浙江省新生儿乙肝疫苗免疫现况调查

本文对浙江省６８个县（区）的４８７８名１９９２年１月１日至１９９６年１０月３１日出生的儿童,进行乙肝疫苗免疫接种率调查,一种标准进行审评分析,结果：儿童免疫接种建证率为９９．６１％;新生儿乙肝疫苗首针接种率三种标准分别达到９９．４３％,９６．１０％和８３．４９％;三针全程合格接种率分别为９６．１０％、９３．０３％和７８．９４％。自１９９２年以来,乙肝疫苗免疫接种率呈逐年上升趋势。山区乙肝疫苗接咎及     

汉川市成人乙肝病毒感染与乙肝疫苗接种状况的对比性分析

[目的]了解成年人乙型肝炎病毒（HBV）感染者乙型肝炎疫苗（HepB）免疫的状况及相关情况,查找成人HBV感染的原因。[方法]采用ELISA法检测所有调查对象的乙肝病毒5项血清标志物、查看乙肝血检报告单和HepB预防接种记录、用自制的调查表进行问答式调查等方法以了解调查对象的相关情况。[结果]21岁以上的已感染HBV者HepB接种率仅为43．0％,其中市区为55．3％、乡村为37．4％,乡村明显低于市区（P〈0．01）。已感染HBV组HepB免疫中：每剂用5μg重组酵母（或10μg CHO）HepB者占98．2％,完成3剂（次）基础免疫接种者占73．4％,接种〉3剂（次）者占0．0％（对组分别为84．3％、100．0％和26．600）;乙肝疫苗首针（HepB1）接种时间距HBV血清学检测结果阴性时间〈24h者占39．5％（对照组为80．4％）;HBV暴露后应急预防接种率为0．0％（对照组为33．3％）;HepB接种前后、接种期间地塞米松等免疫抑制剂使用率占28．8％,其中“常用”率占19．9％（对照组分别为4．o％、0．0％）;接种前HBV血清学总检测率为12．7％,其中“乙肝5项”检测率占2．4％,接种后抗-HBs检测率为0．0％（对照组分别为18．0％、7．4％和69．9％）。以上已感染HBV组与对照组比较,除HBV血清学总检测率组间差异不明显（P〉0．05）外,其余各项率的组间差异均有统计学意义（P〈0．01）。[结论]没有预防接种HcpB和HepB基础免疫失败是成人HBV感染的主要原因,而上述5个方面的问题可能是成人HepB免疫失败的症结所在。需克服各种影响因素,全面开展成人HepB免疫和优质“达标”接种,迅速提升成人对HBV的总体免疫水平。     

某部新兵乙肝疫苗接种情况及表面抗体水平调查

目的了解某部新兵入伍前乙型肝炎疫苗接种情况及乙肝表面抗体水平,为部队进一步防控乙型病毒性肝炎提供科学依据。方法对某部2013-2014年新入伍的4974名士兵乙肝血清流行病学和乙肝疫苗接种情况进行调查。结果该部入伍新兵乙肝疫苗接种率和表面抗体阳性率分别为58.6%和64.7%。乙肝表面抗体阳性率在有乙肝疫苗接种史的人群中为82.0%,高于未接种疫苗人群的40.4%(P0.05)。文化水平低、高年龄段及西部兵员的乙肝疫苗接种率和表面抗体阳性率较低。结论 2013-2014年该部入伍新兵乙肝疫苗接种率和表面抗体阳性率高于全国水平,但仍需进一步强化免疫。     

1999年全国儿童计划免疫与乙型肝炎疫苗接种率及影响因素调查分析

为了解我国儿童计划免疫和乙型肝炎 (乙肝 )疫苗接种的现状 ,在全国 3 1个省 (自治区、直辖市 ,下同 )采用组群抽样法进行了调查。结果显示 ,全国四种疫苗的接种率是 :卡介苗 97 2 % ,口服脊髓灰质炎疫苗 ( 3剂全程 ) 92 0 % ,百白破混合制剂 ( 3针全程 ) 92 7% ,麻疹疫苗 93 0 % ;四种疫苗全程免疫覆盖率平均为 85 3 % ;计划免疫保偿率为 46 0 %。乙肝疫苗 3针全程接种率全国平均为 70 7% ,12月龄内 3针全程接种率平均为 63 5 % ;全国接种点提供乙肝疫苗免疫服务的占 85 4%。向儿童家长的调查表明 ,影响四种疫苗接种的原因是 :( 1)不知道要接种 ;( 2 )时间不合适 ;( 3 )本地无户口 ;( 4 )计划外生育。影响乙肝疫苗接种的原因是 :( 1)本地不提供服务 ;( 2 )不知道要接种 ;( 3 )收费太贵。本次调查也证实 ,我国计划免疫工作薄弱之处主要是少数民族地区、贫困地区、经济发展滞后的边远地区和山区 ;人群主要是流动儿童和计划外生育的儿童。今后在发展当地经济的同时 ,应加强对这些地区和这些特殊人群的宣传教育 ,探讨为当地居民乐于接受的方法和形式来提高居民对计划免疫的认识和要求 ,既有利于减轻计划免疫服务方的工作负担 ,又有利于提高计划免疫服务的质量。     

