翻译完毕乙肝免疫策略资料，感谢大家

正义何在

Multiple sclerosis (MS)和乙肝疫苗之间并没有什么联系。许多具有临床专业知识的人更倾向于认为乙肝疫苗和Multiple sclerosis (MS)（169，171）之间没有联系。在极个别报道中指出的接种乙肝疫苗后发生的慢性疾病包括长期疲劳综合症（171），神经紊乱（例如，leukoencephalitis, optic neuritis, and transverse myelitis) (172–174), rheumatoid arthritis(175,176), type 1 diabetes (177), and autoimmune disease (178)。但是，关于乙肝疫苗和这些情况以及其它慢性疾病之间具有联系的任何证据都还没有得到证实（159，169，170，179-180）。接种乙肝疫苗后间断性脱发的报道暗示了疫苗可能在及其微小的情况下导致脱发（183）。然而，一个基于人口的研究表明乙肝疫苗和脱发之间的联系在统计上没有意义（184）。没有任何证据表明乙肝疫苗，包括婴儿出生后接种的一剂，和婴儿出生后一年内所发生的突然婴儿死亡综合症或者其它原因引起的死亡之间具有联系。婴儿死亡率，包括突然婴儿死亡综合症发生率，在90年代的美国都有了实质上的降低，与此伴随的是儿童接种乙肝疫苗覆盖面的上升，从小于1%升到了大于90%。同时，又做了很大努力通过纠正婴儿睡姿以及在睡眠时和其他人员分离的措施减少突然婴儿死亡综合症的发生（188）。乙肝疫苗和其它疫苗的安全性通过对来自VSD,VAERS和其它监督系统的数据的不间断分析进行不断的评估。接种乙肝疫苗后发生的任何不良反应都要向VAERS报告，报告格式及帮助措施可以拨打电话1-800-822-7967或登陆网站http://www.vaers.hhs.gov.查询。

[此贴子已经被作者于2006-11-7 21:43:38编辑过]

正义何在

禁忌及预防

对酵母菌或者其它疫苗成分过敏的人不宜接种乙肝疫苗（92，189-191）。若对Saccharomyces
cerevisiae (baker's yeast)过敏的人接种乙肝疫苗，尽管在理论上存在可能发生国民反应的危险，然而，还没有任何证据表明具有对yeast allergy过敏史的人接种乙肝疫苗后会发生不良反应。对那些具有不良事件（比如过敏性反应）发生史的人来说，接种乙肝疫苗后不应再接种额外的剂量。像其它疫苗一样，若接种乙肝疫苗后发生中等或严重疾病，不管是否发烧都应暂缓接种疫苗一直等到这些疾病消失（192）。对那些具有MS, Guillain-Barré syndrome, autoimmune disease (e.g.systemic lupus erythematosis or rheumatoid arthritis)，或其它慢性疾病史的人来说，乙肝疫苗对此没有禁忌。怀孕对乙肝疫苗没有禁忌。有限的数据表明怀孕的妇女接种疫苗对正在发育的胎儿没有明显的发生不良事件的危险（193）。当前的疫苗中含有不会传染的HBsAg,因此对胎儿不会有任何危险。

正义何在

未来考虑

在本文中所列建议或策略的实施将最终导致HBV在美国传播的消亡。新的信息将会影响这项工作，预计会发生调整和改革。

 

长期保护和辅助药剂（Booster）

剂量

为了对接种疫苗后的长期保护以及对辅助疫苗剂量的需要进行评估，研究是不可缺少的。已经对那些具有较高地方性乙肝感染（例如，大于8%的慢性流行感染）的人群做了很长时期的乙肝保护研究。该研究表明，通过对易感人群接种乙肝疫苗，在那些具有具有较高地方性乙肝感染率的人群中已经实质上消除了新的感染。在这些人群中，接种乙肝疫苗的人和携带乙肝病毒的人长期接触使评估乙肝疫苗的长期有效性变的复杂。对15-20年后乙肝免疫有效性的评估需要在那些继续与HBsAg呈阳性的人接触的人群中开展研究（这些呈阳性的人包括：来自高感染地区的移民，注射吸毒者，保健工作者）。同时也需要在具有低感染率的人群中开展研究。

 

