新生儿乙肝疫苗对白血病患儿HBV突破性感染的保护作用：一项真实世界研究
Protective Effect of Neonatal Hepatitis B Vaccine Against HBV Breakthrough Infection in Children with Leukemia: A Real-world Study.
作者信息
Yang Yuting, Xiao Jianwen, Zhang Xiuyu, Yang Hui, Zhang Zhenzhen, Xu Hongmei, Huang Ailong, Zhao Yao
机构信息
National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Hematology, Children's Hospital of Chongqing Medical University, Chongqing, China.
出版信息
J Clin Transl Hepatol. 2022 Oct 28;10(5):860-866. doi: 10.14218/JCTH.2021.00291. Epub 2022 Feb 21.
BACKGROUND AND AIMS
Hepatitis B vaccine is the most effective preventive measure against hepatitis B virus (HBV) infection. However, the risk of HBV breakthrough infection in fully immunized children (neonatal hepatitis B immunization) who receive immunosuppressive therapy and transfusion of blood components is not well characterized. In this real-world study, we aimed to investigate the immune protection conferred by neonatal hepatitis B vaccine in children with acute lymphoblastic leukemia (ALL) who were treated with immunosuppressive therapy and blood component transfusions.
METHODS
Children with ALL who had received all three doses of neonatal hepatitis B vaccine were included in this study. HBV seromarkers were detected before and after the initiation of immunosuppressive therapy.
RESULTS
A total of 1,011 children with ALL who were fully vaccinated against hepatitis B in infancy before the initiation of immunosuppressive therapy were eligible for inclusion. HBV infection was detected in four of 410 children (0.98%) with an HBsAg test after the initiation of immunosuppressive therapy. The median interval from treatment initiation was 19 months.
CONCLUSIONS
Three doses of neonatal hepatitis B vaccine conferred adequate protection. In endemic regions, there is a low risk of HBV breakthrough infection in fully immunized children with immunosuppressive therapy.
背景与目的
乙肝疫苗是预防乙肝病毒（HBV）感染最有效的措施。然而，接受免疫抑制治疗和输血的完全免疫儿童（新生儿乙肝免疫）发生HBV突破性感染的风险尚未得到充分描述。在这项真实世界研究中，我们旨在调查接受免疫抑制治疗和输血的急性淋巴细胞白血病（ALL）儿童中，新生儿乙肝疫苗所赋予的免疫保护作用。
方法
本研究纳入了已接种三剂新生儿乙肝疫苗的ALL儿童。在开始免疫抑制治疗前后检测HBV血清学标志物。
结果
共有1011名在开始免疫抑制治疗前婴儿期已完全接种乙肝疫苗的ALL儿童符合纳入标准。在开始免疫抑制治疗后，410名儿童中有4名（0.98%）通过HBsAg检测发现HBV感染。从开始治疗起的中位间隔时间为19个月。
结论
三剂新生儿乙肝疫苗可提供充分的保护。在流行地区，接受免疫抑制治疗的完全免疫儿童发生HBV突破性感染的风险较低。
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