维持性血液透析患者乙肝病毒感染及乙肝疫苗接种现状分析

目的调查维持性血液透析患者乙型病毒性肝炎的感染现状以及乙肝疫苗的接种情况。方法纳入2009年1月~2013年5月间河北省秦皇岛市北京军区北戴河二八一医院维持性血液透析患者601例(血透组),同时选取健康体检者938人作为对照组。采用酶联免疫吸附法(ELISA)检测乙肝表面抗原(HBsAg)、乙肝表面抗体(HBsAb)、乙肝e抗原(HBeAg)、乙肝e抗体(HBeAb)、乙肝核心抗体(HBcAb),并问卷调查乙肝疫苗接种情况。结果血透组和对照组五项指标的阳性率除HBeAg外差异均有统计学意义(P<0.05)。乙肝病毒感染率(HBsAb单独阳性除外)血透组和对照组分别为5.16%和1.81%,二组间差异有统计学意义(P<0.05)。血透组接种过乙肝疫苗的有174人(29.0%),其中101人(58.0%)HBsAb阳性,其余阴性。对照组接种过乙肝疫苗的有287人(30.6%),其中206人(71.8%)HBsAb阳性。未接种的原因主要是认为注意卫生就没必要接种或怀疑免疫效果。结论应加强医源性感染的控制以及积极推广乙肝疫苗接种,以减少维持性血液透析患者的乙肝病毒感染率。     

正常人与乙型肝炎病毒慢性携带者中乙型肝炎疫苗的血清学效果的观察

给61例正常人和33例HBV慢性携带者接种乙肝疫苗,后半年内检测了一些血清学指标。正常人接种疫苗后1,3,6个月时抗—HBs阳性率分别为27.8％,85.2％和90.1％。HBV携带者接种疫苗后6个月HBsAg滴度上升者8例,下降者4例,仅有1例抗—HBs阳性,12例HBeAg阳性者中仅有1例抗—HBe阳性。所有病例接种疫苗后无明显不良反应。结果说明本疫苗抗原性良好,但对HBsAg携带者无效。     

乙肝疫苗接种后无应答61例加强免疫后效果分析

目的　探讨解决乙肝疫苗接种后免疫无应答问题的方法。方法　程序为 0 1 6,效果考核采用流行病学和血清学分析 ,检测采用ELISA法。结果　 61例加强免疫后抗 HBs阳性率为 3 0 .79% ,男 3 5 .14 % ,女 2 9.17% ,差异无显著性。原使用血源性疫苗为 3 4 .3 7% ,原使用基因疫苗为 3 1.0 3 % ,差异亦无显著性。结论　对免疫无应答者应加强免疫 ,这种方法是有作用的 ,应继续观察以得出确切结论     

揭阳市部分从业人员乙型肝炎感染情况调查

目的 了解揭阳市从业人员乙型肝炎感染及乙肝疫苗接种情况，探讨预防对策。方法 对2003—2004年到揭阳市疾病预防控制中心公共卫生科进行健康体检接受注射乙肝疫苗接种人员进行调查，抽血检查乙肝“两对半”检测。并对检测结果进行统计学分析。结果 共调查体检人员6394人，HBV总感染率为74．30％。大三阳及小三阳分别为81人及601人。乙肝疫苗接种率为42．99％，已接种乙肝疫苗者“两对半”五项全阴者为23．97％，未接种疫苗者为27．00％。己接种疫苗者HBsAg总阳性率为3．38％，而未接种乙肝疫苗者为9．74％，两者差异有显著性（X^2=97．18。P〈0．01）。已接种乙肝疫苗者抗-HBs阳性率为80．79％，而未接种乙肝疫苗者为21．98％，两者差异有显著性（X^2=11027，28，P〈0．01）。已接种疫苗者大三阳感染率（0．04％）也低于未接种者（2．19％），差异有显著性（X^2=58．37，P〈0．01），已接种者小三阳感染率（4．50％）也低于未接种者（11．99％），差异有显著性（X^2=66．76，P〈0．01）。结论 揭阳市受检从业人员的乙型肝炎感染率较高；接种乙型肝炎疫苗者HBsAg阳性率较低，而抗-HBs阳性率较高．建议从业人员就业前进行乙肝“两对半”检测并对乙型肝炎易感者进行乙肝疫苗接种。     

