小儿乙肝疫苗接种失败原因调查及补救措施

Investigation into Causes and Remedial Measures for Inoculation Failure of Hepatitis B Virus-Vaccine in Children

目的分析小儿乙肝疫苗接种后免疫失败比例、原因及补救措施。方法选择2007年1月-2008年7月在本院儿科就诊的符合入选条件的儿童1 360例,其中抗-HBs阴性或抗-HBs滴度在0～10 IU/L的免疫失败儿童286例。将286名儿童随机分为5组:A组:单纯增加免疫次数,即再接种3次重组(酵母)乙肝疫苗,剂量为10μg/次;B组:再接种3次,但剂量加倍,即20μg/次;C组:除再接种3次外,同时联合应用免疫调节剂;D组:再接种3次,但改用(CHO细胞)乙肝疫苗;E组为对照组,不予再次免疫。A、B、C、D 4组均按0、1、2个月程序接种。结果小儿乙肝疫苗接种后免疫失败率为21.03%,引起接种失败的原因有免疫功能低下[218例(76.22%)],反复呼吸道感染[192例(67.13%)],滥用激素[140例(48.95%)],锌缺乏[129例(45.10%)],贫血[108例(37.76%)],被动吸烟[80例(27.97%)],母亲为慢性乙肝或HBV携带者[63例(22.03%)],早产[54例(18.88%)],肥胖[38例(13.29%)],营养不良[29例(10.14%)]。再免疫后,A、B、C、D组抗-HBs阳转率分别为90.00%、96.47%、99.08%、95.83%,C组阳转率最高,与其他3组比较均有统计学差异(Pa<0.05)。结论通过免疫疗法、补锌、补铁、合理应用糖皮质激素、产前产后联合阻断母婴传播、合理喂养、规劝父母戒烟等措施后,针对个体制定复种计划,以达到高水平复种成功率,使本地区乙肝发病率降至最低水平。

Objective To analyze the failure ratio and the causes of the inoculation failure of hepatitis B virus （HBV） - vaccine in chil- dren and relevant the remedial measures. Methods One thousand three hundred and sixty cases treated in Suzhou Wuzhong people＇s hospital during Jan. 2007 to Ju]. 2008 were chosen,of whom 286 children from 1 -5 years old to be anti - HBs negative or anti - HBs titre to be 0 - 10 IU/L were screened, and specific failure reasons for the vaecination were analyzed, also the timely treatment measures were taken. Then 286 children were divided into 5 groups randomly. Apart from one group was set up as blank control,the other 4 groups were arranged to accept different immunization methods with 0,1,2 month schedule, group A simply got revaccinated with HB vaccine（ 10 μg） 3 times;group B revac- einated with double dosage of HB vaccine （20 μg） 3 times;group C besides being revaeeinated 3 times,the immune regulatory agent was jointly used;group D revaecinated 3 times with genetically engineered CHO hepatitis B vaccine. Results The ratio of failure of HBV - vac- cine was 21.03% ,what caused failure of hepatitis B vaccine included immunologic inadequacy 218（76.22% ） ,repeated respiratory infection 192 cases（67.13% ）,abuse hormone 140 eases（48.95% ）, zinc deficiency 129 eases（45.10% ）, anaemia 108 eases（37.76% ）,passive smoking 80 eases（27.97% ）, the mother being chronic parenehymatous nephritis or HBV carrier 63 cases（22.03% ）,premature 54 cases （ 18.88% ）, adiposity 38 cases（ 13.29% ） ,dystrophy 29 cases（10.14% ）. There were 4 methods of revaecination, the positive rate for group A, B, C, D were 90.00% ,96.47% ,99.08% ,95.83 % ,respectively. Group C had the highest positive rate,compared with the other 3 groups, which were statistically significant（P 〈0.05）. Conclusions The following measures can be used firstly：immunization therapy,zinc supple- mentation,iron supplementation,reasonable use of glucocortieoid, prenatal and postnatal period interrupting HBV maternal -infant transmis- sion, reasonable feeding, admonish parents to quit smoking, then make the individual HBV - vaccine revaccination plan to increase the success rate of the HBV inoculation,and low down the incidence of hepatitis B in the local area.