中国成年人乙型肝炎疫苗免疫策略的循证与思考

Immunization strategy of hepatitis B vaccine among adults in China：evidence based-medicine and consideration

随着儿童乙型肝炎病毒（HBV）感染得到有效控制，成年人特别是青壮年已成为中国HBV新发感染的主要人群。目前中国成年人乙型肝炎疫苗（HepB）接种主要采取自费、自愿的原则，人群接种率不高。健康成年人接种HepB具有良好的免疫效果；HIV感染者、静脉吸毒者、慢性肝病患者等高危人群接种HepB的安全性已被证实，但其免疫效果低于健康成年人。目前许多国家推荐高危人群接种HepB，且取得了一定效果。加强成年人接种HepB后长期效果观察和特殊人群HepB免疫效果观察等相关研究，开展不同策略成年人HepB免疫经济学评价，完善中国成年人乙型肝炎免疫预防策略，已成为加快中国乙型肝炎控制工作的当务之急。

With the effective control of hepatitis B infection among children, the adults especial the young ones become the main population for new hepatitis B virus infection. Now the adults receive hepatitis B vaccination voluntarily and at their own expense in China and the coverage is low. The high immunogenicity of hepatitis B vaccine has been proven among healthy adults. Although the safety of hepatitis B vaccination has been documented among high-risk population such as HIV-infected people, injecting drug users and patients with chronic hepatitis disease, their antibody seroconversion rate after hepatitis B vaccination is lower than the healthy adults. Hepatitis B vaccination is recommended to population at high risk officially in many countries and some effects have been achieved. It is urgent to improve the strategy of hepatitis B vaccination among adults to fasten the control of hepatitis B in China, along with the researches about the long-term efficacy of hepatitis B vaccine among adults, the immunogenicity of hepatitis B vaccination among high-risk adults and the economical evaluation about different adult immunization strategy of hepatitis B.