印度乙型肝炎疫苗接种提供的保护效果评估。

Evaluation of the Protection Provided by Hepatitis B Vaccination in India.

机构信息

Department of Pediatrics, St Stephens Hospital, Delhi, 110054, India.

Department of Pediatrics, Pathik Children's Hospital, Surat, India.

出版信息

Indian J Pediatr. 2018 Jul;85(7):510-516. doi: 10.1007/s12098-017-2601-0. Epub 2018 Jan 10.

DOI:10.1007/s12098-017-2601-0

PMID:29318526

Abstract

OBJECTIVE

In India, Hepatitis B vaccination is recommended at 6 wk except for hospital-deliveries. The authors examined protection afforded by the birth dose.

METHODS

A case-control study was done. HBsAg and HBcAb were tested in 2671 children, 1 to 5 y and HBsAb was evaluated in a subset of 1413 children. Vaccination history was recorded. Cases were HBsAg carriers. In another analysis, children who got infected (HBsAg and/or HBcAb positive) were considered as cases. Exposed were the unvaccinated. In another analysis, exposed were those vaccinated without the birth dose.

RESULTS

The odds ratio (OR) for HBsAg positivity with birth vaccination was 0.35 (95% CI 0.19-0.66); while with vaccination at 6 wk was 0.29 (95%CI 0.14-0.61), both compared to unvaccinated. Birth vaccination has no added protection when compared to the unvaccinated. Unvaccinated children in index study had HBsAg positivity of 4.38%. The number needed to treat (NNT) to prevent one case of HBsAg positivity was 32.6 (95% CI, 20.9 to 73.6). The odds of getting HBV infection was 0.42 (CI 0.25-0.68) with birth dose and 0.49 (CI 0.30-0.82) without the birth dose compared to the unvaccinated. Protective antibody (HBsAb) was present in about 70% of the vaccinated. In the unimmunised, in the first 2 y HBsAb protection was present in 40%. The odds ratio (OR) for HBsAb in the fully vaccinated between 4 and 5 y was 1.4 (95%CI 0.9-2.18) compared to the unvaccinated.

CONCLUSIONS

The present study lends support to the pragmatic approach of the Government to vaccinate babies born at home starting at 6 wk.

摘要

目的

在印度，除了医院分娩外，建议在 6 周龄时接种乙型肝炎疫苗。作者研究了出生时接种疫苗的保护作用。

方法

进行了一项病例对照研究。在 2671 名 1 至 5 岁的儿童中检测 HBsAg 和 HBcAb，在 1413 名儿童的亚组中评估 HBsAb。记录了疫苗接种史。病例为 HBsAg 携带者。在另一项分析中，感染（HBsAg 和/或 HBcAb 阳性）的儿童被视为病例。暴露于未接种疫苗的儿童。在另一项分析中，暴露于未接种出生剂量疫苗的儿童。

结果

与未接种疫苗相比，出生时接种疫苗的 HBsAg 阳性率的比值比（OR）为 0.35（95%CI 0.19-0.66）；而在 6 周龄时接种疫苗的 OR 为 0.29（95%CI 0.14-0.61）。与未接种疫苗相比，出生时接种疫苗没有额外的保护作用。在本研究中，未接种疫苗的儿童 HBsAg 阳性率为 4.38%。预防一例 HBsAg 阳性的需要治疗人数（NNT）为 32.6（95%CI，20.9 至 73.6）。与未接种疫苗相比，出生时接种疫苗的儿童感染乙肝病毒的风险为 0.42（CI 0.25-0.68），未接种出生时疫苗的风险为 0.49（CI 0.30-0.82）。大约 70%的接种疫苗的儿童存在保护性抗体（HBsAb）。在未免疫的儿童中，在前 2 年，HBsAb 保护率为 40%。与未接种疫苗相比，4 至 5 岁时完全接种疫苗的儿童 HBsAb 的比值比（OR）为 1.4（95%CI 0.9-2.18）。