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ENGLISH ABSTRACT
河南省0~14岁青少年人群乙型肝炎病毒感染血清流行病学分析及儿童乙型肝炎疫苗免疫规划效果初步评估
郭永豪
陈艳萍
豆巧华
刘倩
杨建辉
僧明华
吕宛玉
王长双
路明霞
徐瑾
张延炀
赵东阳
作者及单位信息
·
DOI： 10.3760/cma.j.cn112150-20231127-00378
Seroepidemiological analysis of hepatitis B virus infection among adolescents aged 0-14 years in Henan Province and preliminary evaluation of the effectiveness of childhood hepatitis B vaccine immunization program
Guo Yonghao
Chen Yanping
Dou Qiaohua
Liu Qian
Yang Jianhui
Seng Minghua
Lyu Wanyu
Wang Changshuang
Lu Mingxia
Xu Jin
Zhang Yanyang
Zhao Dongyang
Authors Info & Affiliations
Guo Yonghao
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Chen Yanping
Office of Teaching and Graduate Management, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Dou Qiaohua
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Liu Qian
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Yang Jianhui
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Seng Minghua
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Lyu Wanyu
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Wang Changshuang
Immunization Program, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Lu Mingxia
Immunization Program, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Xu Jin
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Zhang Yanyang
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
Zhao Dongyang
Henan Immunoprophylaxis Key Laboratory of Medical Science, Zhengzhou 450016, China
·
DOI： 10.3760/cma.j.cn112150-20231127-00378
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摘要

目的分析河南省0~14岁青少年人群乙型肝炎（乙肝）病毒感染血清流行病学特征及对儿童乙肝疫苗免疫规划效果进行初步评估。

方法于2021年9月至2022年3月，以河南省18个省辖市的村/社区为研究现场，采用多阶段随机整群抽样的方法，抽取25个村或者社区的4 883名0~14岁青少年人群为研究对象。通过调查问卷收集人口学资料，并对0~4岁对象采集3 ml血样，5~14岁对象采集5 ml血样，检测HBsAg、HBcAb和HBsAb。通过河南省免疫信息系统收集乙肝疫苗接种数据，通过中国传染病报告系统收集河南省的乙肝病例，并分析儿童乙肝疫苗免疫规划效果。

结果4 883名研究对象年龄为（7.32±2.81）岁，HBsAg和HBcAb的阳性率分别为0.1%（7/4 883）和1.0%（50/4 883），按照人口标化后的率分别为0.3%和1.7%。2002年河南省0~14岁青少年人群HBsAg阳性率为3.39%，与2002年相比，2022年河南省0~14岁青少年人群减少了约70万HBV慢性感染者。2002年出生的新生儿完成全部3针次疫苗接种率为6.26%，2003年乙肝疫苗接种率迅速上升，2013年首次达到90%，2014年后河南省乙肝接种率持续保持在95%以上。临床报告病例中1~4岁儿童病例的占比由2006年的0.43%（1 108/256 566）下降至2021年的0.01%（78/80 655）；5~19岁青少年病例的占比由2006年18.21%（46 710/256 566）下降到2021年的1.1%（827/80 655）。

结论2002—2022年河南省0~14岁青少年人群的HBsAg阳性率明显下降；儿童乙肝疫苗免疫规划的实施效果较好。

肝炎，乙型;疫苗;接种
ABSTRACT

ObjectiveTo analyze the seroepidemiological characteristics of hepatitis B virus (HBV) infection among adolescents aged 0-14 years in Henan Province and to evaluate the effectiveness of the childhood hepatitis B vaccine (HepB) immunization program.

MethodsFrom September 2021 to March 2022, a total of 4 883 adolescents aged 0-14 years were selected from 25 villages or communities of 18 provincial-level cities in Henan Province by using the multi-stage random cluster sampling method. Demographic data were collected through questionnaires. The 3 ml of blood samples were collected from individuals aged 0-4 years and 5 ml of blood samples were collected from individuals aged 5-14 years to test HBsAg, HBcAb and HBsAb. Data on vaccination were collected through Henan Provincial Immunization Information System and hepatitis B cases in Henan Province were collected through China Infectious Disease Reporting System. The effectiveness of the childhood HepB immunization program was analyzed.

