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1.
Florent Valour Laurent Cotte Nicolas Voirin Matthieu Godinot Florence Ader Tristan Ferry Philippe Vanhems Christian Chidiac 《Vaccine》2014
Background
Several vaccines are recommended in HIV-infected patients due to an increased risk of vaccine-preventable infections, severe forms of the disease, or shared transmission routes. Few data are available regarding vaccination coverage and its determinants in this population.Methods
A cross-sectional study was performed in HIV-infected patients included in a hospital-based cohort in 2011. Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal and A(H1N1)2009 pandemic influenza, and invasive pneumococcal diseases (IPD) were recorded. Factors associated with vaccination were assessed by multivariate logistic regression.Results
2467 patients were included (median age: 47 years; male gender 71.5%; men having sex with men (MSM): 43.9%; CDC stage C: 24.3%; HBV and/or hepatitis C virus co-infection: 14.4%). Median duration of HIV infection was 10 years and 93.1% of patients received combination antiretroviral therapy. At baseline, the median CD4 count was 527 cells/mm3 and HIV viral load was <50 copies/mL in 83.3% of cases. Vaccination coverage for HBV, HAV, seasonal influenza, A(H1N1)2009 pandemic influenza, and IPD were 61.9%, 47.4%, 30.9, 48.3%, and 64.6%, respectively. Factors independently associated with vaccination were a younger (HBV) or an older age (influenza), male gender (HBV, HAV), MSM (HBV), CD4 count >200/mm3 and HIV-RNA <50 copies/mL (IPD, influenza), longer duration of HIV infection (IPD, influenza), and follow-up by an experienced physician (HBV, IPD).Conclusions
Vaccination coverage remained insufficient for all vaccine-preventable infections investigated in this study. Determinants for vaccination were largely not evidence-based, and efforts should be focused on improving physicians’ knowledge about guidelines. 相似文献2.
Aim
To assess cost-effectiveness of hepatitis B virus (HBV) vaccination strategies from health care payer and societal perspectives, focusing on the long-term effect, in Taiwan where prevalence of HBV and Hepatitis B e Antigen (HBeAg) is high.Methods
A decision analysis was performed to compare total costs and effectiveness between two vaccination strategies: universal vaccination and no-vaccination. The Markov process was defined as a series of states including acute HBV infection, asymptomatic carrier, chronic hepatitis, compensated and decompensated liver cirrhosis, hepatoma, and death. Direct and indirect costs were also imputed based on estimates. The incremental cost-effectiveness ratio (ICER) per life-year gained and quality-adjusted life years gained were calculated at a 3% discount rate. By assigning a series of specific distributions to each parameter, a probabilistic cost-effective analysis using Monte Carlo simulation was conducted to yield 5000 ICER replicates.Results
The effectiveness of a universal vaccination program for reducing hepatocellular carcinoma cases and deaths was approximately 86%. The average life years gained per subject as a result of such a universal vaccination was 3.9. The vaccination program dominated over a no-vaccination program (less cost and more effectiveness).Conclusions
A universal vaccination program against hepatitis B infection is not only effective for reducing long-term sequelae but is also a cost-saving primary preventive strategy, which supports a universal infant immunization in endemic area with high prevalence of HBV and HBeAg. 相似文献3.
Objective
To estimate the long-term cost-effectiveness of universal newborn hepatitis B vaccination in China, an area of high endemicity.Method
A decision tree was used to describe perinatal hepatitis B virus (HBV) transmission, early infection and impact of vaccination. A Markov model based on 1-year cycles was used to simulate these impacts for the lifetime of a cohort of 10,000,000 infants born in 2002 in China. We compared both cost and health outcomes for two strategies: universal newborn vaccination comprising a timely birth dose (HepB1) with a three-dose vaccination (HepB3) compared with no vaccination. Univariate and probabilistic sensitivity analyses using Monte Carlo simulations were performed to test parameter uncertainty.Results
Over the cohort's lifetime, 79,966 chronic infections, 37,553 cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths would be prevented by universal infant vaccination. The prevalence of HBV infection is reduced by 76%. Over 743,000 life-years and 620,000 quality adjusted life years (QALYs) would be gained and there would be monetary benefits of more than 1 billion US dollars in medical care costs and lost productivity avoided.Conclusion
The newborn vaccination programme for Hepatitis B in China both gains QALYs and saves medical care costs. It is important to ensure that timely and comprehensive vaccination programmes continue. 相似文献4.