乙型肝炎疫苗免疫效果回顾性评价

目的：对从化市学龄前儿童乙型肝炎疫苗免疫效果进行回顾性分析,为我市制订乙型肝炎免疫策略提供参考数据。方法：通过对从化市1995～2005年学龄前儿童进行乙型肝炎感染的血清学检测,分析从化市学龄前儿童乙型肝炎病毒表面抗原（HBsAg）携带率,结合对从化市学龄前儿童乙型肝炎疫苗接种率等资料进行对比分析,并将当年该市农村学龄前幼儿HBsAg携带率进行比较,用以对从化市学龄前儿童乙型肝炎疫苗免疫效果进行回顾性评价。结果：随着乙型肝炎疫苗免疫接种率的逐年上升,从化市学龄前儿童乙型肝炎病毒表面抗原携带率则逐年下降,学龄前儿童HBsAg携带率由1995年的15.8%下降到2005年的4.5%（P〈0.05）。乙型肝炎保护性抗体（抗-HBs）则逐年上升,由1995年的39.9%升高到2005年的71.3%（P〈0.05）。同一时期内,城区学龄前儿童HBsAg携带率较农村儿童HBsAg携带率明显降低（P〈0.05）。结论：对学龄前儿童进行有组织有计划的乙型肝炎疫苗免疫接种,能够有效地降低学龄前儿童乙型肝炎病毒表面抗原（HBsAg）携带率;城区儿童乙型肝炎疫苗免疫接种率及接种效果均高于农村儿童。加强对乙肝易感人群的有计划的免疫,是降低乙肝感染的有效途径。     

HBV相关性肝病患者外周血PBMCs表面Tim-3、PD-1表达水平检测及意义

目的 分析乙型肝炎病毒（HBV）感染后相关肝病患者外周血单个核细胞（PBMCs）表面T细胞免疫球蛋白黏蛋白分子-3（Tim-3）、程序性死亡受体-1（PD-1）表达水平变化及意义。方法 选取2017年 1～12月川北医学院附属医院HBV携带者20例,慢性乙型肝炎（CHB）患者30例,重型乙型肝炎患者20例,乙肝肝硬化患者30例,肝细胞癌患者20例,以同期20例健康体检者作为健康对照组。检测各研究对象外周血PBMCs表面Tim-3、PD-1表达水平。结果 PBMCs表面Tim-3、PD-1表达水平在健康对照组最低,与HBV携带组比较差异无统计学意义（P?>0.05）,随着病情加重,PBMCs表面Tim-3、PD-1表达水平逐渐升高,在重型乙型肝炎组、肝细胞癌组最高,各组患者PBMCs表面Tim-3、PD-1表达水平与健康对照组、HBV携带者组比较,差异有统计学意义（P?<0.05）;HBV感染患者PBMCs表面Tim-3、PD-1表达水平与HBV DNA载量呈负相关（r?=-0.431和-0.422,均P?<0.05）,与ALT、AST水平呈正相关（r?=0.214、0.325、0.234和0.354,均P?<0.05）;HBV感染患者总体PBMCs表面Tim-3的表达水平与PD-1表达量呈正相关（r?=0.967,P?<0.05）。结论 免疫负性调节因子Tim-3、PD-1与HBV相关性肝病患者肝组织炎症及纤维化发生相关,对Tim-3、PD-1水平调节可能为其临床免疫治疗提供新思路。     

Markers of hepatitis B virus infection in schoolchildren in the Kimberley, Western Australia

