Black Antony P, Nouanthong Phonethipsavanh, Nanthavong Naphavan, Souvannaso Chanthasone, Vilivong Keooudomphone, Jutavijittum Prapan, Samountry Bounthome, Lütteke Nina, Hübschen Judith M, Goossens Sylvie, Quet Fabrice, Buisson Yves, Muller Claude P
Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR.
BMC Infect Dis. 2014 Aug 23;14:457. doi: 10.1186/1471-2334-14-457.
BACKGROUND: Despite hepatitis B vaccination at birth and at 6, 10 and 14 weeks of age, hepatitis B virus (HBV) infection continues to be endemic in the Lao People's Democratic Republic (PDR). We carried out a cross-sectional serological study in infants, pre-school children, school pupils and pregnant women to determine their burden of disease, risk of infection and vaccination status. METHODS: A total of 2471 participants between 9 months and 46 years old were recruited from urban (Vientiane Capital, Luang Prabang), semi-urban (Boulhikhamxai and Savannakhet) and remote rural areas (Huaphan). All sera were tested for anti-HBs and anti-HBc. Sera testing positive for anti-HBc alone were further tested for the presence of HBsAg. RESULTS: A low prevalence of HBsAg (0.5%) was detected among infants from Vientiane and Luang Prabang, indicating some success of the vaccination policy. However, only 65.6% had protective anti-HBs antibodies, suggesting that vaccination coverage or responses remain sub-optimal, even in these urban populations.In pre-school children from remote areas in Huaphan, 21.2% were positive for anti-HBc antibodies, and 4.6% were for HBsAg positive, showing that a significant proportion of children in these rural regions have early exposure to HBV. In pre-school children with 3 documented HBV vaccinations, only 17.0% (15/55) were serologically protected.Among school-children from semi-urban regions of Luang Prabang, Boulhikhamxai and Savannakhet provinces, those below the age of 9 who were born after HBV vaccine introduction had anti-HBc and HBsAg prevalence of 11.7% and 4.1%, respectively. The prevalence increased to 19.4% and 7.8% of 10-14 year olds and to 27% and 10.2% of 15-19 year olds.Pregnant women from Luang Prabang and Vientiane had very high anti-HBc and HBsAg prevalence (49.5% and 8.2%), indicating high exposure and risk of onward vertical transmission to the unborn infant. CONCLUSIONS: Overall, the results demonstrate a dramatic deficiency in vaccination coverage and vaccine responses and/or documentation within the regions of Lao PDR studied, which included urbanized areas with better health care access. Timely and effective hepatitis B vaccination coverage is needed in Lao PDR.
背景：尽管在老挝人民民主共和国（老挝），婴儿在出生时以及6周、10周和14周龄时均接种了乙肝疫苗，但乙肝病毒（HBV）感染在该国仍然流行。我们对婴儿、学龄前儿童、学生和孕妇开展了一项横断面血清学研究，以确定他们的疾病负担、感染风险和疫苗接种状况。 方法：从城市地区（万象市、琅南塔省）、半城市地区（博利坎赛省、沙湾拿吉省）和偏远农村地区（华潘省）招募了2471名年龄在9个月至46岁之间的参与者。所有血清均检测了抗-HBs和抗-HBc。仅抗-HBc检测呈阳性的血清进一步检测了HBsAg的存在情况。 结果：在万象和琅南塔的婴儿中检测到较低的HBsAg流行率（0.5%），这表明疫苗接种政策取得了一定成效。然而，只有65.6%的人具有保护性抗-HBs抗体，这表明即使在这些城市人群中，疫苗接种覆盖率或接种反应仍未达到最佳水平。在华潘偏远地区的学龄前儿童中，21.2%的抗-HBc抗体呈阳性，4.6%的HBsAg呈阳性，这表明这些农村地区有相当比例的儿童早期接触过HBV。在有3次乙肝疫苗接种记录的学龄前儿童中，只有17.0%（15/55）在血清学上受到保护。在琅南塔省、博利坎赛省和沙湾拿吉省半城市地区的学生中，9岁以下在乙肝疫苗引入后出生的儿童，抗-HBc和HBsAg的流行率分别为11.7%和4.1%。10至14岁儿童的流行率分别升至19.4%和7.8%，15至19岁儿童的流行率分别升至27%和10.2%。琅南塔和万象的孕妇抗-HBc和HBsAg的流行率非常高（分别为49.5%和8.2%），这表明她们接触HBV的几率很高，且存在将病毒垂直传播给未出生婴儿的风险。 结论：总体而言，研究结果表明，在老挝所研究的地区，包括医疗保健可及性较好的城市化地区，疫苗接种覆盖率、疫苗接种反应和/或接种记录存在严重不足。老挝需要及时、有效地提高乙肝疫苗接种覆盖率。
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