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Buebendorf医生问:由于乙型肝炎疫苗的价格为一般人所能承担,因此我们决定对所有儿童(包括较大儿童和新生儿)进行免疫接种。目前我们按标准程序(0、2、6月)对婴儿和青少年进行免疫。但是,要使2～12岁儿童在2个月和4个月后再来接种疫苗较为困难。我们地区的1名儿科肝病学家建议,鉴于所有儿童每年体检1次,因此可在嗣后每年体检时给予第2和第3剂疫苗。她认为这种疫苗间隔时间(需2年完成3剂免疫接种)能诱导足够的抗体应答。但是我查不到支持这种免疫方案的文献资料,请问这种非标准免疫程序可行吗? Greenberg医生(美国Harbor-洛杉矶加利福尼亚大学医学中心)答:为全世界婴儿推荐的乙型肝炎疫苗接种程序是有灵活性的,因此,医生可将该疫苗纳入其常规的儿童保健计划。美国儿科学会及疾病控制和预防中心的免疫实施咨询委员会向未感染乙型肝炎母亲所生的婴儿推荐下列两种免疫程序:(1)出生时,1～2月龄和6～18月龄;(2)1～2月龄、4月龄和6～18月龄。较大儿童和青少年的常规免疫接种程序为0、1、6月。但是,如Buebendorf医生所述,要使较大儿童按该程序完成3次免疫接种给家长带来诸多不便,每年接种1次,2年内完成免疫程序不失
Dr. Buebendorf asked: Since the price of hepatitis B vaccine is affordable for most people, we decided to immunize all children, including older children and newborns. At present, we immunize infants and adolescents according to standard procedures (January, June and June). However, it is more difficult for children 2 to 12 years old to get vaccinated again after 2 months and 4 months. A pediatric hepatologist in our area suggested that the second and third doses of the vaccine be given on each subsequent annual medical examination, given that all children undergo an annual medical examination. She believes that this vaccine interval (3 immunizations take 2 years to complete) can induce sufficient antibody response. But I can not find the literature supporting this immunization program. Could this non-standard immunization program work? Dr Greenberg (University of California-Los Angeles Medical Center, USA) A. Hepatitis B vaccination program recommended for infants worldwide There is flexibility, so doctors can incorporate the vaccine into their regular child care programs. The Advisory Committee on Immunization of the American Academy of Pediatrics and the Centers for Disease Control and Prevention recommends the following two immunization programs to infants born to uninfected hepatitis B mothers: (1) at birth, 1 to 2 months of age and 6 to 18 months of age; (2) 1 ~ 2 months old, 4 months old and 6 ~ 18 months old. Routine immunization programs for older children and adolescents are 0, 1, and 6 months. However, as stated by Dr. Buebendorf, it would be inconvenient for parents to make the 3-time immunization of larger children according to the procedure, once a year, and complete the immunization program within 2 years.