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 Bcore 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(x2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)(x2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)(x2=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(x2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)(x2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(x2=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.
目的 瞭解山東省新生兒普種乙肝疫苗以來兒童中突破性乙肝病毒(hepatitis B virus,HBV)感染髮生率及可能原因.方法 選取2006年山東省乙肝血清學調查中1～15歲(1992-2005年齣生)且明確完成3劑次及以上乙肝疫苗免疫的兒童作為研究對象,共3527名.對所有研究對象進行問捲調查,同時採集靜脈血標本,檢測乙肝病毒錶麵抗原(hepatitis B surface antigen,HBsAg)、乙肝病毒錶麵抗體(antibody against HBsAg,Anti-HBs)和乙肝病毒覈心抗體(antibody against hepatitis Bcore antigen,Anti-HBc)；對其中HBsAg暘性兒童的父母進行隨訪,採集其靜脈血標本檢測HBsAg.採用logistic迴歸分析突破性HBV感染、突破性慢性HBV感染的相關因素.結果 3527名研究對象總體突破性HBV感染率為3.15％ (111/3527),隨齣生年份的後移而呈下降趨勢(x2趨勢=44.83,P＜0.01),其中1992年齣生兒童最高(9.9％,16/161),2000年最低(0.8％,2/258)；自述父、母親及其他傢庭成員HBsAg暘性者(15.22％,7/46、34.09％,15/44、17.65％,6/34)均高于陰性者(2.99％,104/3481、2.76％,96/3483、3.01％,105/3493)(x2值分彆22.28、13.97、23.68,P值均＜0.01)；首針接種不及時者(5.37％,41/763)高于及時者(2.53％,70/2764)(x2=15.60,P值均＜0.01).突破性慢性HBV感染率為1.08％ (38/3527),隨齣生年份的後移而呈下降趨勢(x2趨勢=9.96,P＜0.01),其中1992年齣生兒童最高,為3.1％ (5/161),1997年齣生兒童最低,為0.4％(1/261)；自述父、母親及其他傢庭成員HBsAg暘性者(13.04％,6/46、29.55％,13/44、17.65％,6/34)均高于陰性者(0.92％,32/3481、0.72％,25/3483、0.92％,32/3493)(x2值分彆62.62、338.80、88.44,P值均＜0.05)；首針接種不及時者(1.83％,14/763)高于及時者(0.87％,24/2764),差異均有統計學意義(x2=5.16,P=0.02).多因素分析顯示,自述父、母親HBsAg暘性者突破性HBV感染風險高于陰性者[OR(95％CI)值分彆為3.73(1.09 ～ 12.75)、26.76(11.86 ～60.37)],齣生年份早(1992-2001年)會增加其風險[OR(95％CI)=1.91(1.10 ～ 3.32)],與東部城市相比西部城市的風險最高[OR(95％ CI)=6.00(2.50 ～ 14.40)],自述父、母親及其他傢庭成員HBsAg暘性者突破性慢性HBV感染的風險高于陰性者[OR(95％ CI)值分彆為7.51(1.44 ～39.17)、99.99(34.29 ～ 291.62)、8.94(1.81 ～44.10)]；與他人共用牙刷會增加其風險[OR(95％CI) =8.67(1.14-66.14)],與東部城市相比西部農村的風險最高[OR(95％ CI)=12.51(2.78 ～56.25)].隨訪髮現,HBsAg暘性兒童母親和父親HBsAg暘性者比例分彆為12/23和6/19.結論 山東省兒童突破性HBV感染率和突破性慢性HBV感染率均較低.母嬰傳播可能是兒童突破性HBV感染的主要原因,但傢庭內水平傳播亦不容忽視.
목적 료해산동성신생인보충을간역묘이래인동중돌파성을간병독(hepatitis B virus,HBV)감염발생솔급가능원인.방법 선취2006년산동성을간혈청학조사중1～15세(1992-2005년출생)차명학완성3제차급이상을간역묘면역적인동작위연구대상,공3527명.대소유연구대상진행문권조사,동시채집정맥혈표본,검측을간병독표면항원(hepatitis B surface antigen,HBsAg)、을간병독표면항체(antibody against HBsAg,Anti-HBs)화을간병독핵심항체(antibody against hepatitis Bcore antigen,Anti-HBc)；대기중HBsAg양성인동적부모진행수방,채집기정맥혈표본검측HBsAg.채용logistic회귀분석돌파성HBV감염、돌파성만성HBV감염적상관인소.결과 3527명연구대상총체돌파성HBV감염솔위3.15％ (111/3527),수출생년빈적후이이정하강추세(x2추세=44.83,P＜0.01),기중1992년출생인동최고(9.9％,16/161),2000년최저(0.8％,2/258)；자술부、모친급기타가정성원HBsAg양성자(15.22％,7/46、34.09％,15/44、17.65％,6/34)균고우음성자(2.99％,104/3481、2.76％,96/3483、3.01％,105/3493)(x2치분별22.28、13.97、23.68,P치균＜0.01)；수침접충불급시자(5.37％,41/763)고우급시자(2.53％,70/2764)(x2=15.60,P치균＜0.01).돌파성만성HBV감염솔위1.08％ (38/3527),수출생년빈적후이이정하강추세(x2추세=9.96,P＜0.01),기중1992년출생인동최고,위3.1％ (5/161),1997년출생인동최저,위0.4％(1/261)；자술부、모친급기타가정성원HBsAg양성자(13.04％,6/46、29.55％,13/44、17.65％,6/34)균고우음성자(0.92％,32/3481、0.72％,25/3483、0.92％,32/3493)(x2치분별62.62、338.80、88.44,P치균＜0.05)；수침접충불급시자(1.83％,14/763)고우급시자(0.87％,24/2764),차이균유통계학의의(x2=5.16,P=0.02).다인소분석현시,자술부、모친HBsAg양성자돌파성HBV감염풍험고우음성자[OR(95％CI)치분별위3.73(1.09 ～ 12.75)、26.76(11.86 ～60.37)],출생년빈조(1992-2001년)회증가기풍험[OR(95％CI)=1.91(1.10 ～ 3.32)],여동부성시상비서부성시적풍험최고[OR(95％ CI)=6.00(2.50 ～ 14.40)],자술부、모친급기타가정성원HBsAg양성자돌파성만성HBV감염적풍험고우음성자[OR(95％ CI)치분별위7.51(1.44 ～39.17)、99.99(34.29 ～ 291.62)、8.94(1.81 ～44.10)]；여타인공용아쇄회증가기풍험[OR(95％CI) =8.67(1.14-66.14)],여동부성시상비서부농촌적풍험최고[OR(95％ CI)=12.51(2.78 ～56.25)].수방발현,HBsAg양성인동모친화부친HBsAg양성자비례분별위12/23화6/19.결론 산동성인동돌파성HBV감염솔화돌파성만성HBV감염솔균교저.모영전파가능시인동돌파성HBV감염적주요원인,단가정내수평전파역불용홀시.
Objective To 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.Methods The 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.Results For the 3527 subjects,the overall prevalence rates of breakthrough HBV infection were 3.15％ (111/3527),which decreased while birth year grew(x2Trend =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 thau the negative (2.99％,104/3481,2.76％,96/3483,3.01％,105/3493) (x2 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) (x2 =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 (x2Trend =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) (x2 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) (x2 =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.Conclusion The 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.
