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目的 提高农村儿童乙型肝炎(乙肝)疫苗首针及时接种率。方法 选择离县城>4 0km的乡,随机分成3个组实施不同的策略:第1组用瓶装乙肝疫苗、自毁型(AD)注射器在冷链内使用;第2组用瓶装乙肝疫苗、AD注射器在冷链外使用;第3组用预充式乙肝疫苗(HB -UnijectTM) ,在冷链外使用。实施前后,分别开展了接种率基线和终期调查以及血清学终期调查。结果 不同策略对提高儿童的乙肝疫苗全程接种率和住院分娩儿童的首针及时接种率影响不大,但第1、2、3组儿童的乙肝疫苗首针及时接种率分别由基线调查的8 .1%、13 .0 %、10 . 0 %提高到终期调查的5 7. 9%、70 . 9%、72 .1% ,其中在家出生儿童的首针及时接种率分别由4 . 0 %、4 . 3%、1 .6 %提高到4 0 .0 %、6 0 . 4 %、6 4 .7% ,各组差异均有非常显著的统计学意义。在出生后2 4h内接种首针乙肝疫苗并完成3针后1个月的儿童中,各组乙肝病毒表面抗体(抗HBs)阳转率为90 . 6 % ,在抗 HBs阳转的儿童中,有86 . 6 %产生了保护水平(≥10mIU/ml)的抗体。各组之间、冷链内外、使用AD注射器和使用UnijectTM 之间差异均无显著的统计学意义。结论 使用冷链外存放的乙肝疫苗,由村医及时接种的策略可以安全、有效地提高边远山区儿童,特别是在家出生新生儿的乙肝疫苗首针及时接种率;Un
Objective To improve the timely vaccination rate of hepatitis B (hepatitis B) vaccine in rural children. Methods The townships> 40km away from county town were randomly divided into three groups and divided into three groups. Different strategies were adopted. Group 1 used bottled hepatitis B vaccine and self-destructive (AD) syringes in the cold chain. Group 2 used bottled hepatitis B vaccine, AD Syringes were used outside the cold chain; group 3 was used outside the cold chain with a pre-filled HB vaccine (HB-Uniject ™). Before and after implementation, respectively, the inoculation rate of baseline and terminal investigation and end-stage serological survey. Results The different strategies had little effect on raising the whole vaccination rate of hepatitis B vaccine and the timely first vaccination rate of children born in hospital. However, the first vaccination of hepatitis B vaccine in group 1, 2 and 3 children was investigated by baseline at the same time. 1%, 13.0% and 10.0% increased to 57.9%, 70.9% and 72.1% of the final survey, among which the first needle-inoculation rate of children born at home was increased from 4.0% , 4.3% and 1.6% increased to 40.0%, 60.4% and 64.7% respectively. There were significant differences among the groups. In children born within 24 hours after birth and hepatitis B vaccine after 3 months of completion of 3-needle hepatitis B virus surface antibody (anti-HBs) positive rate of 90.6%, anti-HBs positive in children , 86.6% produced antibodies at the protection level (≥10mIU / ml). There was no statistically significant difference between the groups, between the inside and outside the cold chain, using the AD syringe and using the UnijectTM. Conclusion Hepatitis B vaccine stored outside the cold chain and timely vaccination by village doctors can safely and effectively increase the timely first-dose inoculation rate of hepatitis B vaccine for children in remote mountainous areas, especially newborns born at home.