A mass vaccination program in Taiwan against hepatitis B virus infection in infants of hepatitis B surface antigen-carrier mothers

To combat hepatitis B virus (HBV) infection in Taiwan, a mass immunoprophylaxis program was launched on July 1, 1984, aiming first at prevention of chronic HBV carriage from perinatal mother-to-infant infection. In the first 15-month period, 352,721 (78%) of 450,585 pregnant women were screened for hepatitis B surface antigen (HBsAg); HBsAg was present in 62,359 (18%), with 50% of them categorized as highly infectious. Infants born to HBsAg-positive women were given 5 micrograms of a plasma-derived hepatitis B vaccine at ages 1, 5, and 9 weeks, with a booster at age 12 months. Infants of highly infectious carrier mothers received an additional 0.5 mL of hepatitis B immune globulin within 24 hours after birth. The coverage rate of the hepatitis B immune globulin was 77% in 27,375 infants born to highly infectious mothers, and that of the first, second, third, and the fourth doses of vaccine was 88%, 86%, 84%, and 71%, respectively, in infants of 55,620 carrier mothers. The reported untoward reactions to immunization were negligible. We conclude that a mass hepatitis B vaccination program is feasible in hyperendemic areas such as Taiwan; this should be a significant step toward the effective control of HBV infection in these areas.     

A randomized control trial on interruption of HBV transmission in uterus

Objective To study the interruptive effect of hepatitis B virus (HBV) specific immunolobulin (HBIG) before delivery in attempt to prevent intrauterine transmission of HBV.Methods Nine hundred and eighty HBsAg carrier pregnant women were randomly divided into HBIG group and control group. Each subject in the HBIG group received 200 IU or 400 IU of HBIG intramuscularly at 3, 2 and 1 month before delivery. The subjects in the control group did not receive any specific treatment. All newborn infants received 100 IU of HBIG intramascularty after venous blood samples were taken at birth and 2 weeks after birth, followed by 30 μg plasma-derived HB vaccine or 5 μg recombinant yeast-derived hepatitis B vaccine at 1, 2 and 7 months of age. Blood tests were performed for all the lying-in women and their neonates. Blood specimens were tested for HBsAg and HBeAg by enzyme immunoassay. All infants were followed up for 1 year.Results In the HBIG group, 491 neonates were born to 487 HBV carrier mothers; and in the control group, 496 neonates were born to 493 HBV carrier mothers. The rates of intrauterine transmission in the two groups were 14.3% and 5.7% respectively (χ2=20.280, P<0.001), and the rates of chronic hepatitis B in the two groups were 2.2% and 7.3% respectively (χ2=13.696, P<0.001). The high risk factors of intrauterine HBV infection included HBsAg HBeAg double positive and HBV DNA positive in the peripheral blood of pregnant women.Conclusion HBV infection in the uterus may be interrupted by injecting multiple intramuscular HBIG injections before delivery without causing any side-effects.     

Epidemiology and prevention of hepatitis B virus in China

Hepatitis B virus （HBV） infection is prevalent in China. Approximately 600 million people have ever been infected by HBV. About 130 million are HBV chronic carders and 30 million HB patients. Among them, 50% of HBV carriers are caused by carrier mothers to born infants. Around 300 000 people died of liver disease including liver cirrhosis and primary hepatocellular carcinoma each year and 50% of them died of primary hepatocellular carcinoma. HBV infection is not only the health problem but also becoming a social problem. HBV chronic carriers and patients have endured the great pressure from disease burden and social discrimination. According to the report of the national screening program of HBV released by the ministry of health in 2008, China has taken many effective measures to control the HBV infection, including vaccine immunization program, strengthening the management of blood sources and blood productions, prevention of nosocomial HBV infection, strengthening health education on HBV infection and safe injection techniques. The implementation of HB vaccine immunization program, which China officially introduced into the national immunization program since 1992, has dramatically reduced the incidence of HBV infection among infants and children. Integrated with other interventions, the rate of HBV infection decreased gradually. According to the survey of the national screening program of HBV in 2006, compared with the incidence of HBV in 1992, the incidence rate of HBsAg positive has decreased 26.36%, the number of children who have ever been infected by HBV decreased 80 million since 1992. However some problems are still existing. The solutions of low rate of vaccination in rural areas and migration population, lacking of practical measures on management of hepatitis B patients, the occurrence of health care acquired HBV infection, and low rate of vaccination among high risk groups have also been recommended.     

