| Background:Hepatitis B vaccination is the most economical and effective step in the Hepatitis B prevention and control. There is a high positive conversion rate of anti-HBs in newborn who receive a whole range of Hepatitis B vaccination. So there is notable cost-effectiveness in Hepatitis B vaccination among the crowd especially newborn. Yet, many study showed that HepB vaccination can not bring or can not bring enough protective antibody in some percentage of newborn, so there are still risk of HBV infection after exposing to HBV, and have the possible of conversing into chronic carrier, they are the susceptible population of HepB protection. How to enhance the level of anti-HBs in these newborn and cut down the risk of HBV infection is a serious problem in vaccination. Have a re-immunization in the low/non-responser is a frequently used method in enhancing the immunologic response rate. But there are still no well defined re-immunization strategy for Hepatitis B vaccine.Objective:To investigate the Coverage of Hepatitis B Vaccination; To analysis the safety and primary-immune effect of Hepatitis B in newborn of Yantai. To analysis the reason of low/non-response of Hepatitis B vaccination. To explore the re-immune scheme for low/non-response of Hepatitis B vaccination in Yantai. Methods:1. Statistical reports of HepB1from hospital and healthcare in stitutions in Yantai were used in this study.2. Effect evaluation of Hepatitis B vaccine of newborn:1538children aged from7to12months old who have vaccinated5ug beer yeast Hepatitis B vaccine were selected to draw blood for separating serum. CMIA was used to detect anti-HBs.3.214low/non-responders were divided into two groups,5ug beer yeast Hepatitis B vaccine and lOug Hansenula yeast Hepatitis B vaccine were used to re-immune by0-1-6schedule. We evaluated the the re-immune effect.Results:1. Coverage of Hepatitis B Vaccination in newbornHepatitis B vaccine was brought into planned immunity for children and NIP in1992and2002respectively. Obstetrics in different level of medical establishment vaccinate5μg beer yeast Hepatitis B vaccine for newborn free of charge by the principle of "who delivery, who vaccinate". The first dose timely vaccination rate of Hepatitis B vaccine rose year by year. The HepB1vaccination rate and timely vaccination rate of newborn in Yantai is97.84%and97.12%respectively, keeping stable state, and providing effective immune protection of susceptible children. The premature birth and low birth weight in the children of who were not vaccinate HepB1timely accounted for32.86%and7.37%respectively. It tips for Hepatitis B vaccination contraindications to grasp the scale more strict. Excluding the impact, The HepB1timely vaccination rate of newborn in Yantai will increase to98.71%, which can protect more children from HBV infection. So more training should be conducted to vaccinators in professional knowledge in order to improve the HepB1timely vaccination rate.The infection rate of HBV in pregnant women is5.02%.In2011years old,95.99%of new born whose mother’s HBsAg is positive vaccinated HepB (10μ g) joint HBIG,1.41%of that children vaccinated HepB (10μg) alone and2.60%of that without vaccination. There was still a part of newborn whose mother is HBsAg positive received not effective Combined-blockade of immune. There are98.10%pregnancies receive HBsAg detection voluntarily, the infection rate of HBV in pregnancy is5.02%. There are nearly1000newborns whose mother did not receive HBsAg detection vaccinated HepB-Y(5μg), According to the infection rate of5.02%, there are50newborns whose mother are HBsAg positive. HBsAg screen in pregnancy is necessary to be strengthened, to vaccinate HepB(10ug) for newborn whose mother is HBsAg positive is a good idea for accessing protection from high titer anti-HBs.2. Effect of newborn who vaccinated3doses of HepBThis study make it clear that HepB vaccination (recombined yeast5μg) in newborn of Yantai possess a good reliability. There are not paradoxical reaction in the target population.80.75%children who have5μg beer yeast HepB vaccination by the0-1-6program showed protective reaction,17.56%children showed low reaction, and there are1.69%children left showed non-response state.3. Factors affecting the low/non-response newbornComparing the antibody titers between different groups including different sex, hospital, labor course, premature labor or not, HBsAg positive parents and weight, the level fo GMC were all relatively high which average amount could exceed500mIU/ml. According to the antibody titers, the GMC of male was somewhat lower than that of female, the GMC of the township hospital was somewhat lower than that of the county-level hospital, the GMC of the caesarean section group was somewhat lower than that of the natural birth group, the GMC of the premature labor group was somewhat lower than that of the normal labor group, the GMC of the HBsAg positive group was somewhat lower than that of negative group and the GMC of the low birth weight infant was somewhat lower than that of the normal weight infant, but there were no significant difference among every groups.Comparing the immune response rate among every groups, it showed that the response rate of the premature infant which was vaccinated against Hepatitis B at birth was81.25%(26/32) which was somewhat lower than that of normal infant, but there was no significant difference(χ2=0.74, P>0.05)between each groups. The response rate of the low birth weight infant which