Hepatitis B Virus Infection: Epidemiology and Vaccination

Worldwide, two billion people have been infected with hepatitisB virus (HBV), 360 million have chronic infection, and 600,000die each year from HBV-related liver disease or hepatocellularcarcinoma. This comprehensive review of hepatitis B epidemiologyand vaccines focuses on definitive and influential studies andhighlights current trends, policies, and directions. HBV canbe transmitted vertically, through sexual or household contact,or by unsafe injections, but chronic infections acquired duringinfancy or childhood account for a disproportionately largeshare of worldwide morbidity and mortality. Vaccination againstHBV infection can be started at birth and provides long-termprotection against infection in more than 90% of healthy people.In the 1990s, many industrialized countries and a few less-developedcountries implemented universal hepatitis B immunization andexperienced measurable reductions in HBV-related disease. Forexample, in Taiwan, the prevalence of chronic infection in childrendeclined by more than 90%. Many resource-poor nations have recentlyinitiated universal hepatitis B immunization programs with assistancefrom the Global Alliance for Vaccines and Immunization. Furtherprogress towards the elimination of HBV transmission will requiresustainable vaccination programs with improved vaccination coverage,practical methods of measuring the impact of vaccination programs,and targeted vaccination efforts for communities at high riskof infection. hepatitis B • hepatitis B vaccines • hepatitis B virus • immunization programs     

乙肝疫苗接种对乙型肝炎流行特征的影响

目的了解南京市鼓楼区乙肝疫苗接种前后16年乙型肝炎流行特征的变化，为今后实行新的预防对策提供依据。方法对1990～2005年南京市鼓楼区乙肝疫情报告资料进行分析。结果1992年起该区将乙肝疫苗接种纳入计划免疫管理，目前全区新生儿乙肝疫苗接种率达99％以上。接种疫苗改变了乙肝的流行特征，人群乙肝发病率呈下降趋势，10岁以下儿童下降最明显。结论乙肝疫苗免疫是防制、消除乙肝的有效途径。为进一步降低发病率，在做好新生儿乙肝疫苗接种工作的同时，必须扩大疫苗的接种范围。     

临沂市中小学生重组酵母乙型肝炎疫苗接种效果

目的评价重组酵母乙型肝炎疫苗（以下称乙肝疫苗）在临沂市中小学生中大规模接种后的效果。方法采用随机整群抽样法，选择兰山区中小学各1所。小学1—6年级和中学初一到高三的6—18岁1829名学生，接种重组酵母乙肝疫苗。1年后，采用ELISA检测血清中HBsAg、抗-HBc、抗-HBs。结果乙肝疫苗接种前后乙肝病毒标志物（HBVM）阳性率差异有统计学意义（x^2=236．66，P〈0．01）；HBVM中，接种后抗-HBs阳性率显著高于接种前（x^2=205．42，P〈0．01）；接种前后HBsAg总感染率、抗-HBc总感染率差异无统计学意义。结论中小学生大规模接种的效果较好，低年龄组人群应为乙肝疫苗大规模接种的优选对象。     

乙型肝炎疫苗免疫后免疫回忆应答的观察

乙型肝炎(乙肝)疫苗免疫后,体液和细胞免疫回忆应答的状况和特点,是确定是否需要加强免疫及免疫方案的关键.为此,在湖南省湘潭市随机采样,抽取170名1986～1988年出生、完成了血源乙肝疫苗全程免疫后9～11年的儿童,用重组(酵母)乙肝疫苗进行1～3次加强免疫,观察其体液免疫应答.在浙江省杭州市,随机抽取28名血源乙肝疫苗母婴阻断免疫者、18名全程免疫儿童和11名未免疫的健康人,观察他们的外周血淋巴细胞(PBMC)对基因重组乙肝表面抗原(HBsAg)刺激的增殖反应.结果显示乙肝疫苗全程免疫后9～11年的儿童,完成1针、2针和3针法加强免疫后1年内,乙肝病毒表面抗体(抗-HBs)阳性率和几何平均滴度(GMT)均迅速升高,三组的GMT分别比加强免疫前提高了6.5、9.3、24.2倍,阳性率均上升至100%,加强免疫次数多抗体提高多,各组间GMT差异有非常显著的统计学意义(P＜0.01).完成加强免疫后,3次加强免疫组抗-HBs阳性率比＜3次组下降缓慢,至加强免疫后第3年,抗-HBs阳性率1针法降为71.2%,2针法降为79.2%,而3针法维持在92.5%.血源乙肝疫苗全程免疫者其PBMC对重组HBsAg刺激的特异性增殖反应强度和γ干扰素(INF-γ)水平明显高于对照组,细胞免疫反应的强度还与机体抗体水平相关.说明血源乙肝疫苗免疫后机体特异性体液和细胞免疫记忆均长期存在,回忆反应与免疫背景有关,反应强度与加强免疫的次数正相关,机体免疫记忆可能是维持乙肝疫苗长期保护效果的重要原因之一.     