母亲HBV不同感染状态母婴阻断效果评价

目的 评价母亲HBV不同感染状态乙肝病毒母婴阻断效果，探讨经济、高效乙肝母婴阻断方案。方法 利用血清流行病学方法进行调查和分析。结果 济宁市使用的3种母婴阻断方案，母亲HBsAg单阳儿童母婴阻断率为92．45％，母亲HB出和HBeAg双阳儿童母婴阻断率为89．72％，儿童抗-HBs阳性率为85．21％。189名母亲单纯HBs缸阳性的儿童3种阻断方案HBV母婴阻断率（χ^2=5．47，P〉0．05）和抗-HBs阳性率（χ^2=1．59，P〉0．05），无显著性差异。183名母亲HB出和HBeAg双阳性的儿童，3种阻断方案HBV母婴阻断率（χ^2=12．19，P〈0．005）和抗-HBs阳性率（χ^2=7．77，P〈0．05），差异有显著性。结论 济宁市目前母亲HBsAg阳性的儿童母婴阻断效果比较理想，今后要根据母亲HBV不同的感染状态，选择既经济又高效的母婴阻断方案。     

某高校大学生乙型肝炎病毒携带率调查

目的:调查大学生HBsAg的携带率,以及大学生在校期间HBsAg携带状况的动态变化,为大学生乙型肝炎病毒的预防提供理论依据.方法:对某高校2000级大学生进行2次体检,即新生入校体检和毕业生体检,抽取静脉血,ELISA法检测HBsAg,采用SPSS13.0进行统计学分析.结果:共调查6 244人,新生HBsAg携带率为5.7%,新生HBsAg携带率在性别、专业和地区无显著性差异;毕业生总的HBsAg携带率为13.8%,医学专业的毕业生HBsAg携带率显著低于非医学专业的毕业生,男性毕业生显著高于女性.HBsAg阴转率为7.3%.结论:大学生在校期间可能感染乙型肝炎病毒,大学生是乙型肝炎病毒预防的重点人群.     

广州市三所高校新生乙肝病毒感染状况调查

目的了解乙肝病毒(HBV)在大学新生中的流行分布情况,为今后的防治工作提供科学依据。方法用酶联免疫吸附法(ELISA)检测广州市三所高校新生的乙肝病毒五项标志物,酶动力学法测定丙氨酸氨基转移酶(ALT)。结果4162名大学新生HBsAg阳性总体携带率为13.55%;其中男生为16.11%,女生为9.86%,男生显著高于女生(χ2=18.285,P<0.05);HBsAg阳性的模式中以HBsAg、HBeAb及HBcAb同时阳性者比例最高达66.49%,其次为HBsAg、HBeAg及HBcAb同时阳性者占14.01%。结论广州市三所高校新生的HBsAg携带率高于全国平均水平,对其防治工作不容忽视,在学生中加强乙肝健康教育和传染源管理的同时,对易感人群采取相应的乙肝疫苗注射等措施。     

对西安市大学新生乙型肝炎病毒血清标志物的检测和分析

目的:了解大学新生乙型肝炎病毒(HBV)感染状况。方法:ELISA法检测2555份HBV血清标志物。结果:HBsAg阳性率为1.92%,远低于我国大学生平均阳性率。“大三阳”检出率0.37%,“小三阳”检出率0.71%。结论:应加强大学生HBV感染的预防接种工作,同时加强对HBsAg阳性学生的管理工作。     