was vaccinated against Hepatitis B at birth was72.73%(8/11) which was somewhat lower than that of normal weight infant, but there was no significant difference neither (χ2=3.255, P>0.05)between each groups. There were effective response only in special infants such as the infant undergoing caesarean section, premature infant and low birth weight infant which were vaccinated against Hepatitis B. The response rate of the infant born in the county-level hospital was higher than that of the infant born in the township hospital, which was related to good cold chain system and good quality of vaccination in the county-level hospital. Therefore, the management of the birthing organization should be strengthened and more training should be conducted to vaccinators in professional knowledge in order to enhance the efficiency of HBV vaccine inoculation.The response rate of children of HBsAg negative parents, of which the geometric mean of the autoantibody was at a higher level, was higher than that of children of HBsAg positive parents. The multiple factor analysis showed that excluding other influencing factors, HBsAg positive parents could be the risk factor which affect anti-HBs generation in newborn after inoculation. There were no obvious effect of sex, hospital, labor course, premature labor or not, born weight and punctual vaccination on immune response of newborn.4. Discussions on reinjection strategy for low/non-response newbornsAfter the low/non-response newborns were re-immuned, there was an obvious difference about the response rate between1dose group and3doses group but there was no difference about GMC between two groups. There were82.71%low/non-response newborns which got the protective reaction of antibody after1dose re-immunization and the number of children which got the antibody protection increased to96.67%; there were96.06%low/non-response newborns which got the protective reaction of antibody after3doses re-immunization and the number of children which got the antibody protection increased to99.24%. Both5ug beer yeast Hepatitis B vaccine and lOug Hansenula yeast Hepatitis B vaccine have better immune response. After1dose re-immunization of5ug beer yeast Hepatitis B vaccine, the GMC level of anti-HBs increased to756.06mIU/ml from48.77mIU/ml which grew by14.50times, and after another3doses re-immunization, it increased to1022.91mIU/ml which grew by19.97times. After1dose re-immunization of lOug Hansenula yeast Hepatitis B vaccine, the GMC level of anti-HBs increased to1422.37mIU/ml from45.27mIU/ml which grew by31.42times, and after another3doses re-immunization, it increased to1790.15mIU/ml which grew by38.54times. The low/non-response newborn could get higher response rate after re-immunization. The GMC of non-response group increased to337.46mIU/ml from4.9mIU/ml after1dose anti-HBs for re-immunization which grew by68.87times and it increased to1048.64mIU/ml after3doses re-immunization which grew by209.73times; The GMC of low-response group increased to1114.06mIU/ml from51.6mIU/ml after1dose anti-HBs for re-immunization which grew by21.59times and it increased to1397.64mIU/ml after3doses for re-immunization which grew by27.09times.Studies confirmed that5ug beer yeast Hepatitis B vaccine and10ug Hansenula yeast Hepatitis B vaccine possessed strong immunogenicity, after the re-immunization of which both non-response and low-response newborn could get better antibody response and higher antibody level and the effect of3doses for reinjection was better than that of1dose. Meanwhile, the level of GMC increased faster, the titers induced were higher, re-immuned by lOug Hansenula yeast Hepatitis B vaccine, the immune effect of which was better than that of5ug beer yeast Hepatitis B vaccine.Conclusion:1.The HepB1vaccination rate and timely vaccination rate of newborn in Yantai is higher, keeping stable state, and providing effective immune protection of susceptible children.But we still should relax vaccination and improve the timely vaccination rate.We Should increase propagandist strength, increase Maternity Active Detection of HBsAg, and use effective combination of blocking immune on the mother HBsAg positive newborn.2.Recombinant Hepatitis B vaccine made in China with high safety,less side reaction,and high immunogenicity, can effectively improve the immunity level of susceptible population.3.Research confirms that with the existing5ug beer yeast Hepatitis B vaccine immunization strategy, only80.75%children can generate protective antibodies.While the10ug Hansenula yeast Hepatitis B vaccine to induce anti-HBs GMC with fast lifting speed, high titer, can produce better immune effect than that of5ug beer yeast Hepatitis B vaccine.4.Immune response of neonatal research shows that Caesarean birth, preterm delivery, and, all can obtain effective response.Excluding the influence factors of HepB1vaccination of newborn in Yantai, such as preterm delivery accounting for32.86%, low birth weight accounting for7.37%, HepB1vaccination rate will increase to98.71%, which can protect more children from HBV infection.5. Low/non-response newborn after basic immunity can obtain higher response after re-immunization, agent3doses better than1dose, the protection rate of increasing to99.24%.Screening for low/non-response groups, to which providing re-immunization of3doses would contribute to the reduction of Hepatitis B in susceptible persons, and would establish a good immune barrier. |
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