大理白族自治州14岁及以下儿童乙肝疫苗接种和感染现状及影响因素分析

Analysis in hepatitis B vaccination,infection status,and related influencing factors in children ≤ 14 years old in Dali Bai Autonomous Prefecture

目的了解大理白族自治州≤14岁儿童乙肝疫苗(hepatitis B vaccine,HepB)接种和感染现状及影响因素,评价HepB纳入免疫规划后的预防控制效果,为完善防控策略提供依据。方法采用分层整群抽样,于2017年和2018年5-6月对大理白族自治州8月龄以上的7617名常住居民进行问卷调查和血清采集,并选取≤14岁儿童4000名进行分析和评价。结果大理白族自治州≤14岁儿童HepB接种率为99.20%,首针及时接种率为95.34%,全程接种率为99.05%。0~4岁儿童(OR接种=6.653,OR及时接种=3.229;P均<0.001)和医院出生(OR接种=11.007,OR及时接种=10.747;P均<0.001)是HepB接种和首针及时接种的促进因素。居住地为城镇(OR=0.112,P<0.001)是HepB接种的危险因素,而汉族(OR=1.616,P=0.006)是HepB首针及时接种的促进因素。HBsAg和HBsAb阳性率分别为0.15%和72.28%。HBsAb阳性率与年龄(r=-0.442,P<0.001)和全程接种后间隔时间(r=-0.443,P<0.001)均呈负相关。首针及时接种者HBsAg阳性率低(OR=0.097,P=0.007),全程接种后的间隔时间短HBsAb阳性率高(OR=7.258,P<0.001)。结论大理白族自治州≤14岁儿童处于HepB高接种、HBsAg低流行的现状,HepB免疫及防控效果较为显著。提高住院分娩率和HepB首针及时接种率是重要举措。

Objective To understand the status and influencing factors of hepatitis B vaccination and infection among children≤14 years old in Dali Bai Autonomous Prefecture,evaluate the effect of hepatitis B vaccine(HepB)in immunization program,and provide evidence for improving prevention and control strategies.Methods Stratified cluster sampling was used to conduct a questionnaire survey and serum samples were collected in 7617 permanent residents aged 8 months and older in Dali Bai Autonomous Prefecture from May to June in 2017 and 2018,and among them,4000 children aged under 15 years were selected for analysis and evaluation.Results The vaccination coverage rate of HepB in the children under 15 years old was 99.20%,the timely first dose vaccination rate was 95.34%,and the whole course vaccination rate was 99.05%.Younger age(0-4 years)group(ORvaccination=6.653,ORtimely vaccination=3.229,P<0.001,respectively)and hospital births(ORvaccination=11.007,ORtimely vaccination=10.747,P<0.001,respectively)were protective factors for HepB vaccination and timely first dose vaccination.Birth in town(OR=0.112,P<0.001)was a risk factor for HepB vaccination,while Han nationality(OR=1.616,P=0.006)was a protective factor for the timely first dose vaccination.The positive rates of HBsAg and HBsAb were 0.15%and 72.28%,respectively.The positive rate of HBsAb was negatively correlated with age(rs=-0.442,P<0.001)and time interval after the whole course vaccination(rs=-0.443,P<0.001).The timely first dose vaccination decreased the HBsAg positive rate(OR=0.097,P=0.007)and the short interval after whole course vaccination increase the HBsAb positive rate(OR=7.258,P<0.001).Conclusion The children≤14 years old in Dali Bai Autonomous Prefecture are in high vaccination level of HepB and low prevalence of HBsAg.The immune and prevention effects of HepB vaccine are significant.Improving hospital delivery rates and timely vaccination of HepB are important measures to prevent and control infection.