学龄前儿童乙型肝炎疫苗无应答者HBV感染风险的前瞻性队列研究  

A prospective cohort study on the risk of HBV infection in preschool children without immune response to hepatitis B vaccine

作　　者：黄荟森 韦娜 蓝梅丹 岑祚洁 蒙婞婞 蒋金泰 杨路[1] 谢志春[1] HUANG Hui-sen;WEI Na;LAN Mei-dan;CEN Zuo-jie;MENG Xing-xing;JIANG Jin-tai;YANG Lu;XIE Zhi-chun(Department of EpidemioIogy,School of Public Health,Guangxi Medical University,Nanning 530021, China;Department of Infectious Disease Control and Prevntion,Jiangnan District Center for Disease Prevention and Control,Nanning 530031,China;Department of Public Health,Tingzi Health Center,Jiangnan District,Nanning 530031,China)

机构地区：[1]广西医科大学公共卫生学院流行病学教研室,南宁530021 [2]广西南宁市江南区疾病预防控制中心传染病防制科,南宁530031 [3]广西南宁市江南区亭子卫生院公共卫生科,南宁530031

出　　处：《中华疾病控制杂志》2019年第1期15-18,共4页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81460512)~~

摘　　要：目的评估学龄前儿童乙肝疫苗无应答者未来感染乙肝病毒(hepatitis B virus,HBV)的风险。方法采用前瞻性队列研究的方法,选取南宁市江南区64家幼儿园内、已经按照0、1、6程序全程接种了三针乙肝疫苗的2～5岁儿童,在2015年3～5月期间抽血检测乙肝病毒表面抗原(hepatitis B surface antigen,HBs Ag)和乙肝病毒表面抗体(hepatitis B surface antibody,抗-HBs),HBs Ag阴性儿童为本次研究对象。根据儿童抗-HBs是否阳性,分成暴露组(抗-HBs阴性)和对照组(抗-HBs阳性)。研究开始于2015年6月1日,结束于2016年6月1日,在2016年6月1～30日对儿童进行随访检测血清HBs Ag阳性率,比较两个组的HBs Ag阳性率。结果纳入队列的无应答组人数1 907名,排除随访期间再次接种乙肝疫苗的83人,该队列人数实际为1 824,研究结束时失访151人,实际随访到的人数是1 673人,期间共有5名小孩HBs Ag转成阳性,感染率为0. 30%(5/1673);纳入队列的应答组人数2 054名,研究结束时失访140人,随访到人数为1914,他们均未检测出HBs Ag;研究结束时无应答组HBs Ag阳性率高于应答组(P=0. 023)。结论乙肝疫苗无应答者未来存在感染HBV的风险。Objective To evaluate the risk of hepatitis B virus( HBV) infection among preschool children who were the non-responders to hepatitis B vaccine in future. Methods A prospective cohort study was conducted. Children aged 2 to 5 years were selected from 64 kindergartens. These children were inoculated three doses of hepatitis b vaccine at 0,1 and 6 months after birth. Hepatitis B surface antigen( HBs Ag) and Hepatitis B surface antibody( anti-HBs) were detected during the period from March to May2015. The children who were HBs Ag negative were enrolled in the study. The subjects were divided into exposure group( anti-HBs negative) and control group( anti-HBs positive). The follow-up began on June 1,2015 and ended on June 1,2016. Serum HBs Ag of children in the cohort was then collected and detected from June 1 to 30,2016. At the end of the study,the HBs Ag positive rates between two groups were compared. Results 83 children who received hepatitis B vaccine again during the follow-up period were excluded from 1 907 non-responders. The actual number in non-responders group was 1 824. 151 children were lost at the end of the study. The actual number of follow-up was 1 673 and 5 children were found to be positive for HBs Ag and the infection rate was 0. 30%( 5/1673). In the respondent goup,2 054 were enrolled and followed. Finally,140 children were lost and none of the remaining 1 914 people were HBs Ag positive at the end of the study. HBsAg positive rate was higher in the non-responder group than in the responder group( P = 0. 023). Conclusion There is a risk of HBV infection in the children who are non-responders to hepatitis B vaccine in future.

关 键 词：乙肝疫苗 免疫无应答者 前瞻性队列研究 HBSAG阳性率 

分 类 号：R181.23[医药卫生—流行病学]