Long-term protection against carriage of hepatitis B virus after infant vaccination
Long-term protection against carriage of hepatitis B virus after infant vaccination
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DOI：
10.1086/503433
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发表时间：
2006-06-01
影响因子：
6.4
通讯作者：
Whittle, HC
中科院分区：
文献类型：
--
作者：
van der Sande, MAB;Waight, P;Whittle, HC
背景B肝炎病毒（HBV）的携带是肝硬化和肝细胞癌的主要危险因素。婴儿接种疫苗在预防幼儿期的横向传播方面是有效的。目前尚不清楚保护是否维持到早期成年。1984年，在冈比亚的两个农村实行了儿童早期疫苗接种。2003年，对1350名1-24岁合格参与者中的81.5%进行了血清学评估，以确定疫苗对感染和携带的有效性。疫苗对感染和携带的总体有效性分别为83.4%（95%置信区间[CI]，79.8% - 86.6%）和96.5%（85% CI，93.9% - 98.9%）。当仅限于初级应答者时，疫苗对感染的效力相似（85.3%），但峰值抗体浓度的影响显著。疫苗效果和B表面抗体水平（抗-HBs）随着年龄的增长而下降，导致20-24岁参与者中70.9%的疫苗对感染和携带的有效性（95% CI，60.4% - 80.5%）和91.1%（95% CI，75.8%-100%）。接种疫苗15年后，不到一半的接种者有可检测到的抗-HBs。未接种疫苗人群的携带率与20年前的携带率相似。结论。尽管抗体水平下降，但在生命早期接种HBV疫苗可以提供持久的保护。需要评估亚临床加强的作用和加强剂的必要性。
Background. Carriage of hepatitis B virus (HBV) is a major risk factor for liver cirrhosis and hepatocellular carcinoma. Infant vaccination has been effective in preventing horizontal transmission during early childhood. It is unknown whether protection is maintained into early adulthood.Methods. In 1984, early childhood vaccination was introduced in 2 rural Gambian villages. In 2003, serological assessment of 81.5% of 1350 eligible participants 1-24 years old was done, to determine vaccine efficacy against infection and carriage.Results. Overall vaccine efficacy against infection and carriage was 83.4% (95% confidence interval [CI], 79.8% - 86.6%) and 96.5% (85% CI, 93.9% - 98.9%), respectively. Vaccine efficacy against infection was similar when restricted to primary responders (85.3%), but a significant effect of peak antibody concentration was found. Both vaccine efficacy and levels of hepatitis B surface antibody (anti-HBs) decreased with age, resulting in a vaccine efficacy against infection and carriage among 20-24-year-old participants of 70.9% ( 95% CI, 60.4% - 80.5%) and 91.1% ( 95% CI, 75.8%-100%), respectively. Fifteen years after vaccination, fewer than half of the vaccinees had detectable anti-HBs. The prevalence of carriage in the unvaccinated population was similar to the prevalence 20 years earlier.Conclusions. HBV vaccination early during life can provide long-lasting protection against carriage, despite decreasing antibody levels. The role played by subclinical boosting and the necessity of a booster need to be evaluated.