Thomas Ann R, Fiore Anthony E, Corwith Holly L, Cieslak Paul R, Margolis Harold S
Oregon Department of Human Services, Office of Disease Prevention and Epidemiology, 800 NE Oregon Street, Suite 772, Portland, OR 97232, USA.
Pediatr Infect Dis J. 2004 Apr;23(4):313-8. doi: 10.1097/00006454-200404000-00007.
As a result of controversy about mercury exposures from vaccines containing thimerosal, the American Academy of Pediatrics and the US Public Health Service recommended in July 1999 that the first dose of hepatitis B vaccine be deferred until 2 to 6 months of age, but only for infants born to hepatitis B surface antigen (HBsAg)-negative women. We investigated the effect of these recommendation changes on the management of Oregon infants born to women whose HBsAg status was "unknown."
Infants were identified by reviewing electronic birth certificate data from 34 Oregon hospitals during (1)April through June 1999 [before recommendation changes (T1)], (2) August through October 1999 [after recommendations changes (T2)] and (3) April through June 2000 [when resumption of pre-1999 practices were recommended (T3)]. We verified maternal HBsAg screening and newborn hepatitis B vaccination by chart review.
We identified 147 infants born to women who were not screened for HBsAg. During T1, 27% of infants born to mothers of unknown HBsAg status were vaccinated within 12 h of birth, and 80% were vaccinated before hospital discharge. This decreased to 2 and 4%, respectively, during T2 and continued to remain lower during T3.
Hepatitis B vaccine coverage for infants born to unscreened women declined significantly after the July 1999 announcement and remained significantly lower 10 to 12 months later. When changes are made in established vaccination practices, policy makers should ensure that such changes are not misinterpreted, resulting in failure to immunize appropriate groups.
由于含硫柳汞疫苗汞暴露问题存在争议，美国儿科学会和美国公共卫生服务部于1999年7月建议，首剂乙肝疫苗接种应推迟至2至6月龄，但仅适用于母亲乙肝表面抗原（HBsAg）阴性的婴儿。我们调查了这些建议变更对俄勒冈州母亲HBsAg状态“未知”的婴儿管理的影响。
通过查阅俄勒冈州34家医院的电子出生证明数据来确定婴儿，时间分别为（1）1999年4月至6月[建议变更前（T1）]、（2）1999年8月至10月[建议变更后（T2）]和（3）2000年4月至6月[建议恢复1999年前做法时（T3）]。我们通过查阅病历核实母亲HBsAg筛查和新生儿乙肝疫苗接种情况。
我们确定了147名母亲未进行HBsAg筛查的婴儿。在T1期间，母亲HBsAg状态未知的婴儿中，27%在出生后12小时内接种了疫苗，80%在出院前接种。在T2期间，这一比例分别降至2%和4%，在T3期间仍持续较低。
1999年7月公告后，未筛查母亲所生婴儿的乙肝疫苗接种覆盖率显著下降，10至12个月后仍显著较低。在既定的疫苗接种做法发生变更时，政策制定者应确保此类变更不会被误解，导致未能为适当群体进行免疫接种。
