低体重婴儿的乙肝免疫接种：他们需要额外一剂吗？

Hepatitis B immunization in low birthweight infants: do they need an additional dose?

作者信息

Arora N K, Ganguly S, Agadi S N, Irshad M, Kohli R, Deo M, Paul V K, Deorari A K, Chellani H, Prasad M S, Sharma D

机构信息

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.

出版信息

Acta Paediatr. 2002;91(9):995-1001. doi: 10.1080/080352502760272722.

DOI:10.1080/080352502760272722

PMID:12412879

Abstract

AIM

To determine the influence of gestation and weight on the development of protective anti-HB levels and geometric mean titres after three doses of HBV vaccine and to ascertain the need for a fourth dose in low birthweight infants.

METHODS

Hepatitis B vaccine (Enivac HB, Panacea Biotec Ltd., India) was given to 82 preterm (PT) and 60 term intrauterine growth-retarded (T-IUGR) infants at birth and at 6, 10 and 14wk of life.

RESULTS

Protective anti-HB levels (>10 mIU/ml) were reached in 86.6% (71/82) of PT infants and 96.7% (58/60) of T-IUGR infants after three doses of HBV vaccine (p = 0.044). The odds of having a protective response after the third dose of HBV vaccine was 1.25 (95% CI 1.02-1.53) with every one-week increase in gestation (p = 0.032). Birthweight was not associated with the development of a protective immune response. After the third dose, only 66.7% (8/12) of the PT infants whose mothers had anti-HB antibodies, developed protective anti-HB levels compared with 90% (63/70) of those with no maternal antibodies (p = 0.028). In PT infants after the fourth dose, there was a significant increase in the proportion of infants with protective antibody levels (8.6%, 95% CI 0.6-16.6%) among those with no maternal antibodies and 12.2% overall (95% CI 6.0-21.3) (p = 0.031 to 0.002) over that reached with the third dose. Administration of the fourth dose to T-IUGR infants did not confer such a benefit.

CONCLUSION

In HBV-endemic areas, PT infants, irrespective of their birthweights, may benefit from an additional dose of hepatitis B vaccine in a schedule starting at birth. This approach will prevent vertical transmission and bring their immune response up to par with term infants. Term intrauterine growth-retarded infants should be vaccinated as per the schedule recommended for normal term infants. However, studies in other settings with different vaccine formulations and a longer follow-up period will be required before this strategy can be practised more widely.

摘要

目的

确定妊娠和体重对三剂乙肝疫苗接种后保护性抗-HB水平及几何平均滴度发展的影响，并确定低出生体重儿是否需要接种第四剂疫苗。

方法

对82例早产儿（PT）和60例足月宫内生长受限儿（T-IUGR）在出生时及出生后6周、10周和14周接种乙肝疫苗（印度泛acea生物技术有限公司的Enivac HB）。

结果

三剂乙肝疫苗接种后，86.6%（71/82）的PT婴儿和96.7%（58/60）的T-IUGR婴儿达到了保护性抗-HB水平（>10 mIU/ml）（p = 0.044）。随着妊娠每增加一周，第三剂乙肝疫苗接种后产生保护性反应的几率为1.25（95%可信区间1.02-1.53）（p = 0.032）。出生体重与保护性免疫反应的发展无关。第三剂接种后，母亲有抗-HB抗体的PT婴儿中只有66.7%（8/12）产生了保护性抗-HB水平，而母亲无抗体的婴儿中这一比例为90%（63/70）（p = 0.028）。在PT婴儿中，第四剂接种后，母亲无抗体的婴儿中产生保护性抗体水平的婴儿比例显著增加（8.6%，95%可信区间0.6-16.6%），总体增加12.2%（95%可信区间6.0-21.3）（p = 0.031至0.002），高于第三剂接种后的水平。给T-IUGR婴儿接种第四剂未带来此类益处。