| BackgroundHepatitis B virus(HBV)infection is a serious global public health problem.In China,HBV infection is high and middle prevalent,about 700 million people were infected,and 120 million were longtime carriers,which was one of third of the global carrier.30 million would develop chronic hepatitis,and 300 thousand died from cirrhosis of the liver and HCC from hepatitis B-related disease every year. Acknowledged by all over the world,Hepatitis B vaccination is the most effective measure to prevent HBV infection and its consequences.The hepatitis B vaccine had been introduced into expanded program on immunization(EPI)in our country in 1992, to date,immunization strategy for infants has been implemented with considerable success.But our anti-HBV engineering still face many difficulties and challenges: while the incidence for the vaccinated children had been descending,the rates of HBsAg and all the HBV markers for the total population didn't descend clearly, Currently,the total incidence of Hepatitis B even increased;by near effect,the infant national immunization programme of hepatitis B could prevent perinatal infection (from infected mother to child),but could not prevent adult-to-adult transmission, which was reported more and more often;still about 5～10%vaccinees turned out to be non or hypo-responders,they were susceptible to HBV.To quicken the step of controlling HBV,new adult implementation strategies are needed to protect unvaccinated adults at risk for HBV infection;more researches are needed to find the causes of immunization failure,so that we should improve the rate of successful vaccination.ObjectiveThis paper based on analyzing epidemiological characteristics of hepatitis B from 1998,evaluated the immune effects and failure mechanism of hepatitis B vaccination in adults,so that to explore an effective adult immunization strategy,and to provide scientific evidences for the government.Materials & MethodsCases data from the legal infectious diseases suvelliance system annals from Disease Control and Prevention of Shaoxing City.Population data from Statistic Bureau of Shaoxing City and national census in 2002.Cases data were imput into Excel 2003.The epidemiological characteristics of hepatitis B,such as area,year,sex,occupation distribution,were expressed by statistical charts and sheets.Quasi-experiment epidemiological approach was utilized to statistically analyze immunization effect of the hepatitis B vaccine in adults.The objects were selected in a factory in an urban district of Shaoxing City,which were aged 18～50.Before being vaccinated,they were tested serological HBsAg,anti-HBs.The total negative cases were served as vaccinating objects,3 doses chinese hamster ovary cell (CHO)recombinant hepatitis B vaccines were given to them,following the 0,1,6 months schedule.Anti-HBs,the title of anti-HBs were tested one month and one year after vaccination.The non-or-hyporesponders were paird with the strongresponders and were investigated comparable on some risk factors.The vaccines were provided by the Pharmacy Factory of North of China,Jintan Techno-Biology Ltd.Results1 Epidemiologieal characteristics of hepatitis B during 1998～2006 in Shaoxing city. hepatitis B was a preponderant hepatitis in shaoxing city,and the reported incidence was 93.76 per 100,000 in 2006,which was 2.25 times than that reported first in 1990.There were 74.48%of the total cases in Yuecheng district,Shaoxing county and Zhuji county,because of the floating population swarmming into the three areas recently.The proportion of＜15-year-old children was 2.72%,while 15～59 years was 89.35%,＞60 years was 7.93%,and the high-prevalence ages were 15～59 years.For＜15-year-old children,the reported incidence was 9.71 per 100,000 in 2006,decending 41.29%from 16.54 per 100,000 in 1998,but other age groups still remained high prevalent.The sex ratio of male and female was 2.37:1.The three high-prevalence occupations were farmers(occupied by 59.25%), workers(12.31%)and students(12.31%).2 Immunation effects after the first whole vaccination471 objects test-negative of HBsAg,anti-HBs were provided with 10μg/ml CHO recombinant hepatitis B,401 objects finished the whole procedure,the rate of the whole vaccination was 85.14%,they were divided into the groups of test-all-negative and test-isolated anti-HBc by the serological filtered results,One month after vaccination,the positive rate of anti-HBs was 96.76%,the median of anti-HBs titer was 352.79mIU/ml.Between the two groups,there were the similar changing immune regulations on the sex,age,etc.The immune respose dropped with the age increased, and the immune respose of the male was poorer than the female.One year after vaccination,the positive rate of anti-HBs was 85.71%,the median of anti-HBs titer was 53.86mIU/ml.3 The effect of booster vaccination after first failed immunationTo observe the effect of booster vaccination after first failed immunation,13 non-or hyporesponsers were boosted using 3 doses of 20μg/ml CHO recombinant hepatitis B by 0,1,6 months,one month after booster vaccination,5 objects were tested positive of anti-HBs,the positive rate was38.46%.4 Study on the causes of immunization failure 4.1 Human leucocyte antigen(HLA)DR district surface type13 non-or hyporesponsers and 13 strong-responsers were paired and were tested on HLA DR district surface type,there was no significant difference between the two groups,the result was different from some literatures perhaps because of the sample too small.4.2 Weak virus infection8 non-or-hyporesponsers after booster vaccination were tested serological HBV DNA by per technique,and one was proved positive.4.3 Common behaviors or life style12 non-or hyporesponsers and 24 strong-responsers paired were surveyed by questionnaire,the results suggested that smoking,obesity,history of hepatitis B family infection,history of exodontia were related with non-or-hyporesponse on hepatitis B vaccine.5 Vaccine safetyNone part or whole ill response was reported from all the vaccinators 24h,48h,72h after vaccination.ConclusionsRecently,the incidence of hepatitis B is servious,adults are the main attacked persons,which is a key factor of the high prevalence.Vaccination is the the most effective measure to prevent HBV infection with maximal cost-benefit.The immune effects in adults are similar as in infants,the earlier adults vaccinate,the better the immune effects.Men,old folks had better select high-dose vaccines.The similar changing immune regulations between the healthy group and isolated anti-HBc group, people with isolated anti-HBc should be added into vaccinating objects.Weak virus infection,age,smoking,exodontias are risk factors of immune response on hepatitis B vaccines.The government should make hay while the sun shines to establish immunization strategies implementation scheme for adults,so that we could quicken the steps on playing down and controlling hepatitis B virus.
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