【摘要】 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更多还原

【Abstract】 Objective To improve the first hepatitis B vaccine inoculation rate of the rural children.Methods We selected the townships ≥40km distance from County Center,and randomly devide into 2 groups. We applied hepatitis B vaccine umpoule in the first group. AD sylinges was used in the cold chain and rural doctors used the injector one time every 2 months.AD injector was used outside the cold chain in the second group. HB-Uniject was used in the third group and hepatitis B vaccine can be used outside the cold chain. Hepatitis B vaccine can be preserved under room temperature outside the cold chain. The baseline of inoculation rate and serum HBV-marker on last phase were detected before inoculation and after inoculation. Results There were no different effection on improving hepatitis B vaccine inoculation rate and the first inoculation rate of puerperal children in the groups. The first inoculation rate of hepatitis B vaccine in the groups increased from 8.1%,13.0%,10.0% to 57.9%,70.9%,72.1%.What’s more,the first inoculation rate of hepatitis B vaccine in children who borned in home increased from 4.0%,4.3%,1.6% to 40.0%,60.4%,64.7%.HBs-Ab positive rate in children injected the first hepatitis B vaccine within 24 hours was 90.6%.86.6 percent HBs-Ab(≥10mIU/mL) has protective function among HBs-Ab positive children.There was no remarkably differerent on serum HBs-Ab level among three groups,between inside the cold chain and outside the cold chain,between AD injector and UnijectTM (P>0.05). Conclusion The strategy that rural doctors use hepatitis B vaccines preserved outside chill chain in time can effectively improve the first hepatitis B vaccine inoculation rate of children living in remote regions,especially infants borned at home.UnijectTM is easier used by rural doctors than AD injector and might improve the first hepatitis B vaccine inoculation rate to some extent.更多还原