塘口镇学生应用乙肝疫苗控制HBV感染效果观察

目的　了解塘口镇中小学生学前儿童HBv感染状况和应用乙肝疫苗控制HBV感染效果。方法　1997年应用ELISA法对全镇4811名中小学生学前儿童进行HBsAg检测，HBsAg阴性者进行乙肝疫苗三针基础免疫接种，3年后的2001年再对全镇4891中小学生学前儿童检测HBsAg。结果 1997年学生儿童HBsAg阳性率为13．4％，其中学前儿童、小学生、初中生的阳性率依次为8．1％、14．6％和13．7％，学前儿童与小学生、初中生之间相比，其阳性率具显著性差异，小学生与初中生相比无显著性差异；2001年学生儿童HBsAg阳性率为7．3％，其中学前儿童、小学生、初中生的阳性率分别为3．1％、6．5％和11．1％，三者之间相比具显著性差异。2001年学生的阳性率比197年的有显著性差异。结论 塘口镇在中小学生和婴幼儿学前儿童中开展乙肝疫苗的预防接种可有效控制HBV感染。     

广西灵山县2~6岁儿童乙肝疫苗免疫效果观察

目的 了解广西灵山县2~6岁儿童乙肝疫苗免疫效果,为乙肝病毒（HBV）高流行区乙肝防控提供依据。方法 2016年12月,按照横断面调查研究原理,用整群抽样的方法选取灵山县2~6岁儿童为研究对象,采用问卷调查并采集静脉血3~5 mL,用酶联免疫吸附实验（ELISA）检测HBV血清学标记物。结果 调查了1 594名儿童,乙肝疫苗免疫覆盖率为100%;5岁以下儿童HBsAg标准化阳性率为0.17%（3/832,95%CI：-0.11~0.45）;抗-HBs标准化阳性率为68.98%（95%CI：66.71~71.25）;HBeAg 和抗-HBe 标准化阳性率分别为0.16%（95%CI：-0.04~0.36）和0.38%（95%CI：0.08~0.68）;抗-HBc 标准化阳性率为43.97%（95%CI：41.53~46.41）。不同年龄组间抗-HBs阳性率差异有统计学意义（P<0.001）,且随着年龄增长而呈下降的趋势（P<0.001）。非条件多因素Logistic回归模型分析结果显示,年龄、城乡分布、低出生体重和分娩医院级别与抗-HBs阳性率有关,加强免疫与低龄儿童抗-HBs阳性率无关。3名HBsAg持续阳性儿童的母亲产检检测HBsAg阳性。结论 广西灵山县达到全国乙型病毒性肝炎防治规划的目标 （<1%）;已经完成乙肝疫苗全程基础免疫的学龄前儿童没必要进行乙肝疫苗加强免疫。     

健康大学生血清乙型肝炎病毒感染状况及疫苗接种变化趋势分析

目的:研究健康大学生血清乙型肝炎病毒(HBV)感染状况及变化趋势.方法:用酶联免疫吸附实验测大学生血清中HBV抗原-抗体系统,赖氏法检测丙氨酸转氨酶(ALT)活性,问卷调查入学时学生使用乙肝疫苗的情况.结果:1996-2000年5届学生入学时感染模式1感染率逐年下降,感染模式2感染率逐年升高,感染模式3感染率逐年下降但变化不明显;使用乙肝疫苗后产生的抗-HBs入学时维持率为77.36%,少数个体对乙肝疫苗并不敏感;感染模式1学生接受乙肝疫苗全程免疫1次,抗-HBs阳性率与入学前使用乙肝疫苗有一定关系.结论:各感染模式的感染率呈时间变化,ALT异常者应引起高度重视;注射乙肝疫苗对机体产生保护性抗体,抗-HBs作用明显,乙肝疫苗不敏感的人群可能确实存在.     

