我国新生儿乙肝疫苗免疫后效应概述及相关问题

Protective efficacy against chronic hepatitis B virus infection after neonatal hepatitis B vaccination in China:A summary

我国开展新生儿乙肝疫苗免疫接种后,随着全程接种覆盖率和首针及时接种率的逐年提高,婴儿围产期和幼儿时期乙肝病毒(HBV)的传播得到有效阻断,城乡儿童慢性乙肝病毒表面抗原(HBsAg)流行率和HBV感染率持续下降,儿童和青少年乙肝和肝癌发病率降低.疫苗抗原的特异性免疫记忆与青少年人群中所存在的持久免疫力和长期免疫保护效果相关,免疫记忆反应与疫苗接种者早期的乙肝表面抗体(抗-HBs)滴度水平相关.我们通过对江苏启东地区新生儿乙肝疫苗接种者长期连续性的随访研究结果表明,接受了新生儿乙肝疫苗全程免疫注射者在20岁之前尚不需要进行普遍性的加强免疫.本文还对江苏启东等地区疫苗接种人群中出现的HBV母婴传播阻断失败、抗-HBs无/低应答、HBV隐匿性感染、HBV基因型及基因变异和单项HBV核心抗体(抗-HBc)阳性等问题进行了讨论.

Transmission of hepatitis B virus （HBV） during the perinatal period and in young children has been effectively prevented in recent years, with increased rates of coverage and timely immunization of hepatitis B vaccine to neonates in China's Mainland. Prevalence of HBV surface antigen （HBsAg） and chronic HBV infection in children have decreased both in rural and urban areas. The incidence of hepatitis B and primary hepatocellular carcinoma has also been reduced in children and young people. The effects of immunoprotection against HBV infection were found to last for at least 20 years. The presence of immune memory was associated with titers of antibody to HBV surface antigen （anti-HBs） in young children vaccinated at an early age. Results from our recent clinical investigation suggest that a universal booster immunization is not necessary for children and teenagers after neonatal vaccination. In this review, issues arising from representative vaccination--coverage areas, including Qidong, Jiangsu Province, are also discussed. These include irnmunoprophylaxis failure against vertical transmission, low or no response to the vaccines, isolated anti-HBc positivity, occult HBV infection after vaccination, and the effects of vaccination on HBV genotype and mutation.