HBV (5) _ Prevention

(i) Hepatitis B vaccine prevention

Hepatitis B vaccine is the most effective way to prevent HBV infection. In 1992, our Ministry of health included the hepatitis B vaccine in the planned immunization management, and the hepatitis B vaccine was administered to all newborns, but the cost of the vaccine and its inoculation was to be paid by parents; Since 2002, immunization has been formally included, and hepatitis B vaccines are available to all newborns free of charge, subject to vaccination -All free of charge, since June 1, 2005.

The hepatitis B vaccine is targeted primarily at newborns [25], followed by infants and high-risk groups (such as medical personnel, people with frequent contact with the blood, staff of nurseries, organ transplant patients, people who often receive blood transfusions or blood products, immunocompromised persons, vulnerable persons, HBsAg positive family members, Male homosexual or having multiple sexual partners and intravenous injecting drug users, etc.). Vaccination of hepatitis B vaccine total 3 needles, according to 0, 1, 6 months procedure, that is, after vaccination of the 1th needle vaccine, interval 1 and 6 months injection

2nd and 3rd needle vaccines. The sooner a newborn is vaccinated against a hepatitis B vaccine, the better it is required to be vaccinated within h after birth. In the area of the anterior thigh, children and adults were injected into the muscles of the middle arm deltoid muscle. The protective rate of hepatitis B vaccine alone was 87.8% [26] (ⅱ-3) to prevent mother-to-child transmission.

For newborns with hbsag positive mothers, the hepatitis B immunoglobulin (HBIG) should be injected as soon as possible after birth, preferably within a few h of birth, the dose should be ≥100 IU, and inoculated 10μg recombinant yeast or 20μg Chinese hamster oocytes (CHO) hepatitis B vaccine at different sites, can be significantly To improve the effect of blocking mother-to-child transmission [10, 26, 27] (ⅱ-3). It is also possible to inject 1-pin hbig,1 months after birth and then inject the 2nd needle hbig, and at the same time to vaccinate a needle 10μg recombinant yeast or 20μg CHO hepatitis B vaccine at different sites, 1 and 6 months respectively inoculated with 2nd and 3rd needle Hepatitis B vaccine (each 10μg recombinant yeast or 20 μg CHO hepatitis B vaccine) [28]. The latter is less convenient than the former, but its protection rate is higher than the former. Newborn infants who are vaccinated with hbig and hepatitis B after birth are accepted for breastfeeding in hbsag-positive mothers [+] (III).

Newborns with hbsag negative mothers may be immunized with 5μg recombinant yeast or 10μg cho hepatitis B vaccine; children who have not been vaccinated against hepatitis B during the neonatal period should be replanted with a dose of 5μg recombinant yeast or 10μg cho hepatitis B vaccine; recommended vaccination for adults 20μg recombinant yeast or 20μg CHO hepatitis B vaccine. For immunocompromised or non-responders, the vaccination dose and the needle should be increased, and the 3-pin immune procedure could be inoculated with 3 needles, and the anti--HBS in serum was tested for 1-2 months after the 2nd inoculation of hepatitis B vaccine.

The protective effect of antibody responders after hepatitis B vaccination is generally sustained for at least 12 years, so the general population does not require anti--HBS monitoring or enhanced immunity. However, anti--HBS monitoring can be carried out for high-risk groups, such as anti--hbs< miu/ml, can be given additional

Strong immunity [30] (Ⅲ).

(ii) Means of transmission prevention

vigorously promote safe injection (including needle needles), dental equipment, endoscopy and other medical equipment should be strictly disinfected. Medical personnel should be in accordance with the principles of hospital infection Management standard prevention, in contact with the patient's blood, body fluids and secretions, should wear gloves, to strictly prevent the medical source of transmission. Services such as haircuts, shaving, pedicure, puncture and tattoos should also be strictly disinfected. Attention to personal hygiene,

Do not share razors and dental kits. To carry out the correct sex education, if the sexual partner is HBSAG positive person, should vaccinate the hepatitis B vaccine; For multi-personality partners should be regularly checked, strengthen management, sexual intercourse when applying condoms. For pregnant women with positive hbsag, the amniocentesis should be avoided and the delivery time shortened, the integrity of the placenta ensured and the chances of neonatal exposure to maternal blood minimized.

(iii) Accidental exposure of HBV after prophylaxis [31]

After accidental contact with the blood and body fluids of HBV infected persons, the following methods can be treated:

1. Serological testing should be immediately detected HBSAG, anti--HBS, ALT, etc., and reviewed within 3 and 6 months.

2. Active and passive immunity such as hepatitis B vaccine has been vaccinated, and the known anti--hbs≥10 miu/ml, no special treatment. If you have not been vaccinated against hepatitis B, or have been vaccinated against hepatitis B, but the anti--hbs <10 miu/ml or anti--HBS level is unknown, you should immediately inject Hbig 200~400 IU, and at the same time in different parts of the vaccination of hepatitis B vaccine (20μg), in 1 and

The 2nd and 3rd-needle hepatitis B vaccines (each 20μg) were administered after 6 months.

(iv) Management of patients and carriers

Medical personnel at all levels in the diagnosis of acute or chronic hepatitis B patients should be in accordance with the People's Republic of China infectious Disease Prevention and Control Act, timely report to the local Centers for Disease Prevention and Treatment (CDC), and should be noted as acute hepatitis B or chronic hepatitis B. It is recommended that serum HBSAG, anti--HBC and anti--HBS tests be performed on patients ' family members and other close contacts, and hepatitis B vaccine is administered to susceptible persons (the 3 markers are negative).

For patients with acute or chronic hepatitis B, it is possible to determine whether they are hospitalized or treated at home according to their condition. Patients used medical equipment and appliances (such as blood collection needles, acupuncture needles, surgical instruments, scratches, probes, various endoscopic and dental drill bits, etc.) should be strictly disinfected, in particular, should strengthen the disinfection of blood contaminated with the treatment.

For chronic HBV carriers and HBsAg carriers (see this guide, "v. Clinical Diagnosis"), in addition to the inability to donate blood and special occupations (such as military service, etc.) that cannot be carried out under national law, you can live, study and work as usual, but follow-up should be strengthened.

The infectivity of hepatitis B patients and carriers depends largely on the level of HBV DNA in the blood, regardless of serum alt, AST or bilirubin levels. Follow-up of patients and carriers of hepatitis B is shown in this guide, "21, patient follow-up".

HBV (5) _ Prevention