Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Immune responses of hepatitis B vaccination among very low birth weight infant

극소 저출생체중아의 영아기 B형 간염 항체 생성률 조사

  • Kim, Young-Deuk (Department of Pediatrics and Division of Neonatology, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Han, Myung-Ki (Gangneung Asan Medical Hospital, University of Ulsan, College of Medicine) ;
  • Kim, Ai-Rhan E. (Department of Pediatrics and Division of Neonatology, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Kim, Ki-Soo (Department of Pediatrics and Division of Neonatology, Asan Medical Center, University of Ulsan, College of Medicine) ;
  • Pi, Soo-Young (Department of Pediatrics and Division of Neonatology, Asan Medical Center, University of Ulsan, College of Medicine)
  • 김영득 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 한명기 (울산대학교 의과대학 강릉아산병원 소아과) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아과)
  • Received : 2006.03.17
  • Accepted : 2006.05.12
  • Published : 2006.08.15
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Abstract

Purpose : To evaluate the immunogenicity of hepatitis B vaccine among very low birth weight infants(VLBWI) who were vaccinated at 0, 1, 6 months of chronological age and to determine the factors associated with antibody formations. Methods : A total of 243 VLBWI admitted to Seoul and Gangneung Asan Medical Center neonatal intensive care units from 1997 to 2004 were included. Of 243, 13 infants were born to HBs Ag positive mother. All infants were given DNA recombinant vaccine at 0, 1, and 6 months of chronological age. Infants born to HBs Ag positive mothers received hepatitis B immunoglobulin at birth and a total of 4 doses of vaccinations. An antibody level over 10 mIU/mL, tested at 3-4 months after last vaccination, was regarded as a positive seroconversion. Results : The seroconversion rates were 84.4 percent and 84.5 percent for VLBWI and extremely low birth weight infants(ELBWI), respectively. Of 28 seronegative infants who were given revaccinations, 60.7 percent seroconverted, resulting in 95.3 percent, 97.5 percent seroconversion rates for VLBWI and ELBWI, respectively. 76.9 percent of infants born to HBsAg positive mothers seroconverted and none became hepatitis B carriers. Factors such as gestational age, sex, various neonatal illness, and kinds of vaccinations did not influence the formation of the hepatits B antibody, however, the higher the weight at time of first vacciation yielded better seroconversion rate. Conclusion : Revaccination of seronegative VLBWI after 3 doses of hepatitis B vaccinaton is very effective. Therefore, testing the immune status after the hepatitis B vaccination, a practice not routinely done, is highly recommended.

목 적 : 의료기술과 신생아학의 발전으로 생존된 극소 저출생 체중아의 질병에 대한 관리가 더욱 필요한 시점이다. 이에 본 연구는 극소 저출생 체중아에서 영아기 B형 간염 항체 생성률과 항체 생성 실패에 미치는 요인에 대하여 알아보고자 하였다. 방 법 : 1997년 1월부터 2004년 12월까지 서울아산병원과 강릉아산병원 신생아 중환자실에 입원하였던 1,500 g 미만의 극소저출생 체중아 중에서 영아기에 B형 간염 항체에 대해 검사받은 243명을 대상으로 하였다. 영아들은 역 연령 약 40주경에 첫 간염 예방접종시행 받았으며 1개월 후, 6개월 후에 간염 예방접종을 시행 받았다. 그러나 모체의 B형 간염 항원이 양성인 13명의 영아들은 출생 시에 임신주수와 출생체중과 관계없이 B형 간염 면역글로불린과 B형 간염 예방접종을 1회 더 시행 받았다. 항체검사는 마지막 간염 예방접종 3-4개월 후에 시행하였고 B형 감염 예방접종후의 항체 양전은 항체의 역가가 ${\geq_-}10mIU/mL$로 정의하였다. 결 과 : 총 243명의 극소 저출생 체중아들의 B형 간염 예방접종 후 항체 양전율은 84.4%(205/243명)였다. 항체가 음성인 38명의 극소 저출생 체중아 중에서 재접종이 가능하였던 28명 중 17명(60.7%)에서 항체가 양성으로 전환되었다. 총 243명 중 34.6%(84/243명)을 차지한 초극소 저출생체중아의 항체 양전율은 84.5%(71/84명)이었다. 13명의 항체 음성인 초극소 저출생체중아 중 재접종이 가능하였던 10명의 항체 양전율은 80%(8/10명)로 재접종 후의 극소 저출생 체중아와 초극소 저출생 체중아의 항체 양전율은 각각 95.3%, 97.5%으로 향상되었다. 출생시 임신주수별 항체 양전율은 $28^{+0}$주 미만과 $28^{+0}-36^{+6}$주인 영아들에서 각각 83.5%(66/79), 84.8%(139/164명)이었다. 이들 중 항체가 생기지 않았던 영아에서 재접종 후 각 군에서의 항체 양전율은 각각 96%, 94.9%로 향상되었다. B형 간염 보유자에게 태어난 극소 저출생 체중아의 항체 양전율은 76.9%(10/13명)였고 모두에게서 B형 간염의 항원은 음성이였다. 항체 양전율에 영향을 미치는 요소로는 첫 B형 간염 예방접종시의 체중이 작을수록 항체 양전율이 저하됨을 알 수 있었다. 결 론 : 세 번의 B형 간염 예방접종 후 항체 생성이 되지 않은 극소 저출생 체중아들에서의 재접종은 항체 양전율을 매우 향상시킬 수 있음으로 저자들은 극소 저출생 체중아들에게 아직 국내에서 보편적으로 실시되고 있지 않는 예방접종 후 항체검사를 적극적으로 권장하는 바이다.

Keywords

References

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