新生儿接种乙肝疫苗后无(低)应答率及再免效果分析

Evaluation of non-and low-response after hepatitis B vaccination in infants and the effect of re-vaccination

目的了解新生儿接种乙肝疫苗后无(低)应答率,评价无(低)应答儿童再接种乙肝疫苗后免疫效果。方法在深圳市南山区、东莞市预防接种门诊按0、1、6月龄免疫程序接种5μg重组酵母乙肝疫苗后1～6个月的婴儿中,随机选择1913名作为研究对象,问卷调查儿童性别、出生体重、是否早产、母亲乙肝感染状况、乙肝疫苗接种史等,并采集其血清,用放射免疫法检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)、乙肝病毒核心抗体(抗-HBc)。选择以上研究对象中无(低)应答的109名儿童分别用10μg汉逊酵母乙肝疫苗和10μg CHO重组乙肝疫苗按0、1、6月程序再免疫,接种3针后1个月再检测抗-HBs。结果1913名新生儿接种乙肝疫苗后无(低)应答率为31.42%,其中无应答率为3.24%,低应答率为28.18%。母亲HBsAg阳性或HBeAg阳性的新生儿无应答率为7.47%、18.37%,分别高于母亲阴性的新生儿(3.04%、3.05%)(均P<0.01),低体重儿的无应答率(8.06%)高于非低体重儿(3.12%)(P<0.05),母亲HBeAg阳性的新生儿抗-HBs滴度明显低于母亲阴性的新生儿(P<0.05)。无(低)应答的儿童接种10μg CHO重组乙肝疫苗、10μg汉逊酵母乙肝疫苗后再免成功率分别为83.08%(54/65)、88.64%(39/44)(P>0.05),抗-HBs平均滴度分别为225.56、209.23m IU/mL(P>0.05)。结论新生儿出生体重偏低、母亲乙肝感染状况可能影响新生儿接种乙肝疫苗的应答率,对无(低)应答的儿童进行再免疫3针乙肝疫苗效果良好。

Objective To evaluate the non- and low - response after hepatitis B vaccination in infants and the effect of re - vaccination. Methods 1 913 infants vaccinated with 3 doses of 5 μg hepatitis B vaccines by 0, 1,6 months schedule were selected. The HB seromarks （ HBsAg, anti - HBs and anti - HBc） were detected by RIA. 109 non - and low - responders were re - vaccinated by 3 doses of hepatitis B vaccine （ 10μg/dose） and CHO hepatitis B vaccine （ 10μg/dose） at 0, 1,6 months,respectively. Anti - HBs was tested 1 month after the last dose. Results The rates of non - response, low - response and non - and low - response were 3.24%, 28. 18% and 31.42% in 1 913 infants, respectively. The non - response rate was significantly higher in infants with low birth weight （ 8.06% ） than that in infants with normal birth weight （3.12%） （ P 〈 0. 05） ; the non - response rates in infants of mothers with HBsAg or HBeAg positive （7.47% and 18.37% respectively） higher than that of mothers with HBsAg or HBeAg negative（3.04% and 3.05% ） （both P 〈0. 01 ）. The level of anti- HBs titers was lower in infants of mothers with HBeAg positive. After re - vaccination of 3 doses of hepatitis B vaccine the seroconversion rate was 85.32% （93/109） and the level of anti - HBs titers was 218.97 mIU/mL. Conclusion It confirmed that low birth weight and mother with hepatitis B infection were important variables in determining non - response rate after hepatitis B vaccination in infants. The effect of re - vaccinating hepatitis B to non and low - responder was satisfied.