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山东省儿童突破性乙型肝炎病毒感染发生率及原因初步分析
作者:张丽 颜丙玉 李漫时 宋立志 吕静静 许青 徐爱强
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摘要:

   目的了解山东省新生儿普种乙肝疫苗以来儿童中突破性乙肝病毒(hepatitis B virus, HBV)感染发生率及可能原因。 方法选取2006年山东省乙肝血清学调查中1~15岁(1992—2005年出生)且明确完成3剂次及以上乙肝疫苗免疫的儿童作为研究对象,共3527名。对所有研究对象进行问卷调查,同时采集静脉血标本,检测乙肝病毒表面抗原(hepatitis B surface antigen,HBsAg)、乙肝病毒表面抗体(antibody against HBsAg,AntiHBs)和乙肝病毒核心抗体(antibody against hepatitis B core antigen,AntiHBc);对其中HBsAg阳性儿童的父母进行随访,采集其静脉血标本检测HBsAg。采用logistic回归分析突破性HBV感染、突破性慢性HBV感染的相关因素。 结果3527名研究对象总体突破性HBV感染率为315%(111/3527),随出生年份的后移而呈下降趋势(χ2趋势=4483,P<001),其中1992年出生儿童最高(99%,16/161),2000 年最低(08%,2/258);自述父、母亲及其他家庭成员HBsAg阳性者(1522%,7/46、3409%,15/44、1765%,6/34)均高于阴性者(299%,104/3481、276%,96/3483、301%,105/3493)(χ2值分别2228、1397、2368,P值均<001);首针接种不及时者(537%,41/763)高于及时者(253%,70/2764)(χ2=1560,P值均<001)。突破性慢性HBV感染率为108%(38/3527),随出生年份的后移而呈下降趋势(χ2趋势=996,P<001),其中1992年出生儿童最高,为31%(5/161),1997年出生儿童最低,为04%(1/261);自述父、母亲及其他家庭成员HBsAg阳性者(1304%,6/46、2955%,13/44、1765%,6/34)均高于阴性者(092%,32/3481、072%,25/3483、092%,32/3493)(χ2值分别6262、33880、8844,P值均<005);首针接种不及时者(183%,14/763)高于及时者(087%,24/2764),差异均有统计学意义(χ2=516,P=002)。多因素分析显示,自述父、母亲HBsAg阳性者突破性HBV感染风险高于阴性者[OR(95%CI)值分别为373(109~1275)、2676(1186~6037)],出生年份早(1992—2001年)会增加其风险[OR(95%CI)=191(1.10~3.32)],与东部城市相比西部城市的风险最高[OR(95%CI)=600(250~14.40)],自述父、母亲及其他家庭成员HBsAg阳性者突破性慢性HBV感染的风险高于阴性者[OR(95%CI)值分别为751(144~3917)、9999(3429~29162)、894(181~4410)];与他人共用牙刷会增加其风险[OR(95%CI)=867(114-6614)],与东部城市相比西部农村的风险最高[OR(95%CI)=1251(278~5625)]。随访发现,HBsAg阳性儿童母亲和父亲HBsAg阳性者比例分别为12/23和6/19。 结论山东省儿童突破性HBV感染率和突破性慢性HBV感染率均较低。母婴传播可能是儿童突破性HBV感染的主要原因,但家庭内水平传播亦不容忽视。

关键词:儿童;肝炎疫苗,乙型;肝炎病毒,乙型;突破性感染;危险因素

Abstract:

   ObjectiveTo know the prevalence and probable causes of breakthrough hepatitis B virus (HBV) infection among children born after the introduction of universal infant hepatitis B vaccination in Shandong province, China MethodsThe subjects of this study were selected from the provincial hepatitis B serosurvey conducted in 2006, who were born between 1992 and 2005 (aged 1-15 years) and were confirmed to have completed three or more doses of hepatitis B vaccine Finally 3527 subjects were involved in this study and were investigated using a unified questionare Blood samples were collected from them to detect hepatitis B surface antigen (HBsAg), antibody against HBsAg (AntiHBs) and antibody against hepatitis B core antigen (AntiHBc) The parents of children positive for HBsAg were followed up Blood samples were collected from their parents to detect for  HBsAg The rate and correlative factors of breakthrough HBV infection were gotten by singlefactor and multiplefactor analysis ResultsFor the 3527 subjects, the overall prevalence rates of breakthrough HBV infection  were 315% (111/3527), which decreased while birth year grew(χ2Trend=4483,P<001),the rate of subjects born in 1992 was the highest (99%,16/161),subjects bornd in 2000 was the least(08%,2/258), the rate of the selfreport positive HBsAg status of mother, father and the other family members(1522%,7/46;3409%,15/44;1765%,6/34)were higher than the negative(299%,104/3481,276%,96/3483,301%,105/3493)(χ2 values were 2228,1397,2368,respectively,all P values were <001),timely first dose of hepatitis B vaccine(537%,41/763) was higher than the subjects that not in time(253%,70/2764) (χ2=15596,P<001) The overall prevalence rates of breakthrough chronic HBV infection was 108% (38/3527), which decreased while birth year grew(χ2Trend=996, P<005),the rate of subjects born in 1992 was the most(31%,5/161),subjects born in 1997 was the least(04%,1/261),the rate of the selfreport positive HBsAg status of mother, father and the other family members(1304%,6/46;2955%,13/44;1765%,6/34) were higher than the negative(092%,32/3481;072%,25/3483;092%,32/3493)(χ2 values were 6262,33880,8844,respectively,all P values were <005),timely first dose of hepatitis B vaccine(183%,14/763) was lower than the subjects that not in time(087%,24/2764) (χ2=516,P=002). Multiple factors analysis showed that compared to the negative,the selfreport positive HBsAg status of father, mother increased the risk of breakthrough HBV infection,OR(95%CI)values were 373(109-1275) and 2676(1186-6037),respectively(all P values were<005),compared with eastern cities,the risk of western cities were the highest (OR(95%CI)=600(250-1440),P<005)the risk of children born in 1992-2001 was higher than those born in 2002((OR(95%CI)=191(110-332),P<005).Compared to the negative,the selfreport positive HBsAg status of father, mother and the other family members increased the risk of breakthrough chronic HBV infection,OR (95%CI) values were 751(144-3917),9999(3429-29162),894(181-4410),respectively(all P values were<005),compared with eastern cities,the risk of western rural areas were the highest(OR(95%CI)=1251(278-5625),P<005),sharing tooth brush with the others increased the risk(OR(95%CI)=867(114-6614),P<005) Among HBsAgpositive children, those with HBsAg positive mother and father accounted for 12/23 and 6/19,respectively ConclusionThe prevalence of breakthrough HBV infection and breakthrough chronic HBV infection among children was low in Shandong province Mother to infant transmission might be the main reason for the infection while the role of the horizontal transmission within the family shouldn′t be ignored

Key words: Child;Hepatitis B vaccines;Hepatitis B virus;Breakthrough infection;Risk factor

发表日期:2013/10

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