Background
Few country-level estimates for hepatitis A virus (HAV) seroprevlance are available for the 23 countries in the Eastern Mediterranean region (EMRO) of the World Health Organization.Methods
We used a three-stage approach to assign an HAV endemicity level to each country in North Africa and the Middle East based on the age at midpoint of population immunity. First, we conducted a systematic review to identify all age–seroprevalence studies conducted within the past 10 years. Second, for countries without first-stage evidence we searched for incidence data and older seroprevalence data. Third, for countries with no hepatitis A data, we estimated HAV endemicity based on socioeconomic and water indicators.Results
This three-stage method allowed us to estimate country-specific endemicity levels for every country in EMRO even though first-stage evidence was only available for nine countries and for three countries only third-stage evidence was available. The region has a heterogeneous hepatitis A risk profile, with 13 countries having very high endemicity (an age at midpoint of population immunity in early childhood), three having high endemicity (late childhood), and seven having intermediate endemicity (early adulthood).Conclusions
The three-stage estimation approach enables the creation of a complete country-level map of HAV risk in EMRO. Given the heterogeneity of HAV endemicity levels in the region and the likelihood of transitions to lower incidence rates and greater adult susceptibility in the near future, enhanced surveillance for hepatitis A would strengthen decisions about vaccination policy in the region. 相似文献5.
Objectives
Hepatitis A (HAV) and Hepatitis B (HBV) infections can cause serious morbidity in patients with liver disease, including cystic fibrosis associated liver disease (CFALD). HAV and HBV vaccinations are recommended in CFALD, and maintenance of detectable antibody levels is also recommended with chronic liver disease. A better understanding of factors predicting low HAV and HBV antibodies may help physicians improve protection from these viruses in CFALD patients.Methods
We examined HAV and HBV vaccine protection in children at risk for CFALD. Clinical and vaccine histories were reviewed, and HAV and HBV antibody titers measured. Those with no vaccination history or low HAV or HBV titers received primary or booster vaccinations, and responses were measured.Results
Thirty-four of 308 children were at risk for CFALD per project criteria. Ten had previous HAV vaccination, of which 90% had positive anti-HAV antibodies. Thirty-three of 34 had previously received primary HBV vaccination (most in infancy), but only 12 (35%) had adequate anti-HBs levels (≥10 mIU/mL). Children with adequate anti-HBs levels were older at first HBV vaccine (median 2.3 vs. 0.1 years, p < 0.01), and at final HBV vaccine (median 4.0 vs. 0.8 years, p = 0.01). Fourteen of 19 (74%) responded to HBV boosters. Z-scores for BMI at HBV booster were significantly lower in booster non-responders (p = 0.04).Conclusions
Children at increased risk of CFALD have inadequate HAV and HBV antibody levels, and HBV antibody protection can be enhanced through vaccine boosters. HBV antibody titers should be assessed in CFALD patients with a history of vaccination, particularly in those who received HBV vaccines in infancy or who are malnourished. 相似文献6.
