乙肝病毒感染是全球性的健康问题。普遍的婴儿乙肝疫苗接种是非常有效的。虽然乙肝病毒感染在上述免疫人群中已经有报道。高发人群出生后被动主动乙肝疫苗接种的作用还没有研究。检测8733名1987年7月后出生的高中生的乙肝表面抗原和乙肝表面抗体。总体乙肝表面抗原和乙肝表面抗体阳性率分别为1.9% 和48.3%。乙肝免疫球蛋白接种者的乙肝表面抗体阳性率为15%。（校正后的OR值15.63；95%可信区间: 10.99-22.22）。在没有接受乙肝免疫球蛋白的学生中乙肝疫苗剂量与HBsAg阳性率存在显著负相关。剂量4、3和1-2校正后的OR值分别为1.00、1.52 (95% 可信区间: 0.91-2.53) 和2.85 (95% 可信区间: 1.39-5.81) 。在乙肝免疫球蛋白接种者中， HBsAg阳性率显著高于母亲乙肝e抗原阳性和没有按计划接种的人群。对1974名乙肝表面抗原和乙肝表面抗体均阴性的学生应用加强剂量的乙肝疫苗。对加强剂量之前和之后的血液样本分别检测乙肝表面抗体水平。应用加强剂量后的乙肝表面抗体滴度小于10 mIU/mL 的比例为27.9%。应用加强剂量前乙肝表面抗原滴度在1.0-9.9 mIU/mL的学生比滴度小于1.0 mIU/mL的学生具有更高的加强剂量后的乙肝表面抗体滴度。孕产妇HBeAg阳性是青少年接受出生后被动主动乙肝疫苗HBsAg 阳性最重要的决定因素。显著比例的完整疫苗接种可能会对HBsAg失去免疫记忆。

吉林大学第一医院肝胆胰内科 何芳慧 摘译
本文首次发表于[Hepatology.2012 Aug 1. doi: 10.1002/hep.25988]


 

Chronic hepatitis B infection in adolescents who had received primary infantile vaccination

Hepatitis B virus (HBV) infection is a global health issue. Universal infantile hepatitis B (HB) vaccination is very efficacious. However, HBV infections among those immunized subjects have been reported. The long-term efficacy of postnatal passive-active HB vaccination in high-risk subjects is not well explored.A total of 8733 senior high school students who were born after July 1987 were assayed for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). The overall HBsAg and anti-HBs positive rates were 1.9% and 48.3%, respectively. The HBsAg positive rate was 15% in HB immunoglobulin (HBIG) recipients (adjusted odds ratio [OR]: 15.63; 95% confidence interval [CI]: 10.99-22.22). Among students who didn't receive HBIG, there was a significantly negative association between HB vaccination dosage and HBsAg positive rate (p for trend=0.011). Adjusted ORs for those who received 4, 3 and 1-to-2 doses were 1.00, 1.52 (95% CI: 0.91-2.53) and 2.85 (95% CI: 1.39-5.81) respectively. Among HBIG recipients, HBsAg positive rate was significantly higher in subjects with maternal hepatitis B e antigen (HBeAg) positivity and who received HBIG off-schedule. A booster dose of HB vaccination was administered to 1974 HBsAg- and anti-HBs-negative subjects. A prebooster and a postbooster blood samples were drown for anti-HBs quantification. The proportions of postbooster anti-HBs titer <10 mIU/mL was 27.9%. Subjects with prebooster anti-HBs titers of 1.0-9.9 mIU/mL had significantly higher postbooster anti-HBs titers than those with prebooster anti-HBs titers of <1.0 mIU/mL (p<0.0001). Having maternal HBeAg positivity is the most important determinant for HBsAg positivity in adolescent who had received postnatal passive-active HB vaccination.A significant proportion of complete vaccinees may have lost their immunological memories against HBsAg.

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