effective in perinatal infection.     

Hepatitis B vaccine in the prevention of perinatally transmitted hepatitis B virus infections: initial report of a study in the West Midlands of England

A study was carried out to evaluate the efficacy of hepatitis B vaccine in interrupting perinatal transmission of hepatitis B virus from carrier mothers to their babies. A four-dose schedule was used. Eight of nine babies of e antigen carrier mothers became actively immune when immunisations were started within 48 hr of birth. Effectiveness was reduced if immunisation was delayed. This report includes results from a total of 32 babies, the longest period of follow-up being 2 years. The success of this scheme is comparable to that of more intensive prophylaxis of immunoglobulin either alone or combined with vaccine and should be seriously considered for the babies of all hepatitis B carrier mothers.     

Simultaneous administration of hepatitis B and yellow fever vaccines

In most developing countries, hepatitis B prevention is carried out early in life. In these countries, mobile immunization teams have a limited number of sessions to devote to each rural community; simultaneous administration of multiple antigens is thus normal practice. We compared the immune responses of Senegalese children to the separate or simultaneous injections of yellow fever and hepatitis B vaccines. Injections were given at the time of booster injection for hepatitis B vaccine. Yellow fever antibodies were detected in similar proportions in infants immunized with either yellow fever vaccine alone or yellow fever and hepatitis B vaccines simultaneously. However, a lower proportion of high yellow fever antibody levels were observed when the two vaccines were injected simultaneously. No reduction in the anamnestic response of antibodies against the surface antigen of hepatitis B virus (anti-HBs) was observed when yellow fever vaccine was injected at the same time as the booster dose of hepatitis B vaccine. Since no untoward reactions were noted, it is concluded that hepatitis B and yellow fever vaccines can be administered at the same time.     

HBsAg基因疫苗诱导小鼠抗体产生的观察

将携带编码乙型肝炎病毒(HBV)表面抗原主要蛋白的S基因的质粒,直接注射小鼠肌肉中,小鼠4周后产生抗-HBs,阳转率83.3%(5/6),加强组阳转率66.7%(2/3),未加强组阳转率为100%(3/3);两组小鼠抗体持续时间可达28周以上;4周以后小鼠体内未检测到HBsAg.     

Hepatitis B immunization and hepatocellular carcinoma: The Gambia Hepatitis Intervention Study

The Gambia Hepatitis Intervention Study (GHIS) was initiated by the International Agency for Research on Cancer (IARC) in 1986. It consisted of a randomized trial in the Gambian population, aiming to evaluate the protection provided by HBV vaccination administered during the first year of life against primary infection, the development of chronic carriage, and primary liver cancer. The results, reported at 9 years from the introduction of the vaccine as conferring a high degree of protection (83% against primary infection and 95% against chronic carriage), are briefly discussed. It is expected that HBV vaccination will result in a reduction of mortality from hepatocellular carcinoma, the most frequent cancer in males in sub-Sahara Africa.     

骨骼肌注射乙型肝炎表面抗原基因在小鼠体内诱发乙肝表面抗原特异的免疫反应

将含有乙型肝炎表面抗原（ＨＢｓＡｇ）基因的重组质粒ｐＡｃｔ－ＭＳ直接注入小鼠骨骼肌中，２周后加强免疫１次。免疫后４～９周间，每周检测小鼠血清中ＨＢｓ。结果表明实验组６／８只小鼠ＨＢｓ为阳性，对照组８只小鼠均未检测到ＨＢｓ。本实验证实直接注射质粒ＤＮＡ外源基因能获得表达，并能引起免疫反应。     