In 1986 the Aboriginal community in Western Australia was identified as a high-risk group for hepatitis B virus infection. An immunization programme was commenced in 1988 but concerns were expressed about horizontal transmission, especially in schools, to the low-risk Caucasian group and whether they should also be included in the vaccination programme. To estimate the extent of this occurrence, a survey of schoolchildren from two district high schools in Broome and Derby in the Kimberley Region of Western Australia was carried out in March 1989. A total of 607 students aged 4 to 19 years were included in the study. None of the 300 Caucasian students had any serological markers of hepatitis B virus infection (95% confidence interval (CI) upper limit, 1.3%). Eighteen children were found to be seropositive for hepatitis B surface antigen (HBsAg); 17 were Aboriginal and one Asian. In addition, 61 Aboriginal students and one Asian had hepatitis B surface antibody (antiHBs). The hepatitis B virus infection rate in these Aboriginal children is 28.2% (95% CI, 23.2%-33.7%) with a carrier rate of 6.1% (95% CI, 3.9%-9.6%). This study demonstrates that Caucasian students have a very low risk of infection with hepatitis B virus in this community, and there is therefore no need to extend the hepatitis B vaccination programme beyond the already identified high-risk groups.     

潍坊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)在潍坊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,选择奎文区中小学各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(x2=236.66,P<0.01);HBVM中,接种后抗-HBs阳性率显著高于接种前(x2=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。     

乙型肝炎疫苗预防效果研究

乙型肝炎是我国重大传染病,乙肝疫苗是预防和控制乙肝病毒感染的流行和传播最有效措施."九五"期间"乙肝疫苗预防效果研究"证实我国低剂量单纯乙肝血源疫苗的长期预防效果(新生儿免疫后15年内)持续为90%,新生儿完成全程免疫后无需加强免疫可有效预防乙肝病毒慢性感染而终生受益;乙肝疫苗明显具有免疫选择表面抗原基因变异株的作用;表面抗原基因变异株在未免疫携带者中主要是弱势准种;中国乙肝病毒基因型和血清型的分布有明显的地区性;我国乙肝基因工程疫苗(酵母、CHO)大面积推广使用安全、有效和可行;乙肝基因苗表面抗体阳转率和近期保护效果与相当剂量的血源疫苗效果相似;乙肝基因工程疫苗与50IU乙肝免疫球蛋白联合应用,可将母婴阻断效果提高到90%;我国目前推广乙肝疫苗的成本效益至少为135.     

健康人群自愿接种乙肝疫苗的调查

目的 通过对健康人群(非新生儿)乙肝疫苗接种等知识的调查，寻找降低乙型肝炎病毒携带发病率的最有效方法。方法对来门诊自愿接种乙肝疫苗的健康中，随机抽取200例，采用问卷调查方式，针对乙肝疫苗接种的相关知识进行答卷。结果自愿接种乙肝疫苗中的36．5％回答不知道乙型肝炎传播途经；接种动机方面99．5％是为了预防疾病；家人、朋友的说服来接种比其他原因为多。结论目前预防乙型肝炎最有效的方法仍然是接受乙肝疫苗注射；定期接种乙肝疫苗，对本人、家庭和社会都有重要的现实意义；乙肝疫苗接种纳入全民计划免疫项目，首先在健康教育方面要加强力度。     

大学生乙型肝炎基因重组疫苗接种效果分析

目的 观察乙型肝炎基因重组疫苗的安全性和对大学生的免疫效果,为制定免疫策略提供依据。方法 应用乙肝酶母重组疫苗,按0,1和2月3针接种乙肝血清标志物全阴的156名大学生,并用定量族免法（PIA）对免疫后的抗体反应进行检测。结果 未发现接种对象出现严重副反应。成全程免疫后2个月时,抗体阳转率达81．41％,但大多数接种者体滴度（mean geometric titer,GMT）在（10－99）IU／L之间,为低应答水平,只有1．92％的人GMT在100IU／L以上,男、女生之间抗体阳转率及GMT构成分布差异多无显著性。12名既往疫苗接种抗体无应答者复种疫苗后,有7人抗体转阳。结论 乙肝重组疫苗安全性较,对大学生免疫后的抗体阳转率尚可,但抗体应答水平较低,性别差异不明显。免疫失败后可考虑复种,以增强抗体阳转机会。     

肝炎病人生活质量调查分析(附142份健康状况调查)