免疫逃逸突变

乙肝病毒S基因的突变将会导致在HBsAg蛋白决定方面的构造性变化，而它的主要目标是压制抗—HBs,这些变异已经在感染HBV的人身上有所发现，同时人们也担心这些变异会在疫苗诱导抗HBs或者包含在HBIG里的抗HBs方面得到复制（194，195）。虽然没有任何证据表明s基因的免疫逃逸突变对现在的接种乙肝疫苗计划有威胁（196），但是为弄清折这种变异所做的进一步研究和检查比检测目前疫苗策略的有效性要重要。

上香

感谢大家的鼎力相助！截至目前除了35-37页的临时外加翻译，所有的翻译已经全部到位。

再次感谢提供翻译以及热心参与的所有战友！因为内容基本已经结束，以后再有相关重要英文资料还要麻烦大家了！

再次特别感谢 medline、黑人、linxiao、正义何在、清香百合、李肝、请多关照、life_sun、ponsy、dream_flying、八年抗战、rickljb553和mp4、intoxication、jasmine1

medline

看到我的帐号排在前面。太惭愧了。因为是最后交卷的。
每个人都很热心。论坛真的是藏龙卧虎。
linxiao 特别棒，选了好几页，很快翻完，而且给出很好的分配办法。 佩服一下。

八年抗战

35-37没有收到么?

八年抗战

在这里贴一遍吧

Goal and Objectives
目标和目的
This report updates the immunization strategy to eliminate hepatitis B virus (HBV) transmission in the United States. The report includes new recommendations and
implementation strategies for immunization of infants, children, and adolescents. The goal of the report is to provide guidance for health-care professionals to implement
these recommendations and strategies to prevent perinatal HBV transmission, to promote universal vaccination of infants as part of the routine childhood vaccination
schedule, and to promote vaccination of children and adolescents who were not previously vaccinated. Upon completion of this educational activity, the reader should
be able to a) identify ways to maintain high hepatitis B surface antigen (HBsAg) screening rates among pregnant women, b) describe the components of a case management
program for HBsAg-positive women, c) describe methods to ensure that newborn infants of HBsAg-positive mothers and mothers with unknown HBsAg status receive
appropriate immunoprophylaxis, d) describe how to structure programs to increase the number of infants who receive a birth dose of hepatitis B vaccine, e) list ways to
increase vaccine coverage among adolescents, and f) identify ways to increase rates of HBsAg screening and hepatitis B vaccination of foreign-born persons.

这份报告更新了在美国消除乙型肝炎病毒（HBV)传播的免疫策略。报告包含了对婴儿、儿童、青少年免疫的新建议和实施策略。报告的目标是为保健专业人员提供向导，
以完成这些建议和策略来阻止出生前后的hbv传染，促进婴儿的全体免疫成为儿童常规免疫计划的一部分，促使以前未注射疫苗的儿童和青少年注射疫苗。为了完成这个有教育意义的活动，读者应该
能够：a）确定保持怀孕妇女乙肝表面抗原（hbsag)高阻断率的方式。b）描述对 hbsag-阳性妇女病例的处理方案的步骤 c）描述确保hbsag阳性母亲和hbsag状态未知的母亲的新生儿接受合适的免疫预防的方法
d）描述如何构建方案来增加以乙肝疫苗作为出生后第一针的婴儿的数量 e）列出增加疫苗在青少年中的覆盖范围的方法 和f)确定增加hbsag阻隔率和提高外国出生的人的乙肝接种率的方法。

To receive continuing education credit, please answer all of the following questions.
为获得再教育学分，请回答接下来的所有问题

1. Components of a health department case-management program to
enhance prevention of perinatal hepatitis B virus (HBV) infection
should ensure that…(Indicate all that apply.)
A. all pregnant women are tested for HBsAg.
B. HBsAg-positive women are reported and tracked.
C. prenatal HBsAg testing records are received by maternity hospitals
before delivery.
D. infants born to HBsAg-positive mothers and infants born to mothers
with unknown HBsAg status are identified and managed.
E. all of the above.

1. 确定以下哪些属于健康部门增强防止出生前后乙肝病毒（hbv）感染的案例处理方案中的步骤。。。（指出所有正确项）
A. 所有孕妇应该做hbsag检测.
B. hbsag阳性妇女应该报告并跟踪
C. 在分娩前，产科医院应该收到产前hbsag检测记录
D   应该确认出hbsag-阳性母亲和未知hbsag状态的母亲的婴儿并做处理
E. 以上所有.

