厦门市学龄前儿童乙肝疫苗免疫状况
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摘要
目的分析学龄前儿童乙肝疫苗免疫应答状况,为探索儿童乙肝疫苗无/低应答的再免策略提供依据。方法选取2016年1月—2017年12月在厦门市妇幼保健院儿保门诊体检的7岁以下儿童2 812名,依据乙型肝炎病毒表面抗体(抗-HBs)的定量检测结果,将儿童乙肝疫苗免疫应答情况分为无应答组、低应答组、高应答组3组,对乙肝疫苗免疫应答状况进行统计分析。结果 7岁以下儿童乙肝疫苗免疫无应答率为24.2%;随年龄增加,无应答率逐渐上升、低应答率和高应答率逐渐下降,除>1～2岁组及>6～7岁组与相邻的上一年龄段无应答率差异无统计学意义(χ2值分别为0.10,0.07,P值均>0.05),其余各组与相邻上一年龄组无应答率差异均有统计学意义(P值均<0.05);在1～3岁间,抗-HBs浓度下降幅度最大,中位数从1岁时925.3 m IU/m L下降至3岁时的63.1 m IU/m L。男童无/低应答率分别为23.3%,36.1%,女童无/低应答率分别为25.4%,36.5%,差异无统计学意义(P值均>0.05)。结论在儿童乙肝疫苗免疫2年后,抗体效价随年龄的增加而下降,无应答率也逐年上升,导致感染风险增加。建议以2年为周期对儿童进行抗体检测,及时做好强化免疫。
Objective To explore the prevalence of hepatitis B vaccine immune response in preschool children,and to provide basis for exploring the re-immunization strategies for non-/hypo-response to hepatitis B vaccine in children. Methods A total of 2 812 children under 7 years old who received physical examination in outpatient department of Xiamen Maternal and Child Health Hospital from January 2016 to December 2017 were selected as the study subjects. Based on the concentration of antibody against hepatitis B surface antigen( anti-HBs),all the children were divided into non-response group,low-response group and highresponse group. Results The non-response rate among children who were under 7 years was 24.2%. With age increasing,the rate of non-response gradually increased,and the rates of low-response and high-response gradually decreased. Non-response rate was positively correlated with age. There were significant differences in the response rate among different age groups( P<0.05) expect the 1-2 years old and 6-7 years old group( χ2= 0.10,0.07,P>0.05). The non-response rate of the boy was 23.3%,the low response rate was 36.1%.The non-response rate of the girl was 25.4%,the low response rate was 36.5%; the girl's no/low response rate was higher than that of the boy,but no significant differences between male and female( P<0.05). Conclusion Two years after vaccination,anti-HBs concentration of these children declined with age,while non-response rate increased gradually. Antibody detection cycle should be recommended to children every 2 years,and strengthen the immune system timely.
Objective To explore the prevalence of hepatitis B vaccine immune response in preschool children,and to provide basis for exploring the re-immunization strategies for non-/hypo-response to hepatitis B vaccine in children. Methods A total of 2 812 children under 7 years old who received physical examination in outpatient department of Xiamen Maternal and Child Health Hospital from January 2016 to December 2017 were selected as the study subjects. Based on the concentration of antibody against hepatitis B surface antigen( anti-HBs),all the children were divided into non-response group,low-response group and highresponse group. Results The non-response rate among children who were under 7 years was 24.2%. With age increasing,the rate of non-response gradually increased,and the rates of low-response and high-response gradually decreased. Non-response rate was positively correlated with age. There were significant differences in the response rate among different age groups( P<0.05) expect the 1-2 years old and 6-7 years old group( χ2= 0.10,0.07,P>0.05). The non-response rate of the boy was 23.3%,the low response rate was 36.1%.The non-response rate of the girl was 25.4%,the low response rate was 36.5%; the girl's no/low response rate was higher than that of the boy,but no significant differences between male and female( P<0.05). Conclusion Two years after vaccination,anti-HBs concentration of these children declined with age,while non-response rate increased gradually. Antibody detection cycle should be recommended to children every 2 years,and strengthen the immune system timely.
