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目的评价新生儿乙肝疫苗初免及低/无免疫应答者再免效果,分析影响因素。方法化学发光微粒子免疫分析法(CMIA)检测抗-HBs。结果新生儿首针乙肝疫苗(HepB1)及时接种率97.19%,未种者中早产、低体重儿占53.54%。初免乙肝表面抗体(抗-HBs)保护率80.75%,低、无应答分别占17.56%、1.69%。性别不同、顺产与剖腹产、早产与足月儿应答率差异无统计学意义。县级及以上医院出生、父母乙肝表面抗原(HBsAg)阴性儿童应答率较高。各组抗体几何平均滴度(GMC)差异均无统计学意义。对低/无免疫应答者再免1剂次,有82.71%儿童达到正常应答;再免3剂次,有96.06%儿童达到正常应答。10μg汉逊酵母组GMC高于5μg啤酒酵母组。结论剖腹产、早产儿能产生良好应答。对低/无应答者,再免能取得较高应答,且3剂次效果优于1剂次。需加强孕妇筛查,制订低/无应答儿童补充免疫策略。
Objective To evaluate the effects of initial immunization and low / no immune response in neonates with hepatitis B vaccine and to analyze the influencing factors. Methods Chemiluminescence microparticle immunoassay (CMIA) was used to detect anti-HBs. Results The first-dose hepatitis B vaccine (HepB1) in newborns was 97.19%. The preterm birth and low birth weight children accounted for 53.54%. The protection rate of initial hepatitis B surface antibody (anti-HBs) was 80.75%, low and no response accounted for 17.56% and 1.69% respectively. There was no significant difference in the response rate between preterm and full-term children with different sexes, between birth and caesarean section. Children born at county level and above have higher response rates to children with negative HBsAg. There was no significant difference in geometric mean titer (GMC) among the groups. Of the low / no immunocompromised patients, one more dose was given, and 82.71% of the children reached the normal response. After another 3 doses, 96.06% of the children reached the normal response. 10 g Hansenula group GMC higher than 5 g brewer’s yeast group. Conclusion Caesarean section, premature children can produce a good response. For low / non-responders, and then get a higher response to avoid, and 3 doses better than 1 dose. Need to strengthen screening of pregnant women, the development of low / no response to children’s supplementary immunization strategy.