我国乙型肝炎疫苗免疫

自 1 992年起 ,我国建议对婴儿进行国产乙型肝炎疫苗的常规免疫 ,接种程序为 0、1、6月 ,以预防乙型肝炎病毒 (HBV)的围产期传播。为了评价儿童的乙型肝炎疫苗覆盖率 ,1 999年对我国 31个省市自治区 2 5 878名 3岁以下儿童 ,进行了一次全国性调查。城市 1 2月龄以下儿童的乙型肝炎疫苗覆盖率为 88 5 % ,农村为 6 2 7% ;各省市自治区的乙型肝炎疫苗覆盖率不同 ,有 4个省为≥ 90 % ,9个省为 75 %～ 89% ,8个省为 5 0 %～ 74 % ,1 0个省为 <5 0 %。乙型肝炎疫苗覆盖率高与社会经济状况好、对乙型肝炎认识程度高、卫生保健服务完善 (如城市、非山区 )、非少数民族、在医院而不是在家里出生密切相关。我国于 2 0 0 2年将新生儿乙型肝炎疫苗正式纳入计划免疫 ,向所有新生儿免费 (除手续费外 )接种乙型肝炎疫苗 ,中央政府向贫困地区特别是西部 1 2个省提供资助 ,其他省由地方政府提供乙型肝炎疫苗资金。婴儿乙型肝炎疫苗常规免疫不仅可预防HBV急性感染 ,还可降低慢性肝病包括肝癌的发病率和死亡率。为了提高安全接种 ,我国卫生部实施了一项全国性行动计划 ,包括至 2 0 0 5年时所有免疫接种均使用一次性自毁注射器 ,以及安全免疫接种培训等     

Prevalence of hepatitis B virus infection in a highly endemic area of southern China after catch-up immunization

The Chinese national goals for control of hepatitis B virus (HBV) infection were to achieve a prevalence of HBsAg below 7% for the entire population, and 1% for children under 5-year old, by 2010. To determine whether Guangxi, a multi-minority province with a low socio-economic status and a very high prevalence of HBV, achieved this goal, a seroepidemiological survey of HBV infection was carried out using stratified, random cluster sampling. The results show that the overall prevalence of HBsAg is 9.16% [95% confidence interval (CI) = 8.32-10%]. The prevalence in males (10.96%, 95% CI = 9.64-12.28%) is significantly higher than in females (7.71%, 95% CI = 6.64-8.78%; χ(2) = 10.5923, P < 0.05). The prevalence in children under 5-year old is 3.62% (95% CI = 0.60-6.64%) and increases with age. The prevalence of HBsAg in non-immunized individuals is significantly higher than in those immunized completely, although not within 24 hr of birth (χ(2) = 31.426, P < 0.05); a significant difference was found in those below the age of 20 years but not in older persons. Gender, age, immunization history, and familial HBsAg carriers are risk factors for infection. In conclusion, this study indicates that Guangxi has not reached the goal for the control of HBV infection. Catch-up HBV immunization may not protect adults effectively against infection in highly endemic regions.     

b型流感嗜血杆菌结合疫苗免疫后血清抗Hib PRP IgG抗体的免疫应答

目的 评价兰州生物制品研究所生产的Hib-TT结合疫苗的免疫原性.方法 采用随机、开放的对照研究方法,对6～59月龄儿童分别接种2或1剂实验疫苗,观察免疫后1个月时受试者血清抗Hib PRP IgG抗体几何平均浓度(GMC)和抗体浓度≥1.0 μg/ml的比例;将3～5月龄198名婴幼儿随机分为两组分别接种3剂实验疫苗或对照疫苗结合疫苗,基础免疫后1年时分别给予1剂加强免疫.观察基础免疫后1个月、1年、加强免疫后1个月和1年时血清抗Hib PRP IgG抗体GMC和抗体浓度≥1.0 μg/ml的受试者比例.结果 给6～59月龄健康受试者接种疫苗1个月后,至少有91％以上受试者血清抗Hib PRP IgG抗体浓度≥1.0 μg/ml;其中6～11月龄组2剂免疫后血清抗体GMC为14.04 μg/ml(95％ CI:12.40 ～ 15.90),所有受试者血清抗体浓度均≥1.0 μg/ml;12 ～59月龄幼儿组1剂免疫后血清抗体GMC为14.01 μg/ml(95％ CI:12.99～15.11),至少有91.30％(95％ CI:86.34 ～ 94.98)的受试者血清抗体浓度≥1.0 μg/ml.3～5月龄婴幼儿经3剂试验疫苗接种后血清抗体GMC为14.52 μg/ml (95％ CI:12.31 ～ 17.14),抗体浓度≥1.0 μg/ml的比例为96.90％ (95％ CI:92.50～ 99.20);对照疫苗组血清抗体GMC为22.82μg/ml(95％ CI:18.44 ～28.25),抗体浓度≥1.0 μg/ml的比例为98.55％ (95％ CI:92.20～99.90).加强免疫后1个月时,实验疫苗和对照疫苗受试者血清抗体GMC分别从加强免疫前的6.27 μg/ml(95％ CI:5.28 ～7.4)和5.57 μg/ml (95％ CI:4.45 ～ 6.97)增加至加强免疫后1个月时的63.14 μg/ml(95％ CI:52.14 ～76.47)和73.48 μg/ml(95％ CI:57.37 ～94.11),血清抗体≥1.0μg/ml的受试者比例分别从与加强免疫前的76.35％ (95％ CI:68.7％ ～ 82.9％)和79.55％ (95％ CI:69.60 ～ 87.40)均上升至100％.加强免疫后1年时,虽两组血清抗Hib PRP IgG抗体虽有下降,但GMC仍分别维持在25.02 μg/ml(95％CI:20.51 ～30.48)和23.64 μg/ml(95％ CI:18.40～ 30.43)的较高浓度,两组的所有受试者血清抗体浓度均≥1.0 μg/ml.结论 实验疫苗对3～59月龄儿童能诱导产生长期保护水平的抗HibPRP IgG抗体;两种Hib结合疫苗对3～5月龄婴幼儿具有相同的免疫原性特征.     