引文
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[12]SHI X,BI Y,YANG W,et al.Ca2+regulates T-cell receptor activation by modulating the charge property of lipids[J].Nature,2013,493(7430):111-115.
[13]张爱平,蒲秀君,肖刚.1412名免费乙肝疫苗接种幼儿免疫效果观察及相关分析[J].现代预防医学,2010,37(8):1449-1450.
[14]陈华,段晋超,邓建军,等.15岁及以下儿童乙肝疫苗免疫效果分析[J].免疫学杂志,2013,29(11):1010-1012.
[15]陈永弟,姚军,梁晓峰,等.儿童甲乙型肝炎联合疫苗加强免疫效果评价[J].中国预防医学杂志,2012,13(4):256-259.
[16]LU S,REN J,LI Q,et al.Effects of hepatitis B vaccine boosters on anti-HBs-negative children after primary immunization[J].Human Vacc Immun,2016,13(4):903-908.
[2]ISOLANI A P,SVERSUTI C S,SELL A M,et al.Protection against hepatitis B by the Butang recombinant vaccine in newborn children in South Brazil[J].Mem Do Instituto Oswaldo Cruz,2006,101(5):551-553.
[3]SU F H,CHENG S H,LI C Y,et al.Hepatitis B seroprevalence and anamnestic response amongst Taiwanese young adults with full vaccination in infancy,20 years subsequent to national hepatitis B vaccination[J].Vaccine,2007,25(47):8085-8090.
[4]王存祯,邢秀生,王晓芳,等.重组乙型肝炎疫苗(酿酒酵母)免疫后15年的持久性效果研究[J].中国疫苗和免疫,2013,19(2):147-149.
[5]YAO J,SHAN H,CHEN Y,et al.The one year effects of three doses of hepatitis B vaccine as a booster in anti-HBs-negative children 11-15 years after primary immunization;China,2009-2011[J].Human Vacc,2015,11(5):1114-1119.
[6]梁争论,李河民,张华远.基因工程乙型肝炎疫苗免疫原性和免疫效果的评价[J].中华微生物学和免疫学杂志,2003,9(23):663-665.
[7]叶小霞,陈慧,叶逢梅.2013年北海市学龄前儿童乙肝疫苗接种免疫效果分析[J].应用预防医学,2014,20(5):284-285.
[8]雷仁宇,罗耀星,谢莘,等.珠江三角洲地区16岁儿童乙型肝炎病毒表面抗原和抗体现状调查分析[J].中国计划免疫,2006,12(2):112-114.
[9]林小碧,王小梅,留佩宁,等.3022例儿童乙型肝炎表面抗体检测结果分析[J].中国当代儿科杂志,2012,14(7):536-538.
[10]侯莹.乙肝疫苗接种后无/低应答原因分析及加强对策的进展[J].医学理论与实践,2017,30(8):1123-1124,1127.
[11]KO S C,SCHILLIE S F,WALKER T,et al.Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women[J].Vaccine,2014,32(18):2127-2133.
[12]SHI X,BI Y,YANG W,et al.Ca2+regulates T-cell receptor activation by modulating the charge property of lipids[J].Nature,2013,493(7430):111-115.
[13]张爱平,蒲秀君,肖刚.1412名免费乙肝疫苗接种幼儿免疫效果观察及相关分析[J].现代预防医学,2010,37(8):1449-1450.
[14]陈华,段晋超,邓建军,等.15岁及以下儿童乙肝疫苗免疫效果分析[J].免疫学杂志,2013,29(11):1010-1012.
[15]陈永弟,姚军,梁晓峰,等.儿童甲乙型肝炎联合疫苗加强免疫效果评价[J].中国预防医学杂志,2012,13(4):256-259.
[16]LU S,REN J,LI Q,et al.Effects of hepatitis B vaccine boosters on anti-HBs-negative children after primary immunization[J].Human Vacc Immun,2016,13(4):903-908.