2. All delivery hospitals should implement standing orders for
administration of hepatitis B vaccination before hospital discharge as
part of routine medical care to all medically stable infants weighing
>2,000 g at birth. (Choose the one correct answer.)
A. True.
B. False

   作为对所有出生时重量大于2000g的医学上稳定的婴儿的常规护理的一部分,所有产科医院应该在出院前完成乙肝疫苗接种的标准步骤.
A  真
B  假
 
3 Which of the following statement(s) regarding HBsAg screening and
vaccination of immigrants and international adoptees is true? (Indicate
all that apply.)
A. All foreign-born persons (including immigrants, refugees, asylum
seekers, and internationally adopted children) from Asia, the Pacific
Islands, and Africa and other countries with HBsAg prevalence >2%
should be tested for HBsAg.
B. Persons who test positive for HBsAg should receive appropriate followup,
including counseling, evaluation for chronic liver disease and
antiviral treatment, and vaccination of susceptible household and
sexual contacts.
C. Persons who reside in the United States but who were vaccinated in
other countries should be considered fully vaccinated if they have
written documentation of at least three doses of vaccine administered
at recommended minimum intervals.
D. All of the above.

以下哪条在考虑hbsag阻断和对移民和国际被收养者接种的陈述中,以下哪条是正确的(指出所有正确的)
A 所有来自亚洲，太平洋岛屿，非洲和其他hbsag流行率大于2%的国家的外国出生人口(包括移民,难民,寻求政治庇护者,跨国收养的儿童)应该检验hbsag.
B hbsag检验阳性的人应该接受适当的后续处理，包括建议，慢性肝病的评估和抗病毒治疗,对易受影响的家庭成员和性伙伴的接种.
C 如果已经写下在推荐的最小时间间隔里完成至少3针疫苗的注射的证明,那些定居在美国但是在其他国家注射疫苗的人可以认为是(已经)完全接种的.
D 以上所有

4 Identify health-care settings in which hepatitis B vaccine should be
offered to all unvaccinated adolescents. (Indicate all that apply.)
A. Drug treatment facilities.
B. Institutions for the developmentally disabled.
C. College health clinics.
D. Family planning clinics.
E. All of the above.
确认应该提供乙肝疫苗给所有未接种青少年的保健环境(指出所有正确项)
A  药物治疗所
B  残疾人发展机构
C  大学健康医护所
D  家庭计划诊所
E  以上所有

八年抗战

5 Which of the following statements regarding the hepatitis B vaccination
schedule in infants and children are true? (Indicate all that apply.)
A. Administration of the final dose to infants is not recommended before
age 24 weeks.
B. A vaccine series started with a birth dose of single-antigen vaccine
cannot be completed with 3 doses of combination vaccine.
C. No differences in immunogenicity have been observed when one or
two doses of hepatitis B vaccine produced by one manufacturer are
followed by dose(s) from a different manufacturer.
D. Currently licensed formulations for both single-antigen vaccines have
been demonstrated to produce high (>95%) levels of seroprotection
among infants, children, and adolescents when administered in
different schedules.
E. All of the above.

5 以下哪条关于婴儿和儿童的乙肝接种计划叙述是真的（指出所有正确项）
A  婴儿的最后一剂疫苗不推荐在第24周前。
B  以单抗原疫苗作为出生后第一针的疫苗系列不能以3针剂量的复合疫苗结束。
C  以一个厂家生产的疫苗作为第一针或第二针之后，继续使用其他厂家生产的疫苗没有观察到致免疫性方面的差异
D  当前已经获得执照的两种单抗原疫苗的配方当对婴儿儿童和青少年采用不同的用药计划时 ，已经被证明产生了高水平（〉95%)
血清保护.
E   以上所有

6. Which of the following statements regarding the management of
perinatal HBV exposure are true? (Indicate all that apply.)
A. Passive-active prophylaxis with hepatitis B vaccine and HBIG should
be administered within 12 hours after birth.
B. A vaccine series started with a birth dose of single-antigen vaccine can
be completed with three doses of combination vaccine.
C. Active postexposure prophylaxis with hepatitis B vaccine alone (i.e.,
without HBIG) beginning at birth is frequently used in areas where
implementation of maternal HBsAg testing is difficult (e.g., in Alaska,
Pacific Islands, and developing countries).
D. Although rates of perinatal HBV transmission are higher from HBeAgpositive
mothers compared with HBeAg-negative mothers, testing of
HBsAg-positive pregnant women for HBeAg is not warranted for the
management of the infant because postexposure prophylaxis is
recommended for all infants born to HBsAg-positive women.
E. All of the above.