目的 :调查病毒性肝炎对病人的工作、学习、生活、情绪、社交等方面的影响。方法 :采用“简明健康状况调查表 (中文版 )SF - 36”对肝炎病人及部分健康人进行调查。调查分为两组 ,A组为肝炎病人与健康对照比较组 ,肝炎病人和健康人各 32人。B组为肝炎病人保肝治疗前后比较组 ,肝炎病人 39人 ,治疗前后各 39份答卷。结果 :肝炎病人 10 0 %对上述调查都有一定或较大影响 ,平均每个病人对表中 36项调查有影响的占83 33%。而 32例健康对照中 ,只有 6个人平均每个人对表中 36项调查有影响的只占 16 6 7%。结论 :两组比较有显著性差异 (P <0 0 1)。B组病人 ,保肝治疗前 ,平均每个病人对表中 36项调查有影响的占 84 6 1% ,而保肝治疗后 ,此比例为 5 8 97% ,两组比较有显著性差异 (P <0 0 5 )。同时还报告了肝炎不同的临床类型和病原学类型其调查结果的不同。肝炎病人的生活质量比健康人明显下降。而经过保肝治疗后病人的生活质量较治疗前提高。不同类型的肝炎病人其调查结果有所不同。     

及时接种乙肝疫苗首针对学龄前儿童疫苗完成情况的影响

目的了解乙肝疫苗(hepatitis B vaccine,Hep B)首针及时接种对学龄前儿童完成国家免疫规划疫苗(NIPV)接种的影响,为学龄前儿童完成NIPV接种提供参考依据。方法于2013年10月采用按容量比例概率抽样方法从福建省1 004个合并后的乡镇中抽取34个乡镇(街道),按批质量保证抽样方法抽取其中772名学龄前儿童进行疫苗接种情况调查,评估乙肝疫苗首针及时接种及其对学龄前儿童完成NIPV的影响。结果调查的772名儿童中,738名乙肝疫苗首针及时接种的学龄前儿童完成NIPV接种率为93.4%,34名乙肝疫苗首针未及时接种的学龄前儿童完成NIPV接种率为79.4%,差异有统计学意义(P0.01);多因素非条件logistic回归分析结果显示,乙肝疫苗首针接种时间超过24 h和少数民族学龄前儿童均不利于儿童完成NIPV接种。结论乙肝疫苗首针及时率对学龄前儿童完成国家免疫规划疫苗接种率有积极影响,应继续保持新生儿乙肝疫苗首针及时接种率和加强对该接种率的考核督导要求。     

Normal immune response to hepatitis B vaccine in patients with Down's syndrome. A basis for immunization guidelines

Institutionalized patients with Down's syndrome (DS) are uniquely predisposed to develop chronic hepatitis B infection following exposure. Therefore vaccination is particularly warranted, but there have been concerns that these individuals may react suboptimally. We examined the immune responses of 62 institutionalized patients with DS to 20 and 40 micrograms of hepatitis B vaccine inactivated (Heptavax-B) over one year. The subjects were matched by weight, age, and sex. Seroconversion rates and levels of antibodies to hepatitis B surface antigen (anti-HBs) were comparable to those found in a normal population and were higher than those found in immunocompromised patients undergoing hemodialysis. The anti-HBs levels were consistently higher in the 40-micrograms vaccine group. In patients with DS who were over 30 years old, age was a significant factor in predicting anti-HBs responses. Conversely, in younger subjects, weight was negatively correlated with anti-HBs levels. These data clearly indicate that patients with DS respond normally to hepatitis B surface antigen vaccination and need not be considered a special group when guidelines for vaccination are recommended.     

武鸣县2012年1～6岁儿童乙肝和白喉血清学调查分析

目的了解武鸣县适龄儿童乙肝和百白破疫苗接种现状,评价乙肝疫苗和百白破疫苗纳入免疫规划后的防控效果。方法按《2012年全区免疫规划血清学调查方案》抽样、调查和采集血清,由自治区CDC对血清样本进行乙肝和白喉监测。结果调查的153名儿童HBsAg、HBsAb和DT IgG阳性率分别为0．65％、83．01％和100．00％。HBsAb阳性率最高的为1～岁组,占95．83％;最低的为3～岁组,占69．23％。男性和女性的HBsAg、HBsAb阳性率差异均无统计学意义,加强免疫者HBsAb阳性率高于仅基础免疫者。结论武鸣县将乙肝疫苗和百白破／白破疫苗纳入免疫规划效果显著;每隔3～4年应进行乙肝疫苗加强免疫。采取多种形式开展常规免疫接种、开展母婴安全工程,提高孕产妇住院分娩率和应用儿童预防接种信息管理系统,加强对适龄儿童的预防接种管理是提高预防接种效果的有效措施。     

