Chinese Center for Disease Control and Prevention, Beijing, China.
Centers for Disease Control and Prevention, Atlanta, USA.
Vaccine. 2013 Dec 27;31 Suppl 9:J73-8. doi: 10.1016/j.vaccine.2012.09.060.
During the China GAVI project, implemented between 2002 and 2010, more than 25 million children received hepatitis B vaccine with the support of project, and the vaccine proved to be safe and effective. With careful consideration for project savings, China and GAVI continually adjusted the budget, additionally allowing the project to spend operational funds to support demonstration projects to improve timely birth dose (TBD), conduct training of EPI staff, and to monitor the project impact. Results from the final evaluation indicated the achievement of key outcomes. As a result of government co-investment, human resources at county level engaged in hepatitis B vaccination increased from 29 per county on average in 2002 to 66 in 2009. All project counties funded by the GAVI project use auto-disable syringes for hepatitis B vaccination and other vaccines. Surveyed hepatitis B vaccine coverage increased from 71% in 2002 to 93% in 2009 among infants. The HBsAg prevalence declined from 9.67% in 1992 to 0.96% in 2006 among children under 5 years of age. However, several important issues remain: (1) China still accounts for the largest annual number of perinatal HBV infections (estimated 84,121) in the WHO WPR region; (2) China still lacks a clear national policy for safe injection of vaccines; (3) vaccination of high risk adults and protection of health care workers are still not implemented; (4) hepatitis B surveillance needs to be refined to more accurately monitor acute hepatitis B; and (5) a program for treatment of persons with chronic HBV infection is needed. Recommendations for future hepatitis B control include: using the lessons learned from the China GAVI project for future introductions of new vaccines; addressing unmet needs with a second generation hepatitis B program to reach every infant, including screening mothers, and providing HBIG for infants born to HBsAg positive mothers; expanding vaccination to high risk adults; addressing remaining unsafe injection issues; and improving monitoring of acute hepatitis B. This paper describes findings and discusses perspectives from a final project evaluation, a national stratified validated cross-sectional survey done in October 2010.
在中国全球疫苗免疫联盟（GAVI）项目（2002-2010 年实施）期间，超过 2500 万名儿童获得了项目支持的乙肝疫苗，疫苗证明是安全有效的。考虑到项目节约，中国和 GAVI 不断调整预算，还允许项目使用运营资金支持改善及时出生剂量（TBD）、进行扩大免疫规划工作人员培训以及监测项目影响的示范项目。最终评估结果表明实现了关键成果。由于政府共同投资，从事乙肝疫苗接种的县级人力资源从 2002 年平均每个县 29 人增加到 2009 年的 66 人。所有由 GAVI 项目供资的项目县均使用自毁注射器用于乙肝疫苗和其他疫苗接种。调查显示，乙肝疫苗接种覆盖率从 2002 年的 71%提高到 2009 年的 93%，在 0-5 岁儿童中。然而，仍存在一些重要问题：（1）中国仍然是世卫组织西太平洋地区每年发生围产期乙型肝炎病毒感染数量最多的国家（估计为 84121 例）；（2）中国仍然缺乏安全疫苗接种的明确国家政策；（3）高危成年人的疫苗接种和卫生保健工作者的保护仍然没有实施；（4）乙肝监测需要进一步完善，以更准确地监测急性乙型肝炎；以及（5）需要制定慢性乙型肝炎病毒感染者治疗方案。未来乙肝控制的建议包括：借鉴中国 GAVI 项目的经验教训，为未来引进新疫苗；用第二代乙肝方案满足未满足的需求，为每一名婴儿提供服务，包括筛查母亲，并为乙型肝炎表面抗原阳性母亲所生婴儿提供乙型肝炎免疫球蛋白；扩大高危成年人疫苗接种；解决剩余不安全注射问题；改善急性乙型肝炎监测。本文描述了最终项目评估的发现和讨论的观点，该评估是 2010 年 10 月进行的全国分层验证性横断面调查。
