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Prevalence of HBsAg mutants and impact of hepatitis B infant immunisation in four Pacific Island countries

机译：在四个太平洋岛国中HBsAg突变体的流行和乙型肝炎婴儿免疫的影响

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The prevalence rate of hepatitis B virus (HBV) infection in Pacific Island countries is amongst the highest in the world. Hepatitis B immunisation has been incorporated into national programmes at various times, often with erratic supply and coverage, until a regionally co-ordinated programme, which commenced in 1995 ensured adequate supply. The effectiveness of these programmes was recently evaluated in four countries, Vanuatu and Fiji in Melanesia, Tonga in Polynesia and Kiribati in Micronesia. That evaluation established that the programmes had a substantial beneficial impact in preventing chronic hepatitis B infection [Vaccine 