Mast E E, Mahoney F J, Alter M J, Margolis H S
Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Vaccine. 1998 Nov;16 Suppl:S48-51. doi: 10.1016/s0264-410x(98)00294-1.
The strategy to eliminate hepatitis B virus (HBV) transmission in the United States is comprised of the following components: (1) preventing perinatal transmission, (2) routine infant vaccination, (3) catch-up vaccination of children in high-risk groups at any age, (4) catch-up vaccination of all children at 11-12 years of age and (5) vaccination of adolescents and adults in high-risk groups. According to recent surveys, > 85% of pregnant women are screened for hepatitis B surface antigen (HBsAg). Of infants born to HBsAg-positive women identified in 1995, 93% received appropriate immunoprophylaxis at birth; however, only 69% were fully vaccinated by 6-8 months of age. From 1991 (when routine infant hepatitis B vaccination was first recommended) to 1996, the proportion of 19-35-month-old children who have received three doses of hepatitis B vaccine has increased from < 10 to 83%. During this time, rates of acute hepatitis B in children 7-10 years of age have declined by 27% and rates among children 3-6 years of age have declined by 62%. Implementation of programmes for catch-up vaccination of all adolescents at 11-12 years of age and for vaccination of adolescents and adults in high-risk groups have only recently begun and no data are available to assess the progress of these programmes. However, 26% (13/50) of states now have laws requiring adolescents to be vaccinated in order to enter school. Current data indicate that substantial progress has been made in implementing a strategy to eliminate HBV transmission in the United States. Future efforts need to be focused on improving complete immunoprophylaxis of infants of HBsAg-positive mothers, increasing vaccine coverage among 11-12 year old children and implementing programmes to vaccine adolescents and adults in high-risk groups.
美国消除乙型肝炎病毒（HBV）传播的策略包括以下几个方面：（1）预防围产期传播；（2）婴儿常规接种疫苗；（3）对任何年龄的高危组儿童进行补种；（4）对所有11至12岁儿童进行补种；（5）对高危组青少年和成人进行接种。根据最近的调查，超过85%的孕妇接受了乙肝表面抗原（HBsAg）筛查。在1995年确定的HBsAg阳性母亲所生婴儿中，93%在出生时接受了适当的免疫预防；然而，到6至8月龄时只有69%完成了全程接种。从1991年（首次建议婴儿常规接种乙肝疫苗）到1996年，接受三剂乙肝疫苗接种的19至35月龄儿童比例从不到10%增至83%。在此期间，7至10岁儿童的急性乙肝发病率下降了27%，3至6岁儿童的发病率下降了62%。针对所有11至12岁青少年的补种计划以及针对高危组青少年和成人的接种计划最近才开始实施，尚无数据可评估这些计划的进展情况。不过，目前有26%（13/50）的州制定了法律，要求青少年接种疫苗方可入学。目前的数据表明，美国在实施消除HBV传播策略方面已取得重大进展。未来的工作需要集中在改善HBsAg阳性母亲所生婴儿的全程免疫预防、提高11至12岁儿童的疫苗接种率以及实施针对高危组青少年和成人的接种计划。
