为 2 岁之前母体 HBsAg 阳性的儿童接种乙型肝炎加强疫苗可有

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为 2 岁之前母体 HBsAg 阳性的儿童接种乙型肝炎加强疫苗可有效预防疫苗突破性感染

    宋亚荣、张鑫、刘敏敏、翟向军、刘建勋、李一、李莉莉、肖一伟、段中平、姜静、丁峰、朱立国、姜杰、邹怀斌、庄辉、王杰、李杰

BMC 传染病第 22 卷，文章编号：863 (2022) 引用这篇文章

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抽象的
背景

乙型肝炎疫苗 (HepB) 的长期保护作用、乙型肝炎病毒 (HBV) 疫苗突破性感染 (VBIs) 的发生率以及是否有必要对慢性 HBV 感染的母亲所生的孩子进行加强 HepB 仍有待阐明.
方法

基于 2009 年至 2011 年建立的 1177 名乙型肝炎表面抗原 (HBsAg) 阳性母亲及其配对婴儿的长期随访前瞻性队列，共有 454 名儿童通过疫苗接种后血清学检测 (PVST) 确定免疫预防成功7 个月大时被纳入本研究。在 454 名儿童中，246 名从未接受过乙肝加强针，208 名儿童在 1 至 5 岁期间接受了乙肝加强针。多变量逻辑回归分析用于分析 HBV VBIs 的危险因素。
结果

乙肝表面抗体（抗-HBs）水平从7个月到2岁急剧下降，抗-HBs血清阴性率从2岁开始显着升高。 454 名儿童中共有 31 名 (6.83%) 经历过 VBI，其中 7 名为显性 HBV 感染，7 名为隐性 HBV 感染。值得注意的是，在 31 名患有 VBI 的儿童中，有 14 名 (45.16%) 在 2 岁时被诊断出来，并且他们在 1 岁时都具有抗-HBs 阳性 (> 10 mIU/mL)。母亲乙型肝炎 e 抗原 (HBeAg) 阳性、较高的 HBV DNA 和 HBsAg 水平、较低的初始婴儿抗-HBs 水平和未接受加强 HepB 是 VBIs 的独立危险因素。接受加强 HepB 的儿童的 VBI 发生率显着低于未加强儿童（0.50 对 11.90%，P < 0.001），并且加强儿童均未发生明显或隐匿的 HBV 感染。非加强组 VBIs 儿童的抗-HBs 水平为 76.67%，表明在检测到 VBIs 之前呈阳性。
结论

HepB 初次完全免疫后，慢性 HBV 感染的母亲所生的孩子，尤其是母亲 HBeAg 阳性、HBV DNA 水平高、HBsAg 水平高和/或初始婴儿抗-HBs 水平低的孩子，发生 HB 的风险很高VBIs 和针对 2 岁之前这些儿童的 HepB 加强剂，而不是当他们的抗 HBs 水平为⟉< 10 mIU/mL 时，可以降低 VBIs 的发生率。

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A booster hepatitis B vaccine for children with maternal HBsAg positivity before 2 years of age could effectively prevent vaccine breakthrough infections

    Yarong Song, Xin Zhang, Minmin Liu, Xiangjun Zhai, Jianxun Liu, Yi Li, Lili Li, Yiwei Xiao, Zhongping Duan, Jing Jiang, Feng Ding, Liguo Zhu, Jie Jiang, Huaibin Zou, Hui Zhuang, Jie Wang & Jie Li 

BMC Infectious Diseases volume 22, Article number: 863 (2022) Cite this article

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Abstract
Background

The long-term protective effect of hepatitis B vaccine (HepB), the incidence of hepatitis B virus (HBV) vaccine breakthrough infections (VBIs), and whether a booster HepB is necessary remain to be clarified in children born to mothers with chronic HBV infection.
Methods

Based on a long-term follow-up prospective cohort of 1177 hepatitis B surface antigen (HBsAg)-positive mothers and their paired infants which was established from 2009 to 2011, total 454 children with immunoprophylaxis success as determined by postvaccination serologic testing (PVST) at 7 months old were included in this study. Among the 454 children, 246 never had a booster HepB, and 208 children received a booster HepB from 1 to 5 years of age. Multivariate logistic regression analysis was used to analyse the risk factors for HBV VBIs.
Results

The hepatitis B surface antibody (anti-HBs) levels declined sharply from 7 months to 2 years old, and the anti-HBs seronegative rate in the children increased significantly from 2 years old. A total of 31 (6.83%) of the 454 children experienced VBIs, of which 7 had overt and 7 had occult HBV infections. Notably, 14 (45.16%) of the 31 children with VBIs were diagnosed at 2 years old, and all of them had anti-HBs positivity (> 10 mIU/mL) at 1 year old. Maternal hepatitis B e antigen (HBeAg) positivity, higher HBV DNA and HBsAg levels, lower initial infant anti-HBs levels and not receiving a booster HepB were independent risk factors for VBIs. The incidence of VBIs was significantly lower in children with a booster HepB than in nonboosted children (0.50 vs. 11.90%, P < 0.001), and none of the boosted children developed overt or occult HBV infection. The anti-HBs levels of 76.67% for the children with VBIs in the nonboosted group indicated positivity before VBIs was detected.
Conclusions

After the primary full immunization with HepB, children born to mothers with chronic HBV infection, especially the children with maternal HBeAg positivity, high HBV DNA levels, high HBsAg levels and/or low initial infant anti-HBs levels, were at a high risk of VBIs, and a booster HepB for these children before 2 years old, instead of when their anti-HBs level is < 10 mIU/mL, could reduce the incidence of VBIs.

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https://bmcinfectdis.biomedcentr ... /s12879-022-07854-w