6 以下哪条关于出生前后hbv暴露者的处理叙述是真的（指出所有正确项）
A  在出生后12小时内应该注射被动预防的乙肝疫苗和HBIG
B  以单抗原疫苗为出生后第一针的疫苗系列可以以三针剂量的复合疫苗为最后一剂.
C  在进行母体遗传hbsag检测困难的地方(如阿拉斯加,太平洋岛屿和发展中国家)常在出生时只用乙肝疫苗(即不用hbig)作为暴露后的预防
D  尽管hbeag阳性母亲比hbeag阴性的目前出生前后的hbv感染率更高,但是在对婴儿的处理中,因为建议对hbsag阳性的妇女生下的所有婴儿进行暴露后的预防,所以并没有理由对hbsag阳性的孕妇进行hbeag的检测，
E  以上所有.

7 Which best describes your professional activities:
A. Physician.
B. Nurse.
C. Health educator.
D. Office staff.
E. Other.

7  以下哪条最好的描述了您的职业行为
A  内科医师
B  护士
C  保健教育者
D  办公室文员
E  其他

8. I plan to use these recommendations as the basis for…(Indicate all
that apply.)
A. health education materials.
B. insurance reimbursement policies.
C. local practice guidelines.
D. public policy.
E. other.

8  我计划用这些建议作为...的基础(指出所有正确项)
A  保健教育材料
B  保险补偿政策
C  局部业务指导
D  公共政策
E  其他

9. Overall, the length of the journal report was…
A. much too long.
B. a little too long.
C. just right.
D. a little too short.
E. much too short.
9  总的来说,这份期刊的报告长度是...
A  太长
B  有点长
C  正好
D  有点短
E  太短了

10. After reading this report, I am confident I can identify ways to
maintain high hepatitis B surface antigen (HBsAg) screening rates
among pregnant women.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.

10 在读了这份报告之后,我确信我知道在孕妇中保持高乙肝表面抗原阻断率的方式
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

八年抗战

11 After reading this report, I am confident I can describe the components
of a case management program for HBsAg-positive women.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
11 在读了这份报告之后,我确信我能描述在hbsag阳性妇女的案例处理程序中的步骤
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

12. After reading this report, I am confident I can describe methods to
ensure that newborn infants of HBsAg-positive mothers and mothers
with unknown HBsAg status receive appropriate immunoprophylaxis.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
12 在读了这份报告之后,我确信我能描述确保bbsag阳性母亲和hbs状态未知的母亲的新生儿得到合适免疫预防的方法
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

13. After reading this report, I am confident I can describe how to structure
programs to increase the number of infants who receive a birth dose of
hepatitis B vaccine.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
13  在读了这份报告之后，我确信我能描述如何构建方案来增加出生后以乙肝疫苗为出生后第一针的婴儿数量
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

14 After reading this report, I am confident I can increase vaccine
coverage among adolescents.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
14 在读了这份报告之后，我确信我能提高青少年中的疫苗覆盖率
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

15 After reading this report, I am confident I can identify ways to increase rates
of HBsAg screening and hepatitis B vaccination of foreign-born persons.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.

15 在读了这份报告之后,我确信我能知道增长hbsag阻断率和在外国出生的人群中乙肝接种率的方法
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

16. The learning outcomes (objectives) were relevant to the goal of this report.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.

16 学习结果(客观的)与报告的目的相关
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

17. The instructional strategies used in this report (text, tables, figures,
boxes, and appendices) helped me learn the material.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
17 报告用到的教学策略(文本,表格,数字,花边新闻,附录)
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

18. The content was appropriate given the stated objectives of the report.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.

18 报告的内容与标明的目的相符
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

19. The content expert(s) demonstrated expertise in the subject matter.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
19 内容专家证明了主题素材的专业知识
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

20. Overall, the quality of the journal report was excellent.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
20  总的来说,杂志报告的质量非常好
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意
21. These recommendations will improve the quality of my practice.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
21 这些建议对我的工作质量有改进
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意
22. The availability of continuing education credit influenced my
decision to read this report.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
22 再教育学分的有效性营销了我对这份报告的决定
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意
23. The MMWR format was conducive to learning this content.
A. Strongly agree.
B. Agree.
C. Undecided.
D. Disagree.
E. Strongly disagree.
23 MMWR的格式对学习这个内容有帮助
A  强烈同意
B  同意
C  不能决定
D  不同意
E  强烈不同意

24. Do you feel this course was commercially biased? (Indicate yes or no;
if yes, please explain in the space provided.)
A. Yes.
B. No.
24 你是否觉得这份课程有商业偏见(回答是或否,如果是,在空白处阐明原因)
A  是
B  不
 

25. How did you learn about the continuing education activity?
A. Internet.
B. Advertisement (e.g., fact sheet, MMWR cover, newsletter, or journal).
C. Coworker/supervisor.
D. Conference presentation.
E. MMWR subscription.
F. Other.

