血源性乙肝疫苗远期免疫效果研究

Study on the Long-term Effectiveness of Plasma-derived Hepatitis B Vaccine Immunization

[目的]通过评价新生儿血源性乙肝疫苗免疫后的远期保护效果,为进一步完善乙肝免疫预防策略提供依据。[方法]采用三层抽样方法,从上海市2个区1986—1996年出生的有全程血源性乙肝疫苗接种史的人群中抽取2692人作为调查对象,按免疫后不同时间分11个组,进行问卷调查,并采集静脉血进行乙肝表面抗体(anti-HBs)定量、乙肝表面抗原(HBsAg)与乙肝核心抗体(anti-HBc)检测。[结果]HBsAg阳性率平均为1.75%,未见随年龄增加而上升的趋势。anti-HBc阳性率平均为3.64%,呈随年龄增长而上升趋势。anti-HBs阳性率平均为40.16%;18岁以下青少年anti-HBs阳性率随年龄增长而下降,19岁以上者anti-HBs阳性率随年龄增长而上升。15～19岁组人群anti-HBs阴性率最高(66.80%)。多因素分析显示母亲孕期乙肝e抗原(HBeAg)阳性、家庭成员HBsAg阳性、男性、年龄增大是青少年感染乙肝的危险因素。[结论]血源性乙肝疫苗具有较持久的保护效果。建议开展15岁以上人群的定期随访,对anti-HBs阴性者需加强免疫。

[ Objective ] To evaluate the long-term protective effectiveness of plasma-derived hepatitis B vaccine on neonates, and to provide scientific basis for perfecting the hepatitis B immunization strategy. [ Methods ] Using a three tier sampling strategy, 2692 adolescents born in 1986-1996 in 6 neighborhoods of 2 districts, who were vaccinated with 3 dosages of plasma-derived hepatitis B vaccines after birth, were selected as subjects of the study. They were divided into 11 groups according to the calendar year of vaccinating time. Questionnaires were made and blood samples were collected to test hepatitis B surface antibody （anti-HBs）, hepatitis B surface antigen （HbsAg） and hepatitis B core antibody （anti-HBc）. [ Results ] The average positive rate of HBsAg was 1.75% and did not show an uptrend with the increasing of age. The average positive rate of anti-HBc was 3.64%, and showed a rising tendency along with the increasing of age. The average positive rate of anti-HBs was 40.16%, and that of the adolescents below 18 years old decreased along with the increasing of age; however, that of the adolescents above 19 increased along with the increasing of age. The negative rate of anti-HBs of the 15-19-year olds was the highest （66.80%）. The multivariate logistic regression showed that being infected with hepatitis B e antigen （HBeAg） during pregnancy, family members of HBsAg carrier, gender, and age were the risk factors of hepatitis B virus infection of adolescents. [ Conclusion ] Plasma-derived hepatitis B vaccine has persistent protective effects. It is suggested that the follow-up of people above 15 years old should be strengthened, and people with negative anti-HBs should accept the booster immunization in addition.