ResultsThe average age of 4 883 subjects was (7.32±2.81) years old. The positive rates of HBsAg and HBcAb were 0.1% (7/4 883) and 1.0% (50/4 883), and the population standardized rates were 0.3% and 1.7%. In 2002, the positive rate of HBsAg among adolescents aged 0-14 years in Henan Province was 3.39%. Compared with that in 2002, the number of chronic HBV infections among adolescents in Henan Province in 2022 decreased by about 0.7 million. In 2002, the vaccination rate of newborns who completed all three doses of vaccine was 6.26%. In 2003, the vaccination rate of the hepatitis B vaccine rose rapidly, reaching 90% in 2013 for the first time. After 2014, the vaccination rate in Henan Province continued to remain above 95%. The proportion of cases among children aged 1-4 years in clinical reports decreased from 0.43% (1 108/256 566) in 2006 to 0.01% (78/80 655) in 2021. The proportion of cases among adolescents aged 5-19 years decreased from 18.21% (46 710/256 566) in 2006 to 1.1% (827/80 655) in 2021.

ConclusionsFrom 2002 to 2022, the positive rate of HBsAg among adolescents aged 0-14 years has decreased significantly in Henan Province. The effectiveness of the HepB immunization program for children is good.

Hepatitis B;Vaccines;Vaccination
Zhang Yanyang, Email: mocdef.9ab314891yygnahz
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引用本文

郭永豪,陈艳萍,豆巧华,等. 河南省0~14岁青少年人群乙型肝炎病毒感染血清流行病学分析及儿童乙型肝炎疫苗免疫规划效果初步评估[J]. 中华预防医学杂志,2024,58(02)：202-207.

DOI:10.3760/cma.j.cn112150-20231127-00378

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乙型肝炎（简称“乙肝”）在世界范围内流行较广，主要影响儿童、青少年和免疫缺陷人群 ［ 1 , 2 , 3 ］ 。慢性乙肝患者会发展为肝硬化或肝癌 ［ 4 ］ 。在很多国家，乙肝已经成为公共卫生领域的严重负担。世界卫生组织呼吁，到2030年消除病毒性肝炎对公共卫生的威胁，通过持续的预防、检测和治疗，将乙肝的新增发病率在2015年基线的基础上降低90%，死亡率降低65% ［ 5 ］ 。其中重要的技术措施是提高新生儿中乙肝疫苗（hepatitis B vaccine，HepB）接种率，提高对HBV母婴传播（mother to children transmission，MTCT）的阻断率 ［ 6 ］ 。
世界各地的乙肝表面抗原（hepatitis B surface antigen，HBsAg）流行率差异很大。北美和欧洲等发达地区，HBsAg的流行率很低，5岁以下儿童的HBsAg流行率低于0.2% ［ 7 ］ ；非洲5岁以下儿童的HBsAg阳性率可能高达3% ［ 8 ］ 。西亚太地区的情况较为复杂，印度尼西亚儿童HBsAg的阳性率为2.5%~10%；日本部分地区人群的HBsAg的流行率低于0.1%；而在HepB纳入免疫规划之前，蒙古国儿童的HBsAg流行率高达10%~15% ［ 9 ］ ，在2017—2018年的一项调查中，青少年人群的HBsAg阳性率下降至4.1% ［ 10 ］ 。目前我国正在从中等流行水平（HBsAg阳性率2%~7%）下降至低流行水平（HBsAg阳性率<2%） ［ 11 , 12 , 13 ］ 。作为乙肝患者数量较多的省份之一，1992年河南省的HBsAg阳性者高达850万例，约占当时中国HBsAg阳性患者总数的7%。1992年，河南将HepB纳入计划免疫管理；2002年，按照0-1-6月龄的接种程序，为新生儿免费接种三剂HepB；截至2021年，河南省的HepB免费接种政策已经实施了20年。为了评估HepB免费接种政策实施在青少年人群中的使用效果，河南省疾病预防控制中心于2021年对河南省0~14岁青少年人群进行了HBV血清学调查，现将结果报告如下。
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备注信息
A
张延炀，Email： mocdef.9ab314891yygnahz
B
郭永豪, 陈艳萍, 豆巧华, 等. 河南省0~14岁青少年人群乙型肝炎病毒感染血清流行病学分析及儿童乙型肝炎疫苗免疫规划效果初步评估[J]. 中华预防医学杂志, 2024, 58(2): 202-207. DOI: 10.3760/cma.j.cn112150-20231127-00378.
C
所有作者声明无利益冲突
D
河南省自然科学基金 (222300420466)
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