在塔吉克斯坦引入疫苗后，乙型肝炎病毒感染率大幅下降。
Substantial decline in hepatitis B virus infections following vaccine introduction in Tajikistan.
作者信息
Khetsuriani Nino, Tishkova Faina, Jabirov Shamsidin, Wannemuehler Kathleen, Kamili Saleem, Pirova Zulfiya, Mosina Liudmila, Gavrilin Eugene, Ursu Pavel, Drobeniuc Jan
机构信息
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ministry of Health of Tajikistan, Dushanbe, Tajikistan.
出版信息
Vaccine. 2015 Jul 31;33(32):4019-24. doi: 10.1016/j.vaccine.2015.05.092. Epub 2015 Jun 10.
BACKGROUND
Tajikistan, considered highly endemic area for hepatitis B virus (HBV) in a pre-vaccine era, introduced hepatitis B vaccine in 2002 and reported ≥80% coverage with three doses of hepatitis B vaccine (HepB3) since 2004. However, the impact of vaccine introduction has not been assessed.
METHODS
We tested residual serum specimens from a 2010 national serosurvey for vaccine-preventable diseases in Tajikistan and assessed the prevalence of HBV infection across groups defined based on the birth cohorts' routine infant hepatitis B vaccination program implementation and HepB3 coverage achieved (≥80% versus <80%). Serosurvey participants were selected through stratified multi-stage cluster sampling among residents of all regions of Tajikistan aged 1-24 years. All specimens were tested for antibodies against HBV core antigen (anti-HBc) and those found positive were tested for HBV surface antigen (HBsAg). Seroprevalence and 95% confidence intervals were calculated and compared across subgroups using Satterthwaite-adjusted chi-square tests, accounting for the survey design and sampling weights.
RESULTS
A total of 2188 samples were tested. Prevalence of HBV infection markers was lowest among cohorts with ≥80% HepB3 coverage (ages, 1-6 years): 2.1% (95% confidence interval, 1.1-4.3%) for anti-HBc, 0.4% (0.1-1.3%) for HBsAg, followed by 7.2% (4.1-12.4%) for anti-HBc and 2.1% (0.7-6.1%) for HBsAg among cohorts with <80% HepB3 coverage (ages, 7-8 years), by 12.0% (8.7-16.3%) for anti-HBc and 3.5% (2.2-5.6%) for HBsAg among children's cohorts not targeted for vaccination (ages, 9-14 years), and 28.9% (24.5-33.8%) for anti-HBc and 6.8% (4.5-10.1%) for HBsAg among unvaccinated adult cohorts (ages, 15-24 years). Differences across groups were significant (p<0.001, chi-square) for both markers.
CONCLUSIONS
The present study demonstrates substantial impact of hepatitis B vaccine introduction on reducing HBV infections in Tajikistan. To achieve further progress in hepatitis B control, Tajikistan should maintain high routine coverage with hepatitis B vaccine, including birth dose.
背景
塔吉克斯坦在疫苗接种前被认为是乙肝病毒（HBV）的高流行地区，于2002年引入乙肝疫苗，自2004年以来报告三剂乙肝疫苗（HepB3）接种率≥80%。然而，疫苗引入的影响尚未得到评估。
方法
我们检测了2010年塔吉克斯坦全国可通过疫苗预防疾病血清学调查的残留血清标本，并评估了根据出生队列的常规婴儿乙肝疫苗接种计划实施情况和所达到的HepB3接种率（≥80%与<80%）定义的各组中HBV感染的患病率。血清学调查参与者是通过在塔吉克斯坦所有地区1至24岁居民中进行分层多阶段整群抽样选取的。所有标本均检测乙肝核心抗原抗体（抗-HBc），抗-HBc检测呈阳性者再检测乙肝表面抗原（HBsAg）。计算血清阳性率及95%置信区间，并使用萨特思韦特校正卡方检验在各亚组间进行比较，同时考虑调查设计和抽样权重。
结果
共检测了2188份样本。HepB3接种率≥80%的队列（年龄1至6岁）中HBV感染标志物的患病率最低：抗-HBc为2.1%（95%置信区间，1.1 - 4.3%），HBsAg为0.4%（0.1 - 1.3%）；其次是HepB3接种率<80%的队列（年龄7至8岁），抗-HBc为7.2%（4.1 - 12.4%），HBsAg为2.1%（0.7 - 6.1%）；未纳入疫苗接种对象的儿童队列（年龄9至14岁）中，抗-HBc为12.0%（8.7 - 16.3%），HBsAg为3.5%（2.2 - 5.6%）；未接种疫苗的成人队列（年龄15至24岁）中，抗-HBc为28.9%（24.5 - 33.8%），HBsAg为6.8%（4.5 - 10.1%）。两组间两种标志物的差异均具有统计学意义（p<0.001，卡方检验）。
结论
本研究表明，引入乙肝疫苗对降低塔吉克斯坦的HBV感染有显著影响。为在乙肝防控方面取得进一步进展，塔吉克斯坦应维持包括出生剂量在内的乙肝疫苗高常规接种率。
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