广西灵山县2～6岁儿童乙肝疫苗免疫效果观察

Immune effect of hepatitis B vaccine among children aged 2-6 years old in Lingshan County, Guangxi

目的 了解广西灵山县2～6岁儿童乙肝疫苗免疫效果,为乙肝病毒(HBV)高流行区乙肝防控提供依据。方法 2016年12月,按照横断面调查研究原理,用整群抽样的方法选取灵山县2～6岁儿童为研究对象,采用问卷调查并采集静脉血3～5 mL,用酶联免疫吸附实验(ELISA)检测HBV血清学标记物。结果 调查了1 594名儿童,乙肝疫苗免疫覆盖率为100%;5岁以下儿童HBsAg标准化阳性率为0.17%(3/832,95%CI:-0.11～0.45);抗-HBs标准化阳性率为68.98%(95%CI:66.71～71.25);HBeAg和抗-HBe标准化阳性率分别为0.16%(95%CI:-0.04～0.36)和0.38%(95%CI:0.08～0.68);抗-HBc标准化阳性率为43.97%(95%CI:41.53～46.41)。不同年龄组间抗-HBs阳性率差异有统计学意义(P<0.001),且随着年龄增长而呈下降的趋势(P<0.001)。非条件多因素Logistic回归模型分析结果显示,年龄、城乡分布、低出生体重和分娩医院级别与抗-HBs阳性率有关,加强免疫与低龄儿童抗-HBs阳性率无关。3名HBsAg持续阳性儿童的母亲产检检测HBsAg阳性。结论 广西灵山县达到全国乙型病毒性肝炎防治规划的目标(<1%);已经完成乙肝疫苗全程基础免疫的学龄前儿童没必要进行乙肝疫苗加强免疫。

Objective To understand immune effect of hepatitis B vaccine among children aged 2-6in Lingshan County, Guangxi,to provide a basis for hepatitis B prevention and control in HBV highly endemic area.Methods A cross-sectional investigation was conducted in Lingshan in December,2016,children aged 2-6 years old were selected by cluster sampling,a questionnaire was conducted,3-5mL venous blood specimens were abstracted,serum was separated,then ELISA was used to detect serological markers of HBV.Results A total of 1594 children were investigated.Hepatitis B vaccine immunization coverage rate was 100%.The standard positive rate of HBsAg among children under 5years old was 0.17%(3/832,95%CI: -0.11-0.45).The standard positive rate of anti-HBs was 68.98%(95%CI:66.71-71.25).The standard positive rate of HBeAg and anti-HBe was 0.16%(95%CI:-0.04-0.36)and 0.38%(95%CI:0.08-0.68)respectively.The standard positive rate of anti- HBc was 43.97%(95%CI:41.53-46.41).The positive rate of anti-HBs among different ages was significantly different (P< 0.001)and decreased with age increased(P<0.001).Non-conditional multivariate logistic regression analysis showed that age, urban and rural area,low birth weight,birth hospital were associated with positive anti-HBs,while having booster vaccination history was not.Three children with HBsAg persistent positive were born to HBsAg positive mothers.Conclusion Lingshan County has reached the national goal for the control of HBV infection (<1%).Booster immunization was not necessary among preschool children who had finished basic immunization.