高流行区甲型肝炎疫苗免疫方案研究.docVIP

高流行区甲型肝炎疫苗免疫方案研究张勇1　马景臣2　赵守军3　杨丽华4　韩常全2　张英林2 陈吉朝2　孙永德5　欧阳佩英3　徐志一3 　　【摘要】　目的　探讨甲型肝炎高流行区疫苗免疫方案。方法　观察新生儿母传抗-HAV抗体的衰减及处于甲型肝炎流行不同阶段儿童甲型肝炎病毒感染率随年龄上升的规律。结果　新生儿母传抗体的阳性率按logistic曲线下降，13个月内从97.4%下降为5.0%；非流行期儿童甲型肝炎病毒感染率从1.5岁起随年龄上升，2岁前保持在10%以内；流行期儿童甲型肝炎病毒感染率随年龄增加而起点提前，速度加快。鉴于甲型肝炎发病随年龄上升的起点滞后于感染，认为甲型肝炎高流行区新生儿甲型肝炎母传抗体向自然感染抗体转换的“窗口期”是在出生后12～24个月。结论　根据流行情况与经济条件，儿童适宜的甲型肝炎疫苗免疫时机一般选择在12～24月龄。 　　【关键词】　肝炎，甲型　　免疫 Studies on Immunization Strategy against Hepatitis A in a Highly Prevalent Area　 　Zhang Yong*, Ma Jingchen, Zhao Shoujun, et al.　*Hebei Medical niversity, Shijiazhuang 050017 　　【Abstract】　Objective　To explore a strategy for immunization against hepatitis A (HA) in highly prevalent areas. Methods　Maternal antibodies against hepatitis A virus (anti-HAV) were detected for newly born infants and infection rate of HAV was monitored for children at various stages of epidemic of HA. Results　Proportions of positive maternal anti-HAV in newly born infants decreased from 97.4% to 5.0% during their first 13 months of life in a logistic curve pattern. HAV infection increased with age after one and a half years old during non-epidemic period, and kept in less than 10% before two years old. The age of the increase in HAV infection shifted to an earlier dates and the rate of infection speeded up more for children during an epidemic period. The “window” phase converting maternal anti-HAV to natural infection for infants in the highly prevalent areas was in 12 to 24 months after birth, because the age starting to increase HA infection lagged behind that of infection. Conclusion　Based on the prevalence of HA and economic situation, the appropriate time for childrens HAV immunization is 12 to 24 months of age. 【Key words】　Hepatitis A　　Immunization 　　确定新生儿甲型肝炎(甲肝)母传抗体向自然感染抗体转换的“窗口期”，对制定甲肝免疫方案非常重要。因为接种疫苗时间过早，新生儿体内母传被动甲肝抗体(抗-HAV)能中和疫苗中的甲肝病毒抗原(HAAg)［1］，｀降低疫苗的保护效果，过晚，甲肝发病率会上升［2，3］。本研究对我国北方甲肝病毒(HAV)高流行区的甲肝抗体“窗口期”做了观察［4］ 对象与方法 　　1.资料来源：随机从石家庄地区临产妇及新生儿的血清学定群随访和正定县A、B两个乡婴幼儿的横断面调查中选择117名。其中A乡在初次调查前后数年