杭州市儿童乙肝疫苗接种免疫应答定量分析及强化免疫年龄探讨

Quantitative analysis of immune responses to hepatitis B vaccination in children in Hangzhou and discussion on age of booster immunization

目的探讨0~14岁儿童乙肝疫苗加强针接种的适合年龄。方法回顾性研究。分析2015年1月至2021年10月在杭州师范大学附属医院行乙型肝炎病毒血清学标志物定量检测的3118例儿童的资料,年龄0~14岁,男1702例,女1416例,男女比例为1.20∶1.00。儿童按1岁为间距分为15个组别。采用化学发光微粒子免疫检测法定量检测乙型肝炎病毒表面抗体(Anti-HBs)滴度。应用χ^(2)检验比较不同性别、各年龄组的Anti-HBs阳性率,应用秩和检验比较不同性别、各年龄组乙肝免疫应答情况。结果共调查3118例儿童,Anti-HBs滴度及有效应答率随着年龄增长而逐渐降低,不同组别之间Anti-HBs滴度及有效应答率差异均有统计学意义(均P<0.01),而不同性别之间Anti-HBs滴度及有效应答率差异均无统计学意义(均P>0.05)。3岁以上儿童Anti-HBs滴度中位数为58.49 IU/L(0~1001.00 IU/L),59.1%(1477/2497例)的3岁以上儿童处于无免疫应答及低免疫应答状态(即Anti-HBs滴度低于100 IU/L)。结论在规范接种乙肝疫苗的儿童中,乙肝免疫保护效应逐年下降,3岁以上多数儿童保护效应不足,有必要对3岁以上的儿童开展乙肝疫苗的增强接种计划。

Objective To investigate the appropriate age for booster doses of hepatitis B vaccine in children aged 0-14.Methods Retrospective study.A total of 3118 children aged 0-14 years who underwent quantitative serological marker testing for hepatitis B virus at the Affiliated Hospital of Hangzhou Normal University from January 2015 to October 2021 were recruited in this analysis.There were 1702 males and 1416 females,with a male to female ratio of 1.20∶1.00.Children were divided into 15 groups according to their age,and the classifying interval was 1 year.The hepatitis B virus surface antibody(Anti-HBs)titer was quantified by chemiluminescent microparticle immunoassay.The Anti-HBs positivity rates and hepatitis B immune response among groups of different sexes and age were compared by the chi-square test and rank-sum test,respectively.Results A total of 3118 children were investigated.The titer and effective response rate of Anti-HBs decreased gradually with age.The difference in the titer and effective response rate of Anti-HBs was statistically significant among groups of different age(all P<0.01),but not significant between males and females(all P>0.05).The median titer of Anti-HBs in children aged above 3 years was 58.49 IU/L(0-1001.00 IU/L).About 59.1%(1477/2497 cases)of children aged 3 years and above had no immune response or low immune response(i.e.,the titer of Anti-HBs was below 100 IU/L).Conclusions The immune protective effect of the hepatitis B vaccine decreases year by year in children who have received the standardized vaccine,and the vaccine has poor protective effect on most children aged 3 years and above.Therefore,booster dose vaccination for preventing hepatitis B is necessary for children aged 3 and above.