乙型肝炎疫苗在中国和中国 GAVI 项目中的影响。
The impact of hepatitis B vaccine in China and in the China GAVI Project.
机构信息
Division of Bacterial Diseases, National Center for Immunization and Respiratory Infection, Centers for Disease Control and Prevention, Atlanta, GA, United States.
National Immunization Program, China Center for Disease Control and Prevention, Beijing, China.
出版信息
Vaccine. 2013 Dec 27;31 Suppl 9:J66-72. doi: 10.1016/j.vaccine.2013.03.043.
The China GAVI Project (CGP) was initiated in 2002 to provide hepatitis B (HB) vaccine to infants born in the less developed areas of China including the Western provinces and poverty counties of Middle provinces, to prevent the consequences of hepatitis B virus infection. By 2009, the project areas had raised coverage of 3 doses of HB vaccine and timely birth doses to almost 90% among infants, comparable to those in wealthier Eastern provinces, and reduced HBV prevalence to <1% among children in these areas. We estimated the impact in disease prevented by HB vaccine in China between 1992, when the vaccine was routinely recommended, and 2009, and in CGP areas for the years 2003-2009, when the CGP was active. A published model was used to estimate the burden of chronic and acute HBV infection and death prevented due to HB vaccination in China and the CGP areas using data from national serosurveys in China in 1992 and 2006, and HB vaccine coverage from surveys in 2004, 2006 and 2010. We used sigmoid modeling to estimate vaccine coverage nationally, regionally, and CGP areas. We also estimated the incremental impact of the CGP on HB vaccine coverage in those underserved areas. Our findings suggest that between 1992 and 2009, HB vaccination in China has prevented 24 million chronic HBV infections and 4.3 million future deaths due to cirrhosis, hepatocellular carcinoma and acute hepatitis. During the CGP between 2003 and 2009, an estimated 3.8 million chronic HBV infections and 680,000 deaths were prevented in CGP areas. We found that the CGP funding increased HB vaccine coverage in project areas by 4-15% for HB3 and 4-27% for timely birth dose beyond the coverage expected without the CGP. The CGP represents a highly successful public health collaboration between the national government and international partners.
中国全球疫苗免疫联盟合作项目(CGP)于 2002 年启动,旨在为中国欠发达地区(包括西部省份和中部贫困县)的婴儿提供乙肝(HB)疫苗,以预防乙肝病毒感染的后果。到 2009 年,项目地区的 HB 疫苗 3 针全程接种率和及时出生接种率接近 90%,与较富裕的东部省份相当,并将这些地区儿童的 HBV 流行率降低到<1%。我们估计 1992 年(HB 疫苗常规推荐)至 2009 年在中国以及 2003-2009 年 CGP 活跃期间在 CGP 地区,HB 疫苗预防疾病的效果。我们使用发表的模型来估计中国和 CGP 地区由于 HB 疫苗接种而预防的慢性和急性 HBV 感染和死亡负担,使用中国 1992 年和 2006 年全国血清学调查以及 2004 年、2006 年和 2010 年调查的 HB 疫苗覆盖率数据。我们使用 S 型曲线模型来估计全国、地区和 CGP 地区的疫苗覆盖率。我们还估计了 CGP 在服务不足地区对 HB 疫苗覆盖率的增量影响。我们的研究结果表明,1992 年至 2009 年期间,中国的 HB 疫苗接种预防了 2400 万例慢性 HBV 感染和 430 万例因肝硬化、肝细胞癌和急性肝炎导致的未来死亡。在 2003 年至 2009 年 CGP 期间,估计在 CGP 地区预防了 380 万例慢性 HBV 感染和 68 万例死亡。我们发现,CGP 资金使项目地区的 HB3 疫苗接种覆盖率增加了 4-15%,及时出生剂量增加了 4-27%,超过了没有 CGP 时的预期覆盖率。CGP 代表了国家政府和国际合作伙伴之间非常成功的公共卫生合作。