接受初次接种的婴幼儿在青少年期感染慢性乙型肝炎

liver411

Chronic hepatitis B infection in adolescents who received primary infantile vaccination.
Hepatology 2013 Jan;57(1):37-45 PMID:22858989 查看当期期刊
Wu TW,Lin HH,Wang LY
Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
文献类型：其他
主要主题词：Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis B Vaccines; Hepatitis B, Chronic

导读
警惕乙肝疫苗接种后长期免疫记忆的衰退
新生儿乙肝疫苗接种有效预防了HBV的母婴传播，我国台湾地区是全球最早推行新生儿乙肝疫苗接种的地区，该计划始于1984年，最初面向高危人群，1986年拓展至所有新生儿。近日，Wu等调查了台湾地区8733名1987年7月以后出生的高中生，发现抗-HBs阳性率仅有48.3%，同时，有1.9%的学生呈HBsAg阳性。其中，联合接种乙肝免疫球蛋白和乙肝疫苗者的HBsAg阳性率更高达15%，校正OR为15.63。Wu等认为，“相当一部分于婴幼儿期完整接种乙肝疫苗的青少年中，针对HBsAg的免疫记忆出现了衰退……母体HBeAg阳性是青少年HBsAg阳性的最重要的决定因素。”

研究还显示，在未注射乙肝免疫球蛋白的学生中，乙肝疫苗接种次数与HBsAg的阳性率存在负相关关系（P=0.011），接种4次、3次和1~2次乙肝疫苗者HBsAg阳性的校正OR值分别为1.00、1.52和2.85。

此外，研究者还对1974名HBsAg和抗-HBs双阴性的学生进行了强化乙肝疫苗接种，应答率约为72%。

因此，Wu等建议：“应考虑给15岁或以上的人群进行强化乙肝疫苗接种。”

摘要

Hepatitis B virus (HBV) infection is a global health issue. Universal infantile hepatitis B (HB) vaccination is very efficacious. However, HBV infections among those immunized subjects have been reported. The long-term efficacy of postnatal passive-active HB vaccination in high-risk subjects is not well explored. A total of 8,733 senior high school students who were born after July 1987 were assayed for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). The overall HBsAg and anti-HBs-positive rates were 1.9% and 48.3%, respectively. The HBsAg-positive rate was 15% in HB immunoglobulin (HBIG) recipients (adjusted odds ratio [OR]: 15.63; 95% confidence interval [CI]: 10.99-22.22). Among students who did not receive HBIG, there was a significantly negative association between HB vaccination dosage and HBsAg-positive rate (P for trend = 0.011). Adjusted ORs for those who received 4, 3, and 1 to 2 doses were 1.00, 1.52 (95% CI: 0.91-2.53), and 2.85 (95% CI: 1.39-5.81), respectively. Among HBIG recipients, the HBsAg-positive rate was significantly higher in subjects with maternal hepatitis B e antigen (HBeAg) positivity and who received HBIG off-schedule. A booster dose of HB vaccination was administered to 1974 HBsAg- and anti-HBs-negative subjects. Prebooster and a postbooster blood samples were drawn for anti-HBs quantification. The proportions of postbooster anti-HBs titer <10 mIU/mL was 27.9%. Subjects with prebooster anti-HBs titers of 1.0-9.9 mIU/mL had significantly higher postbooster anti-HBs titers than those with prebooster anti-HBs titers of <1.0 mIU/mL (P < 0.0001). CONCLUSION: Having maternal HBeAg positivity is the most important determinant for HBsAg positivity in adolescents who received postnatal passive-active HB vaccination 15 years before. A significant proportion of complete vaccinees may have lost their immunological memories against HBsAg.

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可可

要打加强针

雁过留声

学习了。

一块麦芽糖

看来打加强针还是很重要的！

雁过留声

接种乙型肝炎疫苗后的免疫力可维持多久?收藏到手机    转发(2)   评论(6)
2012-11-12 19:17

  　　乙型肝炎疫苗接种后产生抗体的保护效果可维持至少12年。HBsAg阴性母亲的新生儿在乙型肝炎疫苗全程免疫后乙肝病毒感染的几率很低，10～11年中感染几率为0.72%，而且多为一过性隐性感染。因此，如果母亲是HBsAg阴性，新生儿和学龄前儿童完成全程免疫后，入初中之前可以不考虑加强接种乙型肝炎疫苗。
　　目前国内尚未制定统一的乙型肝炎疫苗加强免疫方案。北京市在新生儿普遍免疫的基础上，对初中入学新生中未接种过乙型肝炎疫苗者进行全程免疫接种，对出生或学龄前已接种过乙型肝炎疫苗，但接种时间超过5年的学生进行加强免疫。加强免疫的剂量为每次5微克，共2次，间隔1个月。
　　HBsAg阳性母亲的新生儿全程免疫后1岁、3岁和6岁时均应进行抗-HBs检测；对成人，尤其是高危人群，全程免疫后3～6个月应检测抗-HBs。抗-HBs阴性或滴度低于10亳单位/毫升者应进行加强免疫。加强免疫的剂量为每次10微克，共2次，间隔1个月。



http://ditancaihaodong.i.sohu.com/blog/view/245227936.htm

雁过留声

母亲不是乙肝携带者，其新生儿和学龄前儿童完成全程免疫后，入初中之前可以不考虑加强接种乙型肝炎疫苗。
母亲是乙肝携带者，其新生儿全程免疫后7个月、3岁和6岁时均应进行抗-HBs检测。