The Economics of Hepatitis B Virus Vaccination

Objective: To assess and compare the costs and effectiveness of different vaccination strategies against hepatitis B in Switzerland. Design: A birth cohort of 85 000 individuals was followed over their lifetime, using a decision-tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five new vaccination scenarios were assessed and compared with a baseline strategy of vaccination of high-risk groups. The 5 new vaccination scenarios were: (i) systematic prenatal screening and vaccination of newborns at risk; (ii) universal vaccination of infants; (iii) universal vaccination of school children; (iv) universal vaccination of infants and school children; and (v) universal vaccination of infants, school children and adolescents. Results: The incremental cost per year of life saved for systematic prenatal screening and vaccination of newborns at risk compared with the baseline scenario was estimated to be 23 350 Swiss francs (SwF; 1996 values). The 4 universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented. The incremental cost per year of life saved for universal vaccination compared with systematic prenatal screening and vaccination of newborns at risk ranged from SwF6120 (infant vaccination strategy) to SwF10 200 (school children vaccination strategy). In the sensitivity analysis, prevalence, vaccine price and discount rate were key elements. Conclusions: Incremental cost-effectiveness ratios are lower with universal vaccination strategies than with selective vaccination. Furthermore, with universal vaccination strategies, increasingly ambitious strategies result in higher costs but also in more incremental years of life saved.     

成人乙肝基因疫苗接种效果Meta分析与成人接种的必要性

目的 评价成人接种乙肝基因疫苗后的免疫效果。方法 文献检索符合本研究分析条件的成人乙肝基因疫苗接种免疫效果论文10篇,5篇为实验对照研究,5篇为平行对照研究,用抗HBs的转阳率作为效果指标;采用Meta分析中的固定效应模型（General Variance-Based法）和随机效应模型（Der Simonian and Laird法）统计方法进行分析。结果 实验对照研究论文经Meta分析,公共OR的估计值为2．842,95％的可信区间为（1．329,4．354）,实验组和对照组的抗HBs转阳率差别有统计学意义;平行对照研究论文经Meta分析,公共OR的Mantel-Haeszel估计值为0．6592,相应的95％的可信区间为（0．5435,0．7994）,男性组和女性组的抗HBs转阳率差别有统计学意义。结论 成人接种乙肝基因疫苗的免疫仍有较好效果,加强对中青年人群的乙肝疫苗接种宣传,控制人群HBsAg感染率。     

2013年媒体报道的乙型肝炎疫苗事件公众看法网络调查分析

目的调查分析2013年媒体报道的乙型肝炎（乙肝）疫苗事件中公众的看法。方法2013年12月11日-2014年1月15日,利用国家卫生和计划生育委员会信息监测平台,对有关疑似婴儿注射乙肝疫苗死亡事件相关新闻信息进行采集和分析,对新浪财经网和凤凰财经网乙肝疫苗事件的网络调查数据进行收集和分析。结果媒体报道新闻数量随着乙肝疫苗暂停使用、通气会召开发生变化,2013年12月25日相关新闻达到2700多条。18081名网民参与新浪财经网关于乙肝疫苗事件的调查,不支持“偶合死亡”网民的比例从事件之初的90％下降到2014年1月15日的68％,不会继续使用深圳康泰生物制品股份有限公司（康泰公司）乙肝疫苗网民的比例从95％下降到75％。12297名网民参与凤凰财经网调查,不支持“偶合死亡”网民的比例和不会继续使用康泰公司乙肝疫苗网民的比例也均下降,认为政府有关部门应急响应太慢的比例从95％下降到75％。结论及时调查处置和发布有关信息,对平息乙肝疫苗事件起到至关重要的作用,政府有关部门应主动与媒体建立沟通机制,权威发布接种乙肝疫苗的有关信息,采取有效措施,提升公众对疫苗安全和预防接种的信心。     

