Peking University Health Science Center
HBV 20 HBV 1/3 15%~25% HBV HBV 3.5~4 >5% 2/3 1/3 60 100 7 WHO and CDC fact sheets, available at www.who.int and www.cdc.gov Van Damme P. Vaccine, 2004, 3:249-267
HBV 7~8 HBV 1/3 15%~25% HBV HBV 1~1.2 >10% 13 30 7 WHO and CDC fact sheets, available at www.who.int and www.cdc.gov Van Damme P. Vaccine, 2004
( ) 12 648 1 625 6 204 20 477 22 867 1 581 11 875 36 323 21 326 973 14 458 36 753 18 497 5 591 14 179 38 267 17 474 2 299 10 431 30477 ( ) 9151 2.25 1 395 1 1 2,. 2002, 7(2):79-81
1992~2001 10 2 400 41.22 172:1,., 2004, 25:474-478
WHO (1991, 10 7~9 ) HBsAg 8% 1995 1997
, 1990~2004 (%) 100 200 168 151 80 150 141 124 110 60 100 89 80 40 50 20 20 0 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 WHO 2004
2004 2007 HepB3 90% WHO Wkly Epidemiol Report, 2003, 42, 366-370; 2004
1992.01.01 2002.01.01 2005.06.01 HBV HBV 10 HBV
40% 46% 39% 31% 88.5% 62.7% 70.7% 8% 41% 44% 25% 41% (1999) 47% 90% ( 4 ) 75~8% ( 9 ) 50~7% < 50% ( 8 ) (10 )
70 60 50 40 30 20 10 0 (%) 100 90 80 HepB 3, 2004 ( 2003 1~9 41 826 ) : 28.6%~99.8% ( 89.4%)
1992~1995 2002 HBsAg Heilongjian g Heilongjian g Xinjiang Tibet Gansu Qinghai Sichuan Yunnan Ningxi a Chongqing Guizhou Guaangxi Inner Mongolia Shaxi Beijing Hebei Shanxi Henan Liaoning Tianjin Shandong Jiangs u Anhui Hubei Zhejia ng HunanJiangxi Fujian Guangdon g Jilin Shanghai Taiwan Xinjiang Tibet HBsAg 9% Gansu Qinghai Sichuan Yunnan Ningxi a Chongqing Guizhou Guaangxi Inner Mongolia Shaxi Beijing Hebei Shanxi Henan Liaoning Tianjin Shandong Jiangs u Anhui Hubei Zhejia ng HunanJiangxi Fujian Guangdon g Jilin Shanghai Taiwan Hainan 7~8% 4~6% Hainan 1992~1995 2002 1992~1995 2002 HBsAg + (%) No. (x10 6 ) 9.7 8.2 120.6 100.6
12 10 9.7 10.2 11.3 11.5 10.5 2002 HBsAg(%) 8 6 7.1 9.2 9.7 1992~1995 4 4.8 2 3.1 0 1~ 5~ 10~ 15~ 20~ 30~ 40~ 50~ 60~ 1995 2002 HBsAg 1992~1995 2002
1990~2001 10~14 (/10 ) 15~19 1990 12.1 16.9 22.1 1992 8.9 19.2 22.7 1994 6.3 15.9 20.2 1996 4.9 16.4 15.7 1998 6.6 19.3 16.4 2000 4.8 15.6 20.1 2003 2.0 10.6 16.5,., 2004, 25:388-390
(/10 ) ( ) 1969-1988 1996-2001 ( ) ( ) 10~ 1585 365 91( 5.7) 484 390 2( 0.4) 14.3 20~ 836 197 438( 52.4) 415 159 53(12.8) 4.1 30~ 615 279 807(131.2) 261 755 154(58.8) 2.2 40~ 530 998 758(142.8) 194 943 162(83.1) 1.7 50~ 388 921 469(120.6) 159 779 145(90.8) 1.3 60 456 126 265( 58.1) 190 543 118(61.9) 0.9,., 2004, 25:385-387
6~14 1.0 (/10 ) 0.8 0.6 0.4 0.7 /10 0.57 /10 0.36 /10 0.2 0 1981~1986 1986~1990 1990~1996 Chang MH, et al. N Engl J Med 1997