山西农大2000年入学新生HBV感染调查

为保障大学生健康，我们对山西农大2000年入学新生进行了乙肝病毒(HBV)感染情况调查。结果2395名入学新生中，HBV总感染率为4．55％，男5．16％，女3．64％，HBsAg阳性率为2．70％，男3．35％，女1．87％。表明大学生HBV感染仍是一个重要的公共卫生问题，应加强集体学生的卫生管理，搞好健康体检和乙肝疫苗接种。     

开平市学生儿童HBV感染状况调查分析

目的了解开平市学生儿童HBV感染状况和提供防治对策。方法2001年应用ELISA法对全市104630名学生儿童进行HBsAg检测。结果学生儿童HBsAg阳性率为8．6％，其中学前儿童、小学生、中学生的阳性率分别为3.7％(275／7454)、6．8％(3892／57181)和12．1％(4865／40293)。三者之间相比具显著性差异。结论学生儿童阶段是HBV感染传播的重要阶段，提高学生儿童乙肝疫苗接种率，可有效降低人群HBV感染水平。     

职业中学学生乙肝病毒感染情况调查

目的了解职业中学学生中乙肝病毒感染情况,为开展学校乙肝防制工作提供参考。方法采用酶联免疫吸附试验(ELISA)对广州市内3家职业中学二、三年级学生HBsAg进行检测。结果共调查学生9 620名,HBsAg阳性513名,总阳性率为5.33%,男生阳性率为5.88%,女生阳性率为4.74%。结论 2006-2008年间,HBsAg阳性呈下降趋势,但仍应进一步加强对HBsAg阳性者的管理,加强宣传教育,加强乙型肝炎疫苗的接种,降低HBV的感染率和乙型肝炎发病率。     

上海宝山区民工子女乙肝流行状况调查研究

目的了解上海郊区民工子女现阶段乙型肝炎病毒(HBV)感染现状,为制定防治策略提供依据。方法调查上海市宝山区9所民工子弟学校7～15岁非本地户籍民工子女7 239例和同年龄段城区本地户籍学生5 823例,检测外周血中乙肝标志物。调查乙型肝炎病毒表面抗原(HBsAg)阳性率和乙肝感染率,并与该地区本地户籍同年龄例群及该年龄段全国流行病学调查数据比较。结果民工子女HBsAg阳性率为3.0%,本地户籍儿童HBsAg阳性率为0.6%,两组间差异存在统计学意义(P<0.001);民工子女中11～15岁组儿童HBsAg阳性率高于7～10岁组(2.0%vs 4.9%,P<0.001)。民工子女HBV感染率高于本地户籍儿童(6.1%vs 2.34%,P<0.001)。民工子女11～15岁组HBV感染率高于7～10岁组儿童(9.6%vs 3.8%,P<0.001);男生感染率高于女生(7.0%vs 5.0%,P=0.02)。民工子女乙肝疫苗接种率为75.86%,低于本地户籍儿童乙肝疫苗接种率(94.98%),两组具有统计学差异(P<0.001)。结论民工子女HBsAg阳性率显著高于上海本地户籍儿童,且高于2006年全国乙肝血清学流行病学调查结果中同年龄组例群HBsAg阳性率,乙肝疫苗接种率低是其主要原因,需进一步加强民工子女计划免疫接种的宣传和监督。     

某医学院大学生乙型肝炎表面抗原携带率状况调查及分析

目的:了解大学生乙型肝炎病毒携带状况及其影响因素.方法:对某医学院4863名在校大学生用ELISA法测定HBV血清标记物调查,同时对一些相关因素进行分析.结果:男生HBsAg携带率高于女生(P＜0.01),农村学生HBsAg携带率明显高于城市学生(P＜0.01).结论:应加强对农村地区学生的乙肝五项检测和接种乙肝疫苗的力度.     

Elimination of hepatitis B virus infection in children: experience and challenge in China

Chronic hepatitis B virus (HBV) infection is a serious health issue because of its severe sequelae. Prevention of mother-to-child transmission (MTCT) of HBV is critical to eliminate chronic HBV infection. Here, we reviewed the progress toward the elimination of HBV infection in children in China in the recent decade. A universal hepatitis B vaccination program started from 2002 has been intensified, with the coverage of timely birth dose >95% of all newborn infants from 2012. Since 2011, China has taken a nationwide program to administer hepatitis B immunoglobulin (HBIG) with free of charge in all neonates of HBV-infected mothers, leading to a significant increment of timely use of HBIG. The prevalence of hepatitis B surface antigen (HBsAg) was declined from around 10% among children in 1980s to <0.5% among children born after 2011. Administration of oral antiviral agents in HBV-infected pregnant women with HBV DNA >2 × 10⁵ U/mL during the third trimester is increasing, which will further reduce MTCT of HBV. However, there are some challenges in the elimination of HBV infection in children, which need to overcome by the concerted efforts. Nevertheless, it is anticipated that China will achieve the goal set by the World Health Organization that the prevalence of HBsAg in children aged <5 years is ≤0.1% by 2030.     

