乙肝疫苗低(无)应答儿童再免疫效果观察

Effect of Re-vaccinating HepB Vaccine to Non-responsible Children

目的评价乙肝疫苗低应答/无应答儿童重新接种或加大剂量接种后的免疫效果。方法用酶联免疫法（ELISA）筛选出1岁以内已全程接种乙肝疫苗的4-6岁儿童血清HBsAg、抗-HBs、抗-HBc 3项指标全为阴性者,再用固相放射免疫法（RIA）复核并对抗-HBs小于10mIU/ml者,使用重组（CHO细胞）乙肝疫苗,按10μg剂量/1针次和20μg剂量/1针次分2组接种,均为0、1、6程序接种3针,完成接种后1-2月时采血,检测抗-HBs水平。结果2019例筛选儿童血清HBsAg、抗-HBs、抗-HBc 3项指标全为阴性者672例,占33.28%。抗-HBs〈2.1mIU/ml的无应答儿童占27.44%,2.1-9.9mIU/ml的低应答儿童占5.05%。10μg剂量接种组采集到158例血清,抗-HBs≥10mIU/ml者155例,占98.10%,GMT为364.36mIU/ml。20μg剂量接种组采集到173例血清,抗-HBs≥10mIU/ml者172例,占99.42%,GMT为392.86mIU/ml。2组疫苗再免疫后抗-HBs的GMT增幅为53.61-721.87倍。结论乙肝疫苗无（低）应答儿童重新接种乙肝疫苗3针后免疫效果良好,10μg剂量组与20μg剂量组的抗体达到保护水平率差异无统计学意义,无应答儿童再免疫后产生的抗体GMT水平2组差异无统计学意义,低应答儿童的抗体GMT水平则表现为20μg剂量组高于10μg剂量组。

Objective To assess the effect on the low level response or non-response children after being re-vaccinated with once more doses or more dosage. Methods The children who were 4-6 years old with HBsAg （ - ）, HBsAb （ - ） , HBcAb （ - ） were sieved out from the children vaccinated with 3 doses HepB vaccine when under 1 year old by using ELISA. The results were re-checked using RIA, and divided the children whose HBsAb was under 10 mIU/ml into 2 groups. Then the 20 μg/does or 10 μg/does CHO HepB vaccine was given to different groups with 3 doses in 0, 1, 6 months. After 1-2 months, their blood samples were got for HBsAb testing. Results The total sample was 2 019 children, 672 children （33.28%） of total sample were selected. The non-response children with HBsAb 〈 2. 1mlU/ml was 27.44% , the low level response （ HBsAb： 2. 1- 9. 9mIU/ml） children accounted for 5.05%. 158 samples were collected from the 10 μg group and among which 155 samples （98. 10% ） with HBsAb≥10 mIU/ml and GMT 364. 36 mIU/ml. 173 samples were collected from the 20 μg group and among which 172 samples （99.42%） with HBsAb ≥ 10mIU/ml and GMT 392.86 mIU/ml. The GMT of HBsAb in the 2 groups increased by 53.61 to 721.87-fold. Conclusion The effect of re-vaccinating HepB vaccine to non-response children was satisfied, the rates of protecting antibodies between 2 groups （10 μg and 20 μg） were not statistical different. GMT in non-response children between 2 groups was not statistical different, while the GMT of low level response children in 20ug group was higher than that in the 10ug group.