Matheson K Halperin B McNeil S Langley JM Mackinnon-Cameron D Halperin SA 《Vaccine》2010,28(51):8105-8111
Background
Canadian guidelines recommend hepatitis A virus (HAV) vaccination for high-risk persons, such as travelers to HAV-endemic areas. The US CDC advocates universal immunization.Objectives
To explore whether a universal strategy for HAV immunization rather than the Canadian targeted approach for travelers is justified by measuring compliance of postsecondary students with Canadian guidelines.Methods
A cross-sectional study using an electronic survey method elicited HAV risk factors, immunization history, disease status, and factors affecting immunization status from postsecondary students. Seropositivity was determined by measuring HAV antibodies in saliva from a convenience sample of survey participants within each study group. Statistical analysis used Fisher's exact test and logistic regression.Results
We received 2279 completed surveys (10.6% response) and 235 saliva samples (58.7% response). A total of 1380 (60.6%) participants had traveled to HAV-endemic regions and 1851 (81.2%) were planning to do so within the next 5 years. Less than half who traveled to HAV-endemic areas reported a history of HAV vaccination (48.0%). HAV seropositivity rates were higher amongst those who traveled to (63.6%) or were planning to travel to (55.0%) HAV-endemic areas than those who had never traveled or had no plans to travel to such areas (17.4%). Only 8.9% of unvaccinated students were seropositive (5.3% of Canadian-born students). Amongst unvaccinated, seropositive students, there was a nonsignificant trend for higher seropositivity in those who had previously traveled to HAV-endemic areas (14.7%) than those who had not traveled abroad (4.4%), suggesting an exposure to HAV during travel. Nearly all (96.5%) unvaccinated students, who were willing to be vaccinated based on current knowledge or if their doctor recommended it, indicated a willingness to receive vaccine if it were provided free of charge.Conclusions
Current Canadian guidelines for HAV vaccination are not being followed within the postsecondary student population. Given high rates of travel to HAV-endemic areas in this population, a universal approach to HAV vaccination may be warranted. 相似文献7.
Objective
To evaluate the long-term efficacy of Chinese hamster ovary (CHO) cell derived hepatitis B vaccine in country community in China.Methods
A cross-sectional investigation was carried out. Children who were born between 1997 and 1999 and vaccinated with the three doses of CHO-derived hepatitis B vaccine were selected as study objects. Their serum samples were taken to test for hepatitis B virus (HBV) markers, and the results were compared to that before vaccination. In addition, for HBsAg positive children, their mothers were visited.Results
1254 Children were enrolled in the study. The prevalence of HBsAg was 0.24% and the vaccine efficacy was 97.0%, similar to that of yeast derived hepatitis vaccines. Among 3 mothers of HBsAg positive children, 2 were HBsAg positive, indicating maternal HBV transmissions.Conclusion
The long-term efficacy of the CHO-derived hepatitis B vaccine is good and after vaccination maternal transmission is the most important route of spreading HBV. 相似文献8.
Objective
To estimate current age-specific rates of immunity to hepatitis A virus (HAV) in world regions by conducting a systematic review and meta-analysis of published data. The estimation of the global burden of hepatitis A and policies for public health control are dependent on an understanding of the changing epidemiology of this viral infection.Methods
Age-specific IgG anti-HAV seroprevalence data from more than 500 published articles were pooled and used to fit estimated age-seroprevalence curves in 1990 and 2005 for each of 21 world regions (as defined by the Global Burden of Disease 2010 Study).Findings
High-income regions (Western Europe, Australia, New Zealand, Canada, the United States, Japan, the Republic of Korea, and Singapore) have very low HAV endemicity levels and a high proportion of susceptible adults, low-income regions (sub-Saharan Africa and parts of South Asia) have high endemicity levels and almost no susceptible adolescents and adults, and most middle-income regions have a mix of intermediate and low endemicity levels.Conclusion
Anti-HAV prevalence estimates in this analysis suggest that middle-income regions in Asia, Latin America, Eastern Europe, and the Middle East currently have an intermediate or low level of endemicity. The countries in these regions may have an increasing burden of disease from hepatitis A, and may benefit from new or expanded vaccination programs. 相似文献9.
PURPOSE
The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient’s risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity.METHODS
Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations.RESULTS
We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08–1.47) with uptake of routine HIV testing and HAV/HBV vaccination.CONCLUSION
Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians. 相似文献10.
