五專護理學生B型肝炎表面抗原與抗體盛行率調查研究

Prevalence of Hepatitis 巳 Surface Antigens and Antibodies in Nursing Students Who had been Vaccinated against Hepatitis B 16 Years Ago

台灣於1984年開始實施全國性的B型肝炎疫苗計畫，前兩年只有巳型肝炎陽性的母親所生的嬰兒接受疫苗注射，而自1986年開始延伸到所有的新生兒。這個計畫有效的降低B型肝炎的傳染，本研究的目的是經由調查五專護理科新生入學體檢的B型肝炎表面抗原及抗體資料，以了解巳型肝炎表面抗原及抗體的現況與變化。自2000-2008年，共有7,638位就讀於南部某科技大學專科部護理科的新生納入此研究中，B型肝炎HBsAg及Anti-HBs的分析，使用MEIA分析方法。結果顯示，在1984-1985出生世代的學生，其B型肝炎表面抗原陽性盛行率為4.2%，而1986-1992出生世代的學生，其B型肝炎表面抗原陽性盛行率為1.8%，兩者之間達統計學上的差異，p值<0.05。而B型肝炎表面抗體陽性（效價>10mlU/mL）的盛行率，在1984-1985出生世代為74.0%，而在1986-1992出生世代則為42.5%，兩者之間達到統計學上的差異，p值'<0.05。我們的研究再次證明全國性的B型肝炎疫苗注射計畫之成效，巳型肝炎的表面抗原陽性盛行率顯著下降。同時，我們也觀察到B型肝炎表面抗體（Anti-HBs）的陽性率下降的現象。對於B型肝炎抗體效價下降，是否需追加疫苗注射，仍有許多的爭議。然而在B型肝炎高盛行率台灣，目前最佳的策略是針對這些未來的護理工作入員，若有抗體消失的情形，建議給予追加疫苗注射，並於進入醫院實習前完成確認抗體已產生，避免因針頭或尖銳物品扎傷感染B型肝炎。

The national hepatitis B (HB) vaccination program was launched in Taiwan in July 1984. In the first 2 years, only infants born to HBsAg (HB surface antigen) carrier mothers were vaccinated. This program was extended to all infants in July 1986 and was successful in preventing HB virus (HBV) infection. The purpose of this study was to investigate the levels of HBsAg and anti-HBs (antibodies to HBV) in the first-year students of a 5-year nursing program in Taiwan who had received HB vaccination 16 years ago. During 2000-2008, the first-year students of a 5-year nursing program at Fooyin University, a vocational university located in southern Taiwan, were examined for the levels of HBsAg and anti-HB antibodies by using commercially available microparticle enzyme immunoassay. The seroprevalence of HBsAg (+) showed a significant decline, reducing from 4.2% in the 1984-1985 birth cohort to 1.8% in the 1986-1992 birth cohort. The seroprevalence of anti-HBs (+) also showed a decreasing trend, decreasing from 74.0% in the 1984 - 1985 birth cohort to 42.5% in the 1986-1992 birth cohort. These data showed the effectiveness of HB vaccination and the decrease in the anti-HBs seropositivity. The necessity of booster vaccination for health-care workers is still a subject of much debate despite the fact that Taiwan is an endemic area for HBV. To prevent HB infection caused by needle-stick injury, nursing students must be recommended to undergo a serology test and receive HB booster vaccine before they begin their clinical practice.