2020—2022年北京市通州区乙型肝炎病毒暴露儿童免疫后血清学检测影响因素分析

Analysis of influencing factors of post-vaccination serologic testing in children exposed to hepatitis B virus in Tongzhou District,Beijing from 2020 to 2022

【目的】探讨乙型肝炎病毒(HBV)暴露儿童免疫后血清学检测(PVST)的重要性,并分析影响PVST进展的因素。【方法】以2020年1月1日—2022年3月31日在北京市各助产机构分娩且居住在北京市通州区的乙型肝炎表面抗原(HBsAg)阳性产妇及其所生活产儿为研究对象,由助产机构和社区卫生服务中心于儿童接种完3针乙型肝炎疫苗(HepB)后1~2个月进行随访。【结果】北京市通州区新生儿乙型肝炎免疫球蛋白(HBIg)接种率为100.00%(800/800),PVST成功随访率为85.88%(687/800),初次免疫无应答率为0.29%(2/687),但重新免疫后均成功。乙型肝炎母婴传播率为0。未进行PVST的儿童占14.13%(113/800),主要原因有受新型冠状病毒感染(COVID⁃19)疫情影响推迟检测;家长觉得幼儿年龄过小,拒绝静脉采血;幼儿跟随父母迁回原籍导致失访。logistic回归分析显示,高危儿(OR=30.009,P=0.001)、家庭居住北京(OR=2.218,P=0.002)和母亲<35岁(OR=1.687,P=0.020)的HBV暴露儿童PVST比例更高。【结论】PVST对于评估新生儿接种HepB后的HBV免疫应答状态是必要的。COVID⁃19疫情下,HBV暴露儿童PVST受影响。加强非高危儿、居住北京外、母亲≥35岁HBV暴露儿童管理,可能会提高通州区PVST率。

[Objective]To explore the importance of post-vaccination serological testing(PVST)for children exposed to hepatitis B virus(HBV),and analyze the factors affecting the progress of PVST.[Methods]The study focused on hepatitis B surface antigen(HBsAg)-positive pregnant women and their newborns residing in Tongzhou District,Beijing,who delivered at various obstetric institutions from January 1,2020 to March 31,2022.The obstetric institutions and community health service centers conducted follow-up visits 1 to 2 months after the children had received three doses of the hepatitis B vaccine(HepB).[Results]The vaccination rate of hepatitis B immunoglobulin(HBIg)was 100.00%(800/800),with a successful PVST follow-up rate of 85.88%(687/800)in Tongzhou District.The initial non-response rate to immunization was 0.29%(2/687),but successful immunization was achieved after re-immunization.The mother-to-infant transmission rate of hepatitis B was 0.Children who did not undergo PVST accounted for 14.13%(113/800),with the main reasons being delays due to the COVID-19 pandemic,parents’reluctance to allow venous blood collection due to the young age of the children,and loss to follow-up because children moved back to their parents’place of origin.Logistic regression analysis showed that the proportion of PVST was higher among high-risk children(OR=30.009,P=0.001),children with family residing in Beijing(OR=2.218,P=0.002),and children whose mothers were<35 years old(OR=1.687,P=0.020).[Conclusion]PVST is necessary for assessing the status of HBV immune response in newborns after vaccination with HepB.The COVID-19 pandemic impacted the implementation of PVST for children exposed to HBV.Strengthening the management of non-high-risk children,those living outside Beijing,and children with mothers aged≥35 years old may increase the rate of PVST in Tongzhou District.