WPRO 2002 6 26~29 2005 75% 1 HBsAg <1% 2007 1 HBsAg <1%
2005~2015 10 HBsAg <1% HBsAg <7% >90% 24 >80%
12 10 9.7 10.2 11.3 11.5 10.5 2002 HBsAg(%) 8 6 7.1 9.2 <1% 9.7 1992~1995 4 4.8 2 3.1 <1% 0 1~ 5~ 10~ 15~ 20~ 30~ 40~ 50~ 60~ 1995 2002 HBsAg 1992~1995 2002
HBsAg HBIG 24 3
AASLD Practice Guideline: Chronic Hepatitis B (Hepatology, 2004, 39:857-861) Newbornes of HBV-infected mothers should receive HBIG and hepatitis B vaccine at delivery and complete the recommended vaccination series. (I) HBIG and concurrent hepatitis B vaccine have shown to be 95% efficacious in the prevention of perinatal trasmission of HBV. (1, 2) 1. CDC. MMWR, 1985, 34:313-346; 2. Wong VC, et al. Lancet, 1984, 1:921-926
EASL International Consensus Conference on Hepatitis B (J Hepatology, 2003, 38:533-540) Programs of universal HBV vaccination at birth should be implemented in all countries. The babies of HBsAg positive mothers should be vaccinated at birth Hepatitis B immune globulin (HBIG), where available, should also be administrated to neonates of HBV infected mothers and to subjects with recent percutaneous or sexual exposure to HBV.
2.1%~19.0% (10 ) 21.3%~35.0% (16 ) 56.6%~68.9% (5 ) (1999)
HBV 24 2.1%~19.3% (10 ) 21.5%~35.8% (16 ) 57.9%~69.9% (5 ) (1999)
AASLD Practice Guideline: Chronic Hepatitis B (Hepatology, 2004, 39:857-861) Sexual and household contacts of carriers should be tested for HBV (HBsAg and anti-hbs) and if negative receive hepatitis B vaccination. (II-2) Persons who remain at risk for HBV infection such as infants of HBsAg-positive mothers, health care workers, dialysis patients, and sexual partners of carriers should be tested for response to vaccination.
EASL International Consensus Conference on Hepatitis B (J Hepatology, 2003, 38:533-540) Universal immunization programs do not obviate the need to immunise high-risk individuals, including health care workers, subjects with multiple sexual partners, intravenous drug users, and contacts of HBV infected individuals (grade B).
EASL International Consensus Conference on Hepatitis B (J Hepatology, 2003, 38:533-540) Inividuals at high risk of acquiring HBV infection for any medical reason (e.g. haemodialysis) should be offered vaccination early, if there is a possibility that they may become unresponsive later (e.g. terminal renal failure, immunesuppressive therapy) (grade C). Individuals at risk of acquiring HBV infection because of life style should also be offered vaccination (grade C).
