The Assessment Of Immune Efficacy And Study On Hepatitis B Vaccination Strategy For Army Crowd

China is still considered to be a medium and highly endemic region.In 2006sero-surveys,the Ministry of Health reported an HBsAg-positive rate of7.18%,indicating that there were up to 93 million HBV-infected individuals and 25million individuals with chronic hepatitis B in China.Every year the mortality of Hepatiti B related disease is as high as 330 thousands.In the face of threats,reasonable vaccination is still the most internationally accepted measures to chonrol contagion.The army,as a special group with a vital mission,are particularly important for its vaccination.ObjectiveSince 2006,the new recruit has received 3 does immunization schedule of10?g Recombinant Yeast-derived Hepatitis B Vaccine at 0,1,6 month.However,in the past 10 years,the incidence of hepatitis was always the top three in the PLA infections disease reporting system.Hepatitis B,one of the most prevalent disease,has become one of the major infectious diseases that threaten the health of army crowd.Therefore,how to strengthen and improve our army's immune programming has increasingly become a logistics health guarantee focus.Based on the real and effective experiment data,this study comprehensively analyzed the immune background and did the sero-survey data of new recruits after the EPI to make clear the prevention,in this case,to definite the key point for preventive and control measures of Hepatitis B Vaccination.For the first time,we carried out the observation on immune effect which anti-HBs screening following by re-classification 20?g vaccination in military members.Firstly,it provided a full range of data support for the comprehensive exploration of better Hepatitis B immunization strategy,using the method of health economics analysis,so as to achieve the purpose of effectively controlling spread of infectious disease in PLA.Method1.On the basis of random sampling investigation,this study selected recruits from 10 units in 2013 as survey subject,including grassroots units and military academies,and used the self-designed questionnaire of Hepatitis B Vaccination Cases Investigation to collect information,which covered the essential information of new recruits,past vaccination history,history of infection,allergic history,et al.2.Blood samples from recruits'physical reexamination were collected as the serum baseline lever of anti-HBs before vaccination.The combination of ELISA preliminary screening and CLIA retest was used to detect Anti-HBs lever.3.According to the results of pre-immune anti-HBs,the subjects were divided into three groups:anti-HBs positive,anti-HBs weak-positive and anti-HBs negative.For the weak-positive and negative subjects,20?g Hepatitis B Vaccine was inoculated at 0,1,6 month.After 28 days of each dose,blood samples(3ml)were taken for positive seroconversion rate and antibody titres lever test,which used ELISA preliminary Screening and CLIA retest,in addition,seroconversion rate,antibody titres and negative subjects'hige responds were compared with each other.At the same time,Vaccine Adverse Events weretaken down through the vaccination study visit.4.We established 2 decision tree models of the existing immunization scheme and the pre screening one by TreeAge Pro V2011.We adopted the method of benefit-cost analysis to compare the full vaccination with the pre screening one.The data were generated into the cost-benefit formula in order to calculating the annual cost,benefit,net benefit and benefit cost ratio of those 2vaccination scheme separately and comparing the gap between them.Result1.Questionnaire analysis:According to the Questionnaire of Hepatitis B Vaccination Cases Investigation,the recruits age ranged from 16 to 25 years.There were 2914 patients with clear history of hepatitis B vaccination,accounting for 58.58%;963 without vaccination history,accounting for 19.36%;1097 were unknown,accounting for 22.06%.2.Before immunization,serum levels of anti-HBs were detected by ELISA and CLIA.The level of anti-HBs positive in recruits was 5761,accounting for57.03%,1090 anti-HBs weak-positive,accounting for 10.79%,3251 anti-HBs negative,accounting for 32.18%.3.Evaluation Immunization effect of recruits after 20?g HepB-SCY:After the first,second and third dose,the 20 microgram dosages of HepB-SCY increased the seroconversion(anti-hepatitis B surface antigen)rate to 90.24%,97.82%and 99.52%in weak-positive recruits,respectively.There were significant differences between the second dose and the first one(?~2=25.65,P<0.01),but there were no significant differences between the third dose and the second one(?~2=4.66,P>0.01).Geometric Mean Titer(GMT)were more than 1575.92mIU/ml after the first dose and up to 2144.59mIU/ml after the second dose in weak positive recruits,showing significant difference between them(Z=-2.372,P<0.01).After the first,second and third does,seroconversion rates in the negative recruits were 78.18%,86.13%and 98.72%,respectively.There were significant differences between the third dose and the second one(?~2=118.50,P<0.01),also between the second one and the first(?~2=158.09,P<0.01).The high-responding seroconversion rates were 36.9%,56.43%and 87.53%,respectively.There were significant differences between the third dose and the second one(?~2=231.07,P<0.01),also between the second one and the first(?~2=142.81,P<0.01).The GMT in negative recruits were 101.35 mIU/ml,155.81mIU/ml and 747.31 mIU/ml after the first dose,the second and the third,respectively.There were significant different between the third dose and the second(Z=-23.042,P<0.01),the same results between the first dose and the second one(Z=-3.099,P<0.01).Among them,the distribution of GMT data after the third was more concentrated in the high value interval,indicating that its immune effect was significantly better than the second and the first one.The incidence of adverse reactions to the vaccine was 1.97%(95%CI:1.17%~2.89%)and no serious allergic reactions were observed.4.We established 2 decision tree models to compare the existing immunization scheme with the pre screening one.Costs:If the PLA recruits 200 thousands each year,the cost of existing vaccination and vaccination after screening were 312.00 million and 234.73million yuan.Benefits:The annual economic burden of acute hepatitis B,chronic hepatitis B,compensatedhepatocirrhosis,decompensatedhepatocirrhosis,hepatocellular carcinoma and severe hepatitis were 46,300 yuan,79,900 yuan,125,400 yuan,96,500 yuan,192,800 yuan and119,800 yuan.Combined with the probability of all diseases after the hepatitis B virus infection,the annual economic benefits of the two immunization methods were 5.48 million yuan and6.41 million yuan.Cost-Benefit Analysis:The existing immunization method is expected to reduce 106.75 patients within one year,and the pre-screening method reduces124.91 patients.The net benefits of those two methods were 2.29 million and3.93 million yuan with a benefit-cost ratio of 1.76 and 2.72 respectively.Conclusions1.Through the questionnaire and pre-immune anti-HBs test,it shows that more than half of the new recruits have been vaccinated with hepatitis B virus and maintain an effective antibody level.After enlisting,there is no need to repeat the hepatitis B vaccine.2.It is necessary for new recruits to screen serum anti-HBs before immunization,and then carry on scientific vaccination.Pre-immune serum anti-HBs weakly positive subjects select 0-1 two-needle vaccination program,and serum anti-HBs negative subjects select 0-1-6 three needle vaccination program.Inoculation of 20?g HepB-SCY could stimulate the body to produce higher levels of anti-HBs and could effectively increase the population's positive rate and response rate.When conditions permit,inoculation of a 20?g dose of Hepatitis B vaccine will allow troop officers and soldiers to receive more efficient and lasting immunoprotection.3.After screening,the Classification of vaccination methods is more advantageous in health economics than the full vaccination method.Therefore,based on the screening results of target population's anti-HBs level,classified implementation of hepatitis B vaccine inoculation,will significantly improve the efficiency of the use of military health and epidemic prevention funds and the precision of hepatitis B prevention and control.