宁夏某高校2008—2010年入学新生血清HBV 5项检测结果分析

目的了解新生感染HBV的情况,为制定相关防治措施提供科学依据。方法对宁夏某高校2008—2010年入学新生血清HBV 5项指标的检测结果进行分析。结果入校新生5 600名中HBsAg阳性率为2.23%。HB-sAg阳性模式主要以"小三阳"和"大三阳"为主,分别占50.40%和40.80%。虽然新生乙肝疫苗接种率达到89.68%,但HBsAb阳性率仅为46.29%。结论应该对新生及时接种乙肝疫苗,加强对乙肝基本知识的宣传与教育,防止乙肝病毒在校园传播以及乙肝的流行。     

2001-2004年3842例新生HBsAg携带情况调查

目的调查入校新生血清乙型肝炎表面抗原(HBsAg)携带情况。方法2001~2004年新生3842人,采用酶联免疫吸附法检测血清HBsAg。结果3842名新生中,HBsAg阳性123例(3.2%)。2001级男生(5.9%)HBsAg阳性率高于女生(1.9%,Ρ<0.05);2002级男生(4.3%)和女生(2.8%)HBsAg阳性率无显著差异(P>0.05);2003级男生HBsAg阳性率(6.8%)高于女生(1.8%,P<0.001);2004级男生HBsAg阳性率(5.6%)与女生(2.8%)比较无显著性差异(P>0.05)。各年级之间以及不同出生年份新生HBsAg阳性率无显著性差异(P>0.05)。结论对HBsAg阴性新生接种乙肝疫苗,降低乙肝表面抗原携带率是必要的。     

乙型肝炎病毒宫内感染的发生率和机理

本文对乙型肝炎病毒宫内感染的发生率及机理进行了研究。24例HBsAg阳性母亲的新生儿中,5例脐血AntiHBc-IgM阳性,1例引产儿肝组织HBV-DNA阳性(斑点杂交法)。宫内感染率为6/24(25.0％)6例母亲全无先兆流产及/或先兆早产病史。斑点杂交法检测24例HBsAg阳性母亲胎盘组织HBV-DNA,阳性23例。实验结果表明宫内感染发生率较高。胎盘组织可受HBV感染。母血漏入并非宫内感染的唯一途径。     

5985名学生乙肝疫苗接种后免疫效果分析

目的探讨中小学生乙肝疫苗接种后免疫应答状况,为制定有效的乙肝预防措施提供科学依据。方法应用ELISA法测定中、小学生血清三项乙肝感染标志（HBsAg、HBeAg、HBeAb）,对三项标志全阴性者再应用时间分辨荧光免疫分析法（TRFIA）测定血清二项感染标志（HBsAb、HBcAb）。结果血清三项感染标志（HBsAg、HBeAg、HBeAb）全阴性者其HBsAb阳性率为81.27%,中学生阳性率为80.27%,小学生阳性率为82.50%,差异有统计学意义（χ2=4.82,P〈0.05）。HBsAb有应答者HBcAb阳性率为5.12%,中学生阳性率为8.82%,小学生阳性率为0.68%,差异有非常显著性（χ2=164.58,P〈0.01）。HBsAb无应答者HBcAb阳性率为21.14%,中学生阳性率为19.73%,小学生阳性率为7.68%,差异有非常显著性（χ2=87.70,P〈0.01）。HBsAb有应答者和HBsAb无应答者其HBcAb阳性率差异有非常显著性（χ2=313.48,P〈0.01）。结论该地区学生HBsAb阳性率较低,免疫效果不理想,小学生HBsAb阳性率较高,中学生HBcAb阳性率较高,提示学生中乙肝疫苗接种需加强和改进。