HBV / / /
HBsAg(%) HBV (%) 13 10~20 7 70~85 35~80 60~80 6 35~80 3~10 20~80 HBV 3~6 30~60
HBsAg 1~8% HBV 10~80% 1~2% 15~30% 1% 10~25% 0.5% 5~20% 0.3% 3~10% ( ) 0.3% 3~5%
1978~2000 HBV 30000 25000 20000 15000 10000 5000 HBV IV 0 1978 1982 1986 1990 1994 1998
HBV HBV HBV HBV HBV HBV
HBsAg ( )
HBsAg
HBIG HBV? 1. WHO 2. 3. HBV 4. HBIG
5. HBsAg HBIG 6. HBIG IV HBIG 1~7 IV HBIG 10 000 IU 10 000 IU 6 2 1 000 18 -HBs >100~500IU
APASL Consensus Statement on the Management of Chronic Hepatitis B: A 2005 Update (Liver International, 2005,25: 472-489) Liver transplantation for chronic HBV infection: 1. High-dose (10 000 IU/month) intravenous HBIG 2. Low-dose (800 IU daily for 1 week then monthly)
HBV Recombivax HB (Merck) Dose(ml) Engerix-B (GSK) Dose(ml) 11 5 µg(0.5) 10 µg(0.5) 11~19 20 5 µg(0.5) 10 µg(1.0) 10 µg(0.5) 20 µg(1.0) 40 µg(1.0)* 40 µg(2.0)** : 0 1 6 HBsAg HBIG * **0 1 2 6 2ml
20 µg 10 µg HBV ( ) (%) GMT(Miu/ml) 20 µg* 10 µg 20 µg* 10 µg Crovari 83 19.9 96.0 93.3 1098 1013 Dahl-Hanse 139 21~62 100.0 100.0 2943 729 Renzulli 241 20~50 98.3 93.1 15018 1110 Treadwell 392 39~70 91.0 85.0 840 340 Poovorawan 320 18~22 97.9 97.1 4774 2705 Chiaramonte 507 16~40 99.6 99.2 22601 3569 * Engerix-B HBV
Foster GR & Goldin RD. Management of Chronic Viral Hepatitis (Second edition). Taylor & Francis, London & New York, 2005, p12-13 There is ongoing debate as to whether all hepatitis B vaccine recipients should be tested for the presence of antibodies and offered booster vaccinations at regular intervals. The current consensus is that such an approach is unneccessary
(the anamnestic response to the first vaccination schedule should provide sufficient protection against further exposure), but in people at very high risk (e.g. medical personne) it may be prudent to adopt a more cautious approach and maintain high titers of protective antibody, as outlined above.
EASL International Consensus Conference on Hepatitis B (J Hepatology, 2003, 38:533-540) At the moment, booster doses are generally not recommended and the occasional emergence of HBV escape mutants does not threaten effectiveness of immunisation programs with current vaccine.
18 HBsAg (%) -HBs >10IU/ml (%) 5 9 13 16 18 5/988(0.5) 2/374(0.5) 1/520(0.2) 2/422(0.5) 2/402(0.5) 429/716(59.9) 151/374(40.4) 115/422(27.3) 121/402(30.1),., 2005, 11: 204-207.
HBV HBV +/No. (%) +/No. (%) 1-2 3-4 5 6 7 8 9-10 11-12 13-14 15 47/2 849(1.7) 23/1 505(1.5) 51/3 306(1.5) 32/1 924(1.7) 35/2 189(1.6) 33/2 156(1.5) 51/3 171(1.6) 22/1 712(1.3) 19/2 335(0.8) 9/ 551(1.6) 111/2 849(3.9) 51/1 505(3.4) 93/3 306(2.9) 47/1 924(2.5) 83/2 189(3.8) 78/2 156(3.6) 101/3 171(3.2) 51/1 712(3.0) 65/2 335(2.8) 18/ 551(3.3) % (95% CI) 89.6(86.6-92.6) 90.4(86.4-94.3) 90.3(87.6-93.0) 89.5(85.9-93.2) 89.9(86.6-93.3) 90.4(87.1-93.7) 89.9(87.1-92.7) 91.9(88.6-95.3) 94.9(92.6-97.2) 89.7(83.1-96.4). 2002; 16:146~149
HBsAg+ -HBs+ 0.5 7/260 20/274 218/260 20/274 (2.7%) (7.3%) (83.8%) (7.3%) 12 6/171 18/179 79/171 61/179 (1.8%) (10.1%) (46.2%) (34.1%) 15 1/52 9/54 26/52 18/54 (1.9%) (16.7%) (50.9%) (33.3%). Chin Med Sci J 1999; 14(Suppl): 17~20
-HBs (%) 100 80 50 40 20 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 -HBs 2002;16:146~149) (.
-HBs (GMT) -HBs +/N (%) GMT (miu/ml) 83.8 38/57 ( 66.7) 1 57/57 (100.0) 545.9 2 42/57 ( 80.8) 301.9 3 37/52 ( 71.2) 135.8. 2002; 8:61~64
1833 15~18 3 15~18 1.47%HBsAg 98.53%HBsAg 67% -HBs 29% 15~18, 2005
HBsAg HBIG 24 3 HBsAg HBIG HBV -HBs
HAND in HAND to ACT against HBV Thank you!