25 你怎么知道这个再教育活动的
A  网络
B  广告(如 内容概要说明书, MMWR 封面 , 业务通讯, 或期刊)
C  同事/管理人
D  会议介绍
E  MMWR预订
F  其他

八年抗战

MMWR Response Form for Continuing Education Credit
December 23, 2005/Vol. 54/No. RR-16
A Comprehensive Immunization Strategy to Eliminate
Transmission of Hepatitis B Virus Infection in the United States
Recommendations of the Advisory Committee
on Immunization Practices (ACIP)
Part 1: Immunization of Infants, Children, and Adolescents
To receive continuing education credit, you must
1. provide your contact information (please print or type);
2. indicate your choice of CME, CME for nonphysicians, CEU, or CNE credit;
3. answer all of the test questions;
4. sign and date this form or a photocopy;
5. submit your answer form by December 23, 2008.
MMWR再教育学分答题卷 12/23  2005/Vol. 54/No. RR-16
为在美国消除乙肝病毒感染的综合免疫策略
ACIP的建议
第一部分:婴儿,儿童,青少年的免疫
为获得再教育学分,你必须
1 提供你的联系信息(请打印)
2 说明(申请)CME,CME(非医师),CEU或CNE学分的选择
3 回答所有测试问题
4 在这份表格或复印件上签名及时间
5 在2008/12/23日前提交答题卷

Failure to complete these items can result in a delay or rejection of your application
for continuing education credit.
Last Name (print or type) First Name
Street Address or P.O. Box
Apartment or Suite
City State ZIP Code
Phone Number Fax Number
E-Mail Address
Signature Date I Completed Exam
Check One
下列选项如果没有完成可能导致对再教育学分的申请被推迟或驳回
名_____________    姓________________________
街道________________ 地址或(邮箱编号)______________
门牌号码_______________________________
城市________ 州 _____________ 邮政编码______________
电话号码_____________ 传真号码___________________
邮件地址__________________

选择(申请类型)
CEU Credit
CNE Credit
CME Credit
CME for nonphysicians Credit

Fill in the appropriate blocks to indicate your answers. Remember, you must answer all
of the questions to receive continuing education credit!
将你的答案填在合适的括号内,记住,未得到再教育学分,你比学回答所有问题
1. [ ] A [ ] B [ ] C [ ] D [ ] E
2. [ ] A [ ] B
3. [ ] A [ ] B [ ] C [ ] D
4. [ ] A [ ] B [ ] C [ ] D [ ] E
5. [ ] A [ ] B [ ] C [ ] D [ ] E
6. [ ] A [ ] B [ ] C [ ] D [ ] E
7. [ ] A [ ] B [ ] C [ ] D [ ] E
8. [ ] A [ ] B [ ] C [ ] D [ ] E
9. [ ] A [ ] B [ ] C [ ] D [ ] E
10. [ ] A [ ] B [ ] C [ ] D [ ] E
11. [ ] A [ ] B [ ] C [ ] D [ ] E
12. [ ] A [ ] B [ ] C [ ] D [ ] E
13. [ ] A [ ] B [ ] C [ ] D [ ] E
14. [ ] A [ ] B [ ] C [ ] D [ ] E
15. [ ] A [ ] B [ ] C [ ] D [ ] E
16. [ ] A [ ] B [ ] C [ ] D [ ] E
17. [ ] A [ ] B [ ] C [ ] D [ ] E
18. [ ] A [ ] B [ ] C [ ] D [ ] E
19. [ ] A [ ] B [ ] C [ ] D [ ] E
20. [ ] A [ ] B [ ] C [ ] D [ ] E
21. [ ] A [ ] B [ ] C [ ] D [ ] E
22. [ ] A [ ] B [ ] C [ ] D [ ] E
23. [ ] A [ ] B [ ] C [ ] D [ ] E
24. [ ] A [ ] B
25. [ ] A [ ] B [ ] C [ ] D [ ] E [ ] F
签名_____________ 日期_________________ 我已完成测试

1-6题答案
1. E; 2. A; 3. D; 4. E; 5. A, C, and D; 6. E.