The Impact of Hepatitis B Vaccine Failure on Long-term Natural Course of Chronic Hepatitis B Virus Infection in Hepatitis B e Antigen-Seropositive Children
The Impact of Hepatitis B Vaccine Failure on Long-term Natural Course of Chronic Hepatitis B Virus Infection in Hepatitis B e Antigen-Seropositive Children
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DOI：
10.1093/infdis/jix339
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发表时间：
2017-09-15
影响因子：
6.4
通讯作者：
Chang, Mei-Hwei
中科院分区：
文献类型：
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作者：
Tai, Chi-San;Wu, Jia-Feng;Chang, Mei-Hwei
背景B型肝炎疫苗接种后，慢性B型肝炎病毒（HBV）感染的疫苗接种失败仍在儿童中发生。本研究旨在调查疫苗接种失败儿童慢性HBV感染的自然病程，并与未接种疫苗儿童进行比较。300五十六例B e抗原（HBeAg）血清阳性、B表面抗原（HBsAg）携带者儿童，随访至少1年，未接受抗病毒治疗。其中包括105名在婴儿期接受3剂HBV疫苗接种的疫苗失败受试者和251名未接种疫苗的受试者。比较两组患者的临床、血清学和病毒学特征。疫苗接种失败组的HBeAg累积血清转换率显著低于未接种组（30.5%比77.7%，P <0.0001）。C基因型HBV感染在疫苗接种失败组中更常见（33.7%比13.4%，P < .0001），母亲HBsAg阳性率更高（97.1%比66.4%，P < .0001）。在多因素分析中，疫苗失败、C基因型感染和母亲HBsAg阳性与延迟HBeAg血清转换显著相关。HBeAg血清阳性疫苗接种失败的HBV携带儿童在长期随访中与延迟的HBeAg血清转换、更多的HBV C基因型感染和母亲HBsAg血清阳性相关。
Background. Vaccine failure with chronic hepatitis B virus (HBV) infection still develops in children after universal hepatitis B immunization. This study aimed to investigate the natural course of chronic HBV infection in children with vaccine failure and compare it with that of nonvaccinated children.Methods. Three hundred fifty-six hepatitis B e antigen (HBeAg)-seropositive, hepatitis B surface antigen (HBsAg) carrier children, who were followed for at least 1 year without antiviral therapy, were enrolled. These comprised 105 vaccine failure subjects who received 3 doses of HBV vaccine in infancy and 251 nonvaccinated subjects. The clinical, serologic, and virologic features were compared between the 2 groups.Results. The cumulative HBeAg seroconversion rate was significantly lower in the vaccine failure group than in the nonvaccinated group (30.5% vs 77.7%, P < .0001). Genotype C HBV infection was more frequent in the vaccine failure group (33.7% vs 13.4%, P < .0001), and the maternal HBsAg-positive rate was higher (97.1% vs 66.4%, P < .0001). In a multivariate analysis, vaccine failure, genotype C infection, and maternal HBsAg positivity were significantly associated with delayed HBeAg seroconversion.Conclusions. HBeAg-seropositive vaccine failure HBV-carrier children were associated with delayed HBeAg seroconversion during long-term follow-up, and more HBV genotype C infection and maternal HBsAg seropositivity.