接种乙肝疫苗发生变态反应一例报告

患者,女,14岁,于2004年7月12日10时30分,黄石市中心医院保健科按常规操作在其左上臂三角肌下缘附着处,皮下注射重组（酵母）乙肝疫苗。由北京生物制品研究所提供,乙肝疫苗冷藏在（2～8）℃冰箱内,批号2003050108,接种剂量为10μg／支（1ml）。接种14h后,患者自觉颜面肿胀,疼痛、奇痒,双眼睑、口唇水肿。面部皮肤可见淡红色斑丘疹,皮疹周围量苍白色,融合成片,高出皮肤,压之褪色。立即送往该院治疗。查体;T37℃,P120次／min。BP90／70mmHg,一般情况尚好,心、肺、腹来见异常。询问既往无对敏电。     

Understanding Adult Vaccination in Urban,Lower-Socioeconomic Settings: Influence of Physician and Prevention Systems

PURPOSE Vaccination rates for pneumococcal polysaccharide vaccine (PPV) and influenza vaccine are relatively low in disadvantaged urban populations. This study was designed to assess which physician and practice characteristics might explain differences in rates across physicians.METHODS PPV and influenza vaccination rates were determined for 2,021 patients aged 65 years and older receiving care from 30 physicians in 17 practices surveyed about their office systems for providing adult immunizations. Hierarchical linear modeling (HLM) analyses were used to examine the relationships among vaccination rates, patient-level characteristics, and physician variables.RESULTS Overall, the weighted PPV vaccination rate was 60.0% and varied widely across physicians (range, 11%–98%). At the patient level in HLM, patient race (P=.01) and age (P = .02), but not neighborhood income, were associated with PPV status. By linking physician survey data with PPV rates, we found the best pair of physician variables to be “reported time spent with patients for a well visit” (P = .01) and “use of enhanced immunization documentation” (P=.10). The overall influenza vaccination rate was 51.9% (range, 22%–96%). Patient race (P=.003) and age (P = .002) were associated with influenza vaccination. The pair of physician variables with the strongest association with influenza vaccination was “use of standing orders” (P <.001) and “average observed physician examination room time,” regardless of visit type (P=.02).CONCLUSIONS Vaccination rates vary widely in urban settings and are associated with practice characteristics such as time spent with patients and, for influenza vaccine, use of standing orders.     

乙肝疫苗接种前筛检指标的探讨

目前乙肝疫苗接种前要进行ＨＢｓＡｇ、抗－ＨＢｓ和抗－ＨＢｃ三项指标的筛检。为了节省检验费用，并能达到一定的预防效果，我们对八个城市的乙肝感染情况进行了分析，在常规筛检时，只需筛检一项抗－ＨＢｃ。新生儿和０～３岁幼儿可以直接接种。这样，即能节省费用又能达到一定预防效果，符合费用－效果原则。     

成人乙型肝炎疫苗预防接种的成本-效益分析

为了解成人接种乙型肝炎(乙肝)疫苗后的经济效益和社会效益,为预防成人乙肝提供依据.以1990～1991年接种乙肝疫苗与否,采用多级分层抽样的方法,调查接种者1344人,调查未接种者1476人,对116名乙肝患者进行乙肝费用调查.结果表明,成本-效益1990～1991年攀枝花钢铁公司投入成本235.58万元(1999年的贴现值),产出的效益9283.81万元,净效益9048.23万元,效益成本比值为39.41.社会效益这次乙肝疫苗接种减少乙肝病人669人,减少乙肝病毒表面抗原(HBsAg)携带者1737人,减少工作寿命损失639.47人年,减少寿命损失1418.30人年.研究结果提示成人接种乙肝疫苗具有巨大的经济效益和社会效益.     

Physician attitudes regarding the Advisory Committee on Immunization Practices Adult Immunization Schedule

The Advisory Committee on Immunization Practices (ACIP) was created out of the need to formalize vaccine recommendations for the United States. Annually, ACIP delivers recommendations to the CDC director for guidance about United States vaccine use and publishes the Adult Immunization Schedule. Updated schedules feature changes to vaccine recommendations as well as changes to the schedule’s usability for physicians. The objective of this study was to determine physicians’ attitudes about the Adult Immunization Schedule. Surveys were administered to a sentinel physician network from October 2019 through January 2020. Physicians that responded were comfortable using the Adult Immunization Schedule, but reported confusion about some medical condition-based indications. Physicians reported a lack engagement with mobile applications, CDC Vaccine Schedules and Shots by STFM (the Society for Teachers of Family Medicine). Future work should focus on increasing clarity regarding the recommendations with medical condition-based indications and increasing knowledge of mobile applications for physicians.