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目的评价广西隆安县乙肝血源疫苗长期免疫效果,为乙肝疫苗加强免疫策略提供依据。方法在广西隆安县开展横断面调查,采用多阶段抽样方法选取766名1987—1989年出生,并于出生72 h内全程接种乙肝血源疫苗者作为研究对象。采集血清标本用微粒子酶免疫法(microparticle enzyme immunoassay,MEIA)检测乙肝表面抗原(hepatitis B surface antigen,HBs Ag),抗乙肝病毒表面抗原抗体(antibody to HBs Ag,Anti-HBs),抗乙肝病毒核心抗原抗体(antibody to HBV core antigen,Anti-HBc)。结果 766名研究对象中,HBs Ag携带率为4.96%,首针不及时接种组(10.42%)显著高于及时接种组HBs Ag阳性率(4.60%)(P<0.05)。首针及时接种的718例研究对象中,HBs Ag和Anti-HBc阳性率分别为4.60%(95%CI:3.29~6.38)和22.42%(95%CI:19.52~25.62)。Anti-HBs阳性率为21.59%(95%CI:18.73~24.74)。Anti-HBs阳性者抗体几何平均浓度(geometric mean concentration,GMC)为98.39 m IU/m L(95%CI:60.87~135.91),单独Anti-HBs阳性者平均GMC为47.34 m IU/m L(95%CI:40.58~54.10),随着免疫年限延长呈下降趋势。GMC<10 m IU/m L组随着免疫年限延长构成比呈上升趋势,而100~999.99 m IU/m L组构成比呈下降趋势。首针及时接种乙肝血源疫苗保护率为74.30%。结论乙肝血源疫苗免疫后26~28年抗体水平已降至较低水平,疫苗保护HBV感染和发病的效果已显著下降。建议继续提高新生儿乙肝疫苗首针接种及时率,对Anti-HBs阴性(GMC<10 m IU/m L)且未感染HBV者应进行乙肝疫苗加强免疫。
Objective To evaluate the long-term immunization efficacy of Hepatitis B blood-borne vaccine in Long’an County, Guangxi Province, and to provide basis for strengthening the immunization strategy of Hepatitis B vaccine. Methods A cross-sectional investigation was conducted in Long’an County, Guangxi. A total of 766 newborns from 1987 to 1989 were selected by multistage sampling and were vaccinated with whole blood serum of hepatitis B within 72 hours after birth. Serum samples were collected for the detection of hepatitis B surface antigen (HBsAg), anti-HBsAg (Anti-HBs), anti-HBV core by microparticle enzyme immunoassay (MEIA) Antibody to HBV core antigen (Anti-HBc). Results Among 766 subjects, the HBs Ag carrier rate was 4.96%, and the first-dose needle inoculation group (10.42%) was significantly higher than that of the timely vaccination group (4.60%, P <0.05). The positive rates of HBs Ag and Anti-HBc were 4.60% (95% CI: 3.29 ~ 6.38) and 22.42% (95% CI: 19.52 ~ 25.62) respectively in 718 subjects who were vaccinated in time. The positive rate of Anti-HBs was 21.59% (95% CI: 18.73-24.74). The geometric mean concentration (GMC) of anti-HBs positive antibody was 98.39 m IU / m L (95% CI: 60.87-135.91), and the average GMC of Anti-HBs positive individuals was 47.34 m IU / m L % CI: 40.58 ~ 54.10) showed a downward trend with the extension of immunization years. The proportion of GMC <10 m IU / m L group increased with the extension of the immunization time, while the composition ratio of 100 ~ 999.99 m IU / m L group showed a decreasing trend. The first needle timely vaccination Hepatitis B vaccine protection rate was 74.30%. Conclusion The antibody level of Hepatitis B vaccine decreased to a lower level in 26-28 years after vaccination, and the effect of vaccine on HBV infection and incidence has been significantly reduced. Proposed to continue to improve the first-dose neonatal hepatitis B vaccination timely rate, anti-HBs negative (GMC <10 mIU / m L) and should not be infected with hepatitis B should be boosted with hepatitis B vaccine.