乙型肝炎病毒感染者血清抗-HBC/IgA检测及其临床意义

以抗人IgA包被反应板,建立血清抗-HBc/IgA ELISA方法,应用此方法对154例HBsAg阳性的HBV感染者进行检测,并对抗-HBc/IgA检测与患者肝组织损伤程度及与血清和组织内HBV标志之间的关系进行了探讨。     

High rate of Hepatitis B virus infection among hairdressers in Ibadan,Nigeria

Hepatitis B virus (HBV) infection is a major public health problem for over two billion people infected globally. Occupationally exposed persons are at high risk of HBV infection and, apart from medical personnel, there is dearth of information concerning the prevalence and awareness of HBV among this population in Nigeria. This study was designed to determine the levels of HBV awareness and prevalence of HBV infection among hairdressers in Ibadan, Nigeria. Hairdressers and teachers (unmatched controls) in four local government areas in Ibadan were tested for HBV infection using ELISA technique. Dried blood spot (DBS) samples were collected from 171 participants. DBS elutes from the samples were tested for HBV surface antigen (HBsAg). The rate of HBV infection was higher (p = 0.005) among the hairdressers (13.0%) than teachers (4.8%). However, teachers were better informed about HBV (38%) compared to hairdressers (13%; p = 0.0001). Differences in HBV awareness and occupation type were found to be significant (P = 0.001). Hairdressers are at high risk of HBV infection and may constitute a major source of HBV spread among urban dwellers, especially in areas where awareness is low. Routine HBV screening and appropriate interventions for hairdressers are recommended to interrupt HBV transmission.     

新生儿单纯乙型肝炎血源疫苗的免疫持久性和远期保护效果

目的 掌握我国新生儿单纯接种乙型肝炎血源疫苗后的免疫持久性和远期预防效果；观察新生儿免疫较长时间后是否需加强免疫。方法 在湖南湘潭市等4个乙型肝炎疫苗试点区间，对1986－1988年出生并接种乙型肝炎血源疫苗的新生儿，连续14－15年按免疫儿年龄分层随机抽样采血随访，累计随访21680人次，观察免疫儿HBsAg、抗－HBs和抗－HBc的动态变化。结果 新生儿单纯乙型肝炎血源疫苗全程基因免疫后，在15年随访中没有加强免疫，各试点区免疫儿童HBsAg携带率低于1．66％，携带率没有随免疫后的延长而增加；阻断HBV慢性感染的效果持续在90％左右（95％可信限为：83．1％－97．2％）；免疫后不同年限间HBsAg携带率、HBV感染率和保护效果差异均无显著性（P＞0．05）。免疫儿抗－HBs阳性率随免疫后年限延长而逐年明显下降，至第9－10年下降为40％－50％，之后数年内下降幅度不大，至免疫后13－14年抗－HBs阳性率维持在30％－42％；抗－HBs滴度下降了90％。结论 新生儿单纯乙型肝炎疫苗接种后抗－HBs阳性率与滴度的下降不影响其远期预防效果；就群体而言，新生儿及时完成全程免疫后，无需加强免疫可有效阻断HBV感染后成为HBsAg慢性携带者，而很有可能终生受益。