Guillermo Mena Alberto L. García-Basteiro Anna Llupià Consolación Díez Josep Costa Josep-María Gatell Felipe García José-María Bayas 《Vaccine》2013
Introduction
HIV seropositivity is considered a risk factor for complications in hepatitis A virus (HAV) infection. HAV vaccination schedules are widely implemented in HIV-infected patients, but the immune response remains impaired.Methods
We analysed the response to vaccination (antiHAV titres ≥20 IU/l) in 282 HIV-infected patients included in a standard (1440 Elisa Units (EU) at 0, 6 months) or rapidly accelerated schedule (720 EU at 0, 7, 21 days and 6 months) between 1997 and 2009. Factors associated with the response to vaccination were analysed using logistic regression.Results
The overall response rate was 73.4%. Male sex (OR: 0.16, 95% CI 0.05–0.51) and hepatitis C virus co-infection (OR: 0.30, 95% CI 0.14–0.74) were associated with a lower probability of response. Protective antibody response was associated with a higher CD4/CD8 ratio (OR: 3.69, 95% CI 1.3–10.5) and having received two doses of standard schedule (compared with patients receiving only one dose of the same schedule) (OR: 2.51, 95% CI 1.22–5.15). Three doses of the rapidly accelerated schedule were not more effective than a single dose of 1440 EU (OR: 1.32, 95% CI 0.48–3.63).Conclusion
The low responses observed in patients receiving a single dose suggest the need to emphasize adhesion to vaccination protocols to avoid failure. The CD4/CD8 ratio may be considered as an immune status marker which could help to better choose the moment of vaccination. Our findings underscore the importance of identifying strategies that optimize the timing and effectiveness of hepatitis A vaccination in HIV-infected patients and of the need for further studies on individual factors such as sex and hepatitis C co-infection that may affect the response to vaccination. Likewise, the sub-optimal effectiveness of three doses of 720 EU in the rapidly accelerated schedule, if confirmed in future studies, might lead to a revision of the current schedule recommended for HIV-infected travellers. 相似文献11.
Rosa Carreras-Valls Judit Valverde-Lozano Dolors Benito-Carreras Joan Inglés-Torruella Miquel Vilardell-Ynaraja Josep Garre-Olmo Rosa Gil-Soto Margarita Escalé-Roca 《Gaceta sanitaria / S.E.S.P.A.S》2013
Objective
Vaccination against hepatitis A is recommended in risk groups, including healthcare workers. The objective of this study was to determine the prevalence of antibodies to HAV (IgG) among workers in the healthcare setting in order to establish criteria for vaccination.Methods
A cross-sectional, analytic, observational study of 4,864 employees was undertaken in four healthcare companies in Catalonia (Spain). The variables gathered included personal data, professional category, location of employment, and serology.Results
The overall prevalence of antibodies to HAV was 52.7%. The prevalence significantly increased with greater age. The mean age of seropositive workers was 41.5 years compared with 34.3 in workers with negative serology. The highest prevalence of antibodies was found in cleaning employees (74.2%) and catering staff (75.3%).Discussion
Given the high prevalence of seronegative adults susceptible to infection and the characteristics of their professional activities, vaccination of all staff working in health institutions should be considered. 相似文献12.
Background
Cambodia is highly endemic for hepatitis B virus (HBV) infection. Preventing perinatal HBV transmission should be prioritized in health facilities by providing hepatitis B vaccination to all infants within 24 h of birth (timely birth dose coverage).Methods
Teams assessed birth dose policy, practices and coverage in hospitals and health facilities in 10 provinces in Cambodia.Results
Fifty-one sites were assessed. Median (interquartile range) timely birth dose coverage was 66% (48–92%); coverage was 88% (range = 60–96%) in facilities vaccinating on-site and 48% (range = 20–52%) in those referring off-site (p < 0.0001). Overall, 5 (29%) of 16 hospitals that referred vaccination off-site did not tell mothers vaccination should take place within 24 h of birth, and 6 (35%) discharged mothers when no vaccination services were available for infants to receive the birth dose.Conclusions
Newborns can miss a time-sensitive opportunity to be protected against perinatal HBV infection when they are referred for vaccination off-site rather than being vaccinated in the delivery facility. These data support the case to strengthen policies and practices to provide hepatitis B birth dose vaccination in the delivery facility. 相似文献13.
