Pokorska-Lis Maria, Marczyńska Magdalena
Klinika Chorób Zakaźnych Wieku Dzieciqcego Warszawskiego Uniwersytetu Medycznego, SPZOZ Wojewódzki Szpital Zakainy w Warszawie.
Med Wieku Rozwoj. 2011 Jan-Mar;15(1):62-8.
Incidence of hepatitis B in Poland decreased significantly after implementation of routine immunization in infants. Natural boosters may influence the long-term post vaccination immunity in countries, where endemicity is high. In areas of low incidence this influence may be limited. The aim of the study was to analyze the influence of risk factors for HBV infection (potential natural boosters) on long-term post vaccination immunity against hepatitis B and the possibilityof HBVinfection in previously vaccinated individuals.
In 130 children aged 10-12years, vaccinated with 4 doses ofrecombinantvaccine against hepatitis B in infancy, exposure to risk factors for HBV infection (infection in family members including mother, hospitalization, surgical interventions, blood transfusion, dental treatment, piercing, tattooing) was analyzed. Markers of HBVinfection (anti-HBc and HBsAg) and humoral immunity against hepatitis B were determined. Protective level of anti-HBs antibodies was defined as > or =10 IU/1.
Statistically significant influence of dental treatment (p<0.02) andsurgicalinterventions (p<0.05) on possessing very high anti-HBs titer (> or = 1000 IU/) was revealed, which indicates that these factors act as natural boosters. Children, who previously received blood transfusion, statistically more frequently did not have protective level of anti-HBs (p<0.0 I). In all 6 children with confirmed HBV infection there was exposure to risk factors for infection in anamnesis. In children with chronic hepatitis B (positive HBsAg) statistically significantly more frequently surgical interventions were performed (p<0.05).
I. Despite of low incidence of hepatitis B in Poland, natural boosters, especially dental and surgical treatment, may stimulate the post vaccination immunity. 2. Blood transfusion is currently not a source of infection, however, children who received blood transfusion in the neonatal period, may require control of immunization efficacy or a booster dose. 3. HBVinfection and chronic hepatitis B may occur in previously vaccinated children, especially if they underwent surgical intervention.
在波兰，婴儿实施常规免疫后乙肝发病率显著下降。在乙肝地方性流行程度高的国家，自然增强因素可能会影响疫苗接种后的长期免疫力。在低发病率地区，这种影响可能有限。本研究的目的是分析乙肝病毒（HBV）感染的危险因素（潜在的自然增强因素）对乙肝疫苗接种后长期免疫力的影响，以及既往接种疫苗个体感染HBV的可能性。
对130名10 - 12岁儿童进行研究，这些儿童在婴儿期接种了4剂重组乙肝疫苗，分析他们接触HBV感染危险因素（家庭成员包括母亲感染、住院、外科手术、输血、牙科治疗、穿孔、纹身）的情况。检测HBV感染标志物（抗-HBc和HBsAg）以及乙肝体液免疫情况。抗-HBs抗体的保护水平定义为≥10 IU/L。
研究发现牙科治疗（p<0.02）和外科手术（p<0.05）对拥有非常高的抗-HBs滴度（≥1000 IU/L）有统计学显著影响，这表明这些因素起到了自然增强作用。既往接受过输血的儿童，统计学上更频繁地未达到抗-HBs的保护水平（p<0.01）。在所有6例确诊HBV感染的儿童中，既往病史中均有感染危险因素暴露。在慢性乙肝（HBsAg阳性）儿童中，外科手术的实施频率在统计学上显著更高（p<0.05）。