青海省儿童监护人预防接种知识、态度、行为抽样调查

目的了解青海省儿童预防接种及监护人对预防接种知识、态度、行为的现状（KAP）,促进青海省免疫规划工作发展,提高免疫服务工作质量,为制定免疫规划策略提供科学依据。方法在化隆、循化、共和、海晏4个项目县采取入户调查的方法对724名儿童及监护人,采用问卷调查的方式进行接种率和KAP调查。结果乙肝疫苗24 h内首针及时接种率77.4%;93.9%的家长认为接种疫苗对孩子有好处,66.0%的家长知道孩子出生后需要接种疫苗;82.5%的家长认为接种疫苗可以预防疾病,72.2%的家长不知道孩子出生时需要接种乙肝疫苗,46.4%的家长不知道孩子出生后需办理预防接种证。结论应加大免疫规划工作的相关法规的宣传以及免疫规划配套政策的执行力度,提高乙肝及时接种率和其它疫苗的接种率,提升儿童家长/监护人对疫苗针对疾病的知识知晓率。     

13282名儿童乙肝表面抗体监测结果分析

目的：了解晋中市榆次区儿童乙型肝炎（简称乙肝）疫苗接种后的免疫效果,为儿童乙肝疫苗再次加强免疫提供科学依据。方法：在2007年7月1日到2011年6月30日间到晋中市榆次区城区防疫妇幼保健中心体检的儿童中,随机抽取13 282名健康儿童进行乙肝表面抗体的检测,按年龄进行分析。结果：乙肝表面抗体的平均阳性率为69.30%,其中～1岁组为95.29%,〉1～2岁组为80.21%,〉2～3岁组为59.98%,〉3～4岁组为40.35%,〉4～5岁组为33.77%,≥5岁组为30.92%,随着年龄增大,抗体阳性率趋低。结论：抓好儿童乙肝的全程基础免疫接种,定期检测儿童体内乙肝抗体的水平,根据结果及时对儿童进行乙肝疫苗的强化免疫。     

Detection of core antibody in hepatitis B infection.

Hepatitis B core antigen (HBcAg) is found on the decoated Dane particle and on a morphologically similar particle detected mainly in the nucleus of hepatocytes of patients with hepatitis B. HBcAg prepared from the liver of a chimpanzee infected with hepatitis B virus was used to test human serum for core antibody (anti-HBc) by complement fixation. Anti-HBc was found in serum collected from patients with hepatitis B in both the acute and convalescent stages, from carriers of hepatitis B surface antigen (HBsAg) and from patients with chronic liver or renal disease who were carriers of HBsAg. It was not found in patients with hepatitis A or infectious mononucleosis, or in healthy persons who were not carriers of HBsAg.     

Nonblack patients with sickle cell disease have African beta S gene cluster haplotypes

Of 18 nonblack patients with sickle cell disease, 14 had sickle cell anemia, 2 had hemoglobin SC disease, and 2 had hemoglobin S-beta o-thalassemia. The beta s gene cluster haplotypes that were determined in 7 patients were of African origin and were identified as Central African Republic, Central African Republic minor II, Benin, and Senegal. The haplotype Central African Republic minor II was present on the beta o-thalassemia chromosome in 2 patients. None of 10 patients whose alpha-gene status was determined had alpha-thalassemia-2. These data strongly support the concept that the beta s gene on chromosome 11 of these individuals is of African origin and that the alpha-gene locus on chromosome 16 is of white or native American origin. The clinical severity of the disease in these nonblack patients is appropriate to their haplotype without alpha-thalassemia-2 and is comparable with that of black patients. All persons with congenital hemolytic anemia should be examined for the presence of sickle cell disease regardless of physical appearance or ethnic background.     

Perspectives on hepatitis B infections and the efficacy of vaccination (hepatitis B and pneumococci) in dialysis patients

Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p < 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p < 0.01) (n = 21) than in dialysis patients (n = 28). Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.