健康人群乙型肝炎疫苗接种效果评估

Evaluation on the effect of immunization with hepatitis B vaccine in healthy people

目的了解健康人群乙型肝炎（乙肝）疫苗接种情况，评价乙肝预防效果，为制定免疫策略提供依据。方法按照两阶段抽样法，在马鞍山市三区一县抽取8个行政村1～59岁常住人口2038人，进行问卷调查，并采集静脉血，用ELISA法检测乙肝血清标志物。率的比较采用卡方检验。结果乙肝疫苗调查接种率为50．54％，城市高于农村，低年龄组（98．14％）到高年龄组（0．95％）逐渐降低，男性高于女性。散居和托幼儿童接种率最高（96．58％和98．77％），学生次之（87．17％），农民最低（4．26％）。1～59岁人群HBsAg阳性率从低年龄组到高年龄组逐渐增高（0％-10．48％），抗-HBs阳性率为14．58％-50．18％，15．岁组最低（14．58％）。1990--2007年间乙肝报告发病率以1999年最高，为67．0660／10万，之后呈逐年下降趋势。2005—2007年平均乙肝报告发病率在≤14岁的人群中低于4．6731／10万，在≥15岁的人群中高于32．0789／10万。乙肝血源疫苗接种后HBsAg和抗-HBs阳性率分别为0．98％和39．54％，与基因工程疫苗接种后阳性率（0．49％和43．28％）的差异无统计学意义（χ^2=0．107，P=0．744；χ^2=1．004，P=0．316）。结论应继续开展新生儿乙肝疫苗接种，推广成年人接种，并将预防乙肝资源向农村倾斜。

Objective To evaluate the effect of hepatitis B vaccination in healthy people and provide the basis for developing immunization strategy. Methods Two-stage sampling method was designed. A questionnaire survey was conducted among 2038 permanent residents aged 1-59 years old from 8 villages. Intravenous blood samples were taken and detected for hepatitis B virus serum markers by ELISA. Results The surveyed inoculation rate of hepatitis B vaccine was 50.54% , with the rate being higher in urban area than in rural area and being higher in men than in women. The vaccination rate decreased gradually from the youngest group （98. 14% ） to the oldest group （0.95%）. The scattered and nursery children had the highest rate （96.58% and 98.77% ）, followed by students （87.17%）, farmers had the lowest rate （4.26%）. HBsAg positive rates increased gradually from the youngest group to the oldest one （0%-10.48% ）. Anti-HBs positive rates were between 14.58% -50.18% ,with 15-year old group having the lowest rate （ 14.58% ）. The reported incidence rate of hepatitis B was the highest in 1999 （67. 0660/100 000） from 1990 to 2007, and showed a descending tendency since then. The average reported incidence rate was lower than 4. 6731/100 000 among age groups 14 years and under and was higher than 32. 0789/100 000 among age groups 15 years and above between 2005 and 2007. HBsAg and anti-HBs positive rates after vaccination with plasma-derived hepatitis B vaccine （0.98% and 39.54% ） had no statistical difference from those vaccinated with genetically engineered vaccine（0.49% and 43.28% ） （χ^2 =0. 107,P =0. 744; χ^2 = 1. 004,P =0. 316）. Conclusions We should continue hepatitis B vaccination for neonates, expand adult hepatitis B vaccination and allocate more resources of hepatitis B prevention to the rural.