病毒学报

在上海、广东、湖南、河北四省市试点区200万人口中,每年用乙型肝炎血源疫苗免疫新生儿3万人。四省市四年平均接种率为91％～95％。除上海地区对HBsAg阳性母亲的新生儿的免疫剂量为20μg×3外,其余地区大多来用10μg×3。免疫后1至2年和3至4年期间两次考核免疫效果。免疫后3～4年检检测省市HBsAg阳性率平均为1.78％,同免疫前本底对照的16.2％相比,下降88.98％(82.68％～92.71％)。上海4岁婴儿HBsAg阳性率降至0.98％,比免疫前本底对照的9.38％降低89.57％。四年后抗HBs阳性率在67.8％～81.6％之间。本项研究表明,新生儿血源乙型肝炎疫苗普遍免疫的效果极佳。如普遍使用10μg剂量,HBsAg阳性率可从10％下降至2％～3％左右。结合其它研究结果,如对HBsAg阳性孕妇的新生儿首剂使用30μg免疫,或加用HBIg,则新一代人HBsAg阳性率将降至1％以下。

A demonstration project of immunization of all neonates with 10μg or 20μg dose hepatitis B vaccine was carried out in four provinces in China with two millions population. Thirty thousand neonates were vaccinated each year, three doses of vaccine were given, first at birth and the 2nd and 3rd at 1 and 6 months respectively. The vaccination coverage ranged between 91-95%. Examination of 3,920 sera detected a HBsAg positves rate of 1.76% among the vaccinated babies at 1-2 years and 1.78 at 3-4 years of age, compared to 10.32% and 16.20% respectively of the historical baseline. The effectiveness was estimated to be 82.99% ( 77.09-91.39% ) and 88.98% ( 82.68-92.71% ) respectively. The anti-HBs positivity rate at 3-4 years of age in the four provinces ranged between 67.8%-81.6%. When all infants are given three 10μg doses of the vaccine, the HBsAg positivity rate can be reduced to about 2-3%. On the basis of the result of other studies, if the first vaccine dose is increased to 30μg or given in combination with HBIg for babies born to HBsAg carrier mothers,the chronic HBV carrier rate can be reduced to lower than 1%.