天津市初一学生乙型肝炎疫苗免疫现状及加强免疫后记忆反应研究

目的 了解初中一年级学生(12～14岁)对出生时接种的乙肝疫苗免疫现状、感染乙型肝炎病毒(HBV)现状以及进行乙肝疫苗加强免疫的效果.方法 按整群分层后单纯随机抽样方法,根据Epi Info3.3.2软件计算样本量,依抗-HBs阳性率最低可接受度53%,计算其95%的可信限样本量至少为218名,而免疫现状检测的实际样本量为250名,加强免疫的实际样本量为236名;HBsAg、抗-HBs和抗-HBc IgG均采用酶联免疫吸附试验(ELISA)法检测,试剂分别由Abbott公司、Diasorin公司和北京万泰药业科技公司生产;HBV DNA用荧光定量PCR法检测.结果 加强免疫前免疫现状:抗-HBs阳性率为62.80%(157/250),几何平均滴度(GMT)为73.79 IU/L;现时期HBV自然感染(HBsAg和抗-HBc IgG阳性)率为2.80%(7/250).加强免疫效果:抗-HBs阳性率94.92%(224/236),较加强免疫前明显提高,差别有统计学意义(x=73.92,P=0.00),GMT为521.15 IU/L,较加强免疫前有显著提高,差别有统计学意义(t=15.98,P=0.00);在加强免疫前抗体消失的人群(86名)中加强免疫后的抗-HBs阳转率为91.86%(79/86);对加强免疫1针次的11名无应答者行第2针加强后,有8名产生了抗体.结论 对初中一年级学生实施乙肝疫苗加强免疫可有效提高机体免疫水平,防止免疫记忆丧失.

Current status of hepatitis B immunization and strengthened immune memory among first-year middle school students in Tianjin

Objective To investigate the immunization status of hepatitis B vaccine who were inoculated at birth.HBV infections and the vaccine booster effect in the first-year middle school students (12-14 years old).Methods A cluster,stratified simplified random sampling method was administrated.The sample size was at least 218.which was calculated by Epi Info 3.3.2 software at 53% the minimum acceptable anti-HBs positive rate and 95%confidence level.A total of 250 and 236 students participated in the infection status and booster immunization effects investigation.The HBsAg.anti-HBs and anti-HBc IgG were detected by Enzyme-linked immunosorbent assay (ELISA).HBV DNA was detected by fluorescence quantitative PCR,and the diagnostic test kit were produced respectively by ABBOTT,Diasofin and Beijing Wantai Biological Pharmacy Enterprise Co.Results For the immunization status before booster:the positive rate of anti-HBs was 62.80%(157/250),the GMT was 73.79 IU/L;the currently HBV infection rate(HBsAg and anti-HBc positive) was 2.80%(7/250).After injection,the anti-HBs positive rate was 94.92%(224/236).Compared with the before booster results,the significant difference was observed(χ2=73.92,P=0.00).The GMT was 521.15 IU/L,comparing with the before booster results,there was significant difference(t=15.98,P=0.00).The anti-HBs conversion rate(from negative to positive)was 91.86%(79/86) after immune-enhancement;of which,11 students got the second dose of booster vaccine who are no-responders after first injection.in addition 8 students got the anti-HBs.Conclusion It is an effective method to put the first-year middle school students into the immune-enhancement program,so as to improve the immunization memory effect and avoid the loss of protective antibodies.