Mannose-binding lectin and ficolin-2 do not influence humoral immune response to hepatitis B vaccine
Michael Osthoff Elizabeth Irungu Kenneth Ngure Nelly Mugo Katherine K. Thomas Jared M. Baeten Damon P Eisen 《Vaccine》2014
Background
Host genetics appear to be an important factor in the failure to generate a protective immune response after hepatitis B (HBV) vaccination. Mannose-binding lectin (MBL) and ficolin-2 (FCN2), two pattern recognition receptors of the lectin pathway of complement, influence the clinical outcome of HBV, and MBL deficiency has been shown to augment the humoral response to HBV vaccination in several experimental models. Here, we investigated the association of MBL and FCN2 with the humoral response to HBV vaccination in a candidate gene and functional study.Patients and methods
A post hoc analysis of a prospective, interventional HBV vaccination study among human immunodeficiency virus type 1 (HIV-1) uninfected individuals in Kenya was conducted. Serum levels and polymorphisms of MBL and FCN2 were analysed in relation to the immune response to HBV vaccination.Results
Protective hepatitis B surface antibody levels (≥10 mIU/mL) were evident in 251/293 (85.7%) individuals. Median MBL and FCN2 levels were similar in responders vs. non-responders with a weak trend towards lower median MBL levels in non-responders (1.0 vs. 1.6 μg/mL, p = 0.1). Similarly, there was no difference in four MBL and six FCN2 polymorphisms analysed in the two groups with the exception of an increased frequency of a homozygous MBL codon 57 mutation in non-responders (4 (9.5%) vs. 8 (3.2%), p = 0.05) corresponding to lower MBL levels. Results were similar after adjusting for age and sex.Conclusions
Our study does not support a prominent role of the lectin pathway of complement in general and MBL and FCN2 in particular in the humoral immune response to HBV vaccination in African adults. 相似文献14.
Bette Liu Steven Guthridge Shu Qin Li Peter Markey Vicki Krause Peter McIntyre Elizabeth Sullivan James Ward Nicholas Wood John M. Kaldor 《Vaccine》2012
Background
A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced.Methods
A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs.Findings
Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43–0.88) and 0.8% versus 3.5% (OR 0.21, 95%CI 0.11–0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women.Interpretation
The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally. 相似文献15.
Objectives
The objective of this study was to determine whether use of a longer (1 in.) rather than a standard (5/8 in.) needle used for macrosomic neonates (birthweight over 4000 g) may affect antibody titers after immunization against hepatitis B virus (HBV).Methods
Fifty nine healthy infants were vaccinated at birth, 1, and 6 months of age with hepatitis B vaccine, with follow up to 7 months of age. Infants were randomized into two groups according to needle length of first vaccine at birth. First group vaccinated with standart needle length and other group received vaccine by longer needle length.Results
Macrosomic infants who were immunized with a longer needle achieved significantly higher antibody titers to hepatitis B surface antigen than standart needle length (median, 3890.2 vs 1311.7 mIU/mL, respectively; p = 0.001).Conclusions
Macrosomic neonates benefit from longer needle length with higher levels of antibody titers after HBV vaccination. 相似文献16.
Background
The Netherlands is a very low endemic country for hepatitis A virus infections (HAV, notification rate of <1/100,000). Historically in Amsterdam, a large proportion of infections are imported from Turkey and Morocco in children returning from summer holiday. Annually since 1998, the public health service of Amsterdam has targeted these children for HAV vaccination before the summer. As the population of non-western immigrants and their descendents increases, we describe recent trends in HAV in ethnic groups in Amsterdam (1996–2011), identifying current risk groups and recommending targeted prevention through vaccination.Methods
We studied all cases of (non-homosexually acquired) HAV infection notified in the Amsterdam region (1996–2011, n = 819) by ethnic group and generation (first/second generation migrants: FGM and SGM respectively). Incidence rates were estimated as the average number of cases per 100,000/year. Using Poisson regression, we calculated incidence rate ratios (IRR) by ethnic group and generation adjusted for age and calendar year, and modeled seasonal variation using a smoothed time series.Results
Incidence of HAV in Amsterdam dropped from 24.8/100,000 population in 1996 (178 cases) to 1.0/100,000 in 2011 (8 cases). Since 2005, 56% of cases are imported, the majority (62%) in second generation migrant (SGM) children of Moroccan, or other non-western ethnic backgrounds. The adjusted IRR in SGM relative to the ethnic Dutch population was 3.7 (95% CI: 2.3–6.1) in Moroccan SGM, 4.3 (95%CI: 2.6–7.2) in SGM of other non-western backgrounds and 1.9 (95%CI: 0.8–4.1) in Turkish SGM.Conclusion
Though incidence of HAV in Amsterdam has declined substantially since 1996, it is still higher in SGM children of Moroccan & other non-western ethnic backgrounds. In line with WHO recommendations of June 2012, introduction of single-dose HAV vaccination, targeted at SGM children from HAV endemic countries, could be considered within the routine childhood vaccination schedule. 相似文献17.
David W. Scheifele Gaston De Serres Vladimir Gilca Bernard Duval Ruth Milner Margaret Ho Jan J. Ochnio 《Vaccine》2010
Background
Hepatitis A virus (HAV) infection rates in Canada are low and declining. A nationwide pediatric serosurvey in 2003 confirmed that HAV infection is uncommon in children. Additional seroepidemiological data for adults would help to guide domestic use of HAV vaccines.Methods
A country-wide survey of HAV antibody positivity and selected risk factors was conducted among 18–69 year olds identified by random digit dialing, in samples proportional to regional populations. Volunteers were sent study materials and returned oral fluid and completed questionnaires by mail. An ultra-sensitive assay was used to detect HAV antibody in oral fluid. Multiple logistic regression was used for risk factor assessment.Results
Of 2104 potential study participants, 1552 (74%) returned an adequate oral fluid specimen and questionnaire. Anti-HAV was detected in 509 individuals (33%) and was associated with birth in HAV endemic areas, self-reported hepatitis A vaccination, prior travel to endemic areas, and increasing age. Only 15% reported having been vaccinated. Among Canadian-born, non-vaccinated participants anti-HAV was present in 20%, ranging regionally from 14% to 30%. Age-specific positivity rates in this subset were: 18–29 years 2.6%; 30–39 years 6.1%; 40–49 years 11.4%; 50–59 years 26.4% and 60–69 years 45.9%. Travel to HAV-endemic countries was reported by 55% of participants but only 24% of travelers had been vaccinated.Conclusions
Past HAV infection rates among Canadian-born, non-vaccinated individuals are low in young adults and increase by two-fold per age decade. Travel to endemic areas is a significant risk factor, amenable to prevention by greater use of HAV vaccine. 相似文献18.
Liping Shen Fuzhen Wang Feng Wang Fuqiang Cui Shuang Zhang Hui Zheng Yong Zhang Xiaofeng Liang Shengli Bi 《Vaccine》2012
Objective
To evaluate the long-term efficacy and duration of yeast-derived recombinant hepatitis B vaccine in hepatitis B virus (HBV)-endemic areas.Method
A cross-sectional investigation was carried out in five HBV-endemic areas. Children who were born between 1997 and 2008 and vaccinated with yeast-derived recombinant hepatitis B vaccine were selected. Serum samples were taken to test HBV infection markers by microparticle enzyme immunoassay, and the results were compared to those before vaccination.Results
7066 subjects were enrolled. The average adjusted hepatitis B surface antigen (HBsAg) prevalence was 1.02%. HBV core antibody (anti-HBc) prevalence was 3.54%. The overall percentage of HBsAg(−)&Anti-HBc(−)&Anti-HBs(+) was 61.34%. With time after immunization, the percentage annually decreases from 86.11% in 2008 to 49.80% in 1997. Geometric mean concentration (GMC) of anti-HBs decreased significantly annually. The portion of GMC = 100–999.9 mIU/ml was 48.0% in 2008, and decreased to 16.7% in 1997.Conclusion
HBsAg prevalence decreased dramatically. This shows that the yeast-derived recombinant hepatitis B vaccine is effective and stable after being used for 12 years in HBV-endemic areas. It is not suggested to carry out booster immunization. 相似文献19.
Evan Freeman Glenda Lawrence Jeremy McAnulty Sean Tobin C. Raina MacIntyre Siranda Torvaldsen 《Vaccine》2014
Background
In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP).Aims
(1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases.Methods
A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP.Results
The uptake of PEP by susceptible contacts increased from 76% (n = 133) to 89% (n = 127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%–99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP.Conclusion
The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection. 相似文献20.