张家界市提高乙型肝炎疫苗首针及时接种率策略研究  

Study on Strategy of Enhancing the Vaccivation Coverage Rate of Timely First Dose of Hepatitis B Vaccine in Zhangjiajie City

作　　者：林麒[1] 王贞明 陈长[3] 艾于勤[1] 付祖云 

机构地区：[1]张家界市疾病预防控制中心,湖南张家界427000 [2]桑植县疾病预防控制中心 [3]湖南省疾病预防控制中心

出　　处：《实用预防医学》2005年第3期540-542,共3页Practical Preventive Medicine

摘　　要：目的探讨研究边远贫困山区提高新生儿乙肝疫苗首针及时接种率的策略。方法2003年9月～2004年9月,将张家界市桑植县所有距离县城20km以上的32个乡(镇)随机分为三组,分别实施不同策略,即第一组用自毁型注射器、瓶装疫苗冷链内使用;第二组用自毁型注射器、瓶装疫苗冷链外使用;第三组用Uniject预充式乙肝疫苗冷链外使用。分别开展基线调查和终期调查,比较和评价不同策略对乙肝疫苗接种率的影响。在终期调查时,选择一个GAVI项目县开展对照调查。为了解乙肝疫苗冷链外免疫策略的安全性和有效性,开展血清学调查,并对各组之间的检测结果进行比较。结果在边远山区,由于采取了干预措施,不仅提高了乙肝疫苗全程接种率,而且首针及时接种率由7.5%提高到68.3%,并高于对照组32.3%的水平,尤其是第三组高达81.3%。对于住院分娩的儿童,不同策略对提高首针及时接种率影响不大,但对于在家出生的儿童,不同策略组之间的首针及时接种率则存在差异,以第三组最高,为68.3%,而同期对照组只有7.3%。血清学调查证明,抗体阳转率达90%以上,有89%以上的儿童产生了达到保护水平(≥10mlU/ml)的抗体,抗体滴度(GMT)在65～89mlU/ml之间,各组之间无差异。结论实行乙肝疫苗的冷链外存放、使用,是在交通不便、住院分娩率低的边远贫困山区提高乙肝疫苗首针及时接种率的有效策略之一,尤其是对在家出生儿童而言。而乙肝疫苗在冷链外存放、使用也是安全有效的。Objective To study the strategy about enhancing the vaccination coverage rate of timely first dose of Hepatitis B vaccine of newborns in the remote poverty mountain areas. Methods From September 2003 through September 2004, 32 towns in Zhangjiajie City Sangzhi County were randomly divided into three groups and treated with different strategies. The first group., AD injection machine, bottled vaccine, transport and storage in the cold- chain; the second group： AD injection machine, bottled vaccine, transport and storage out of the cold- chain; the third group： HB - Uniject, transport and storage out of the cold - chain. Through initial base - line and end point investigation, we compared and evaluated these three strategies. We selected a GAVI Project County as a control in end point investigation, in order to understand about the safety and the validity of out of cold - chain of Hepatitis B vaccine, we performed serological screen and simultaneously compared the test results of the three groups. Results After these intervention measures, not only the full course vaccination rate but also timely vaccination rate of first dose were increased in the remote mountain areas, and the latter was increased from 7. 5 % to 68.3 %. In these areas the vaccination coverage rates were higher than 32.3 % of the control and the third group even reached 81.3%. For babies born in hospital, different strategies had only a little influence on the rates of the first timely vaccination dose; but for babies born in home, there were signigicant difference. As the control group was only 7.3%, the third group reached 68.3 % which was the highest. The serological screen demonstrated that the rate of seroconversion reached 90%, more than 89% children had their antibody reached protection level （≥ 10 mlU/ml） and their geometric mean titer （GMT） was between 65-89 mlU/ml, no significantly difference was found among these 3 groups. Conclusion It is an effective method for taking out of the cold - chain to improve the vaccination co

关 键 词：边远山区 乙型肝炎疫苗 接种率 冷链 策略 

分 类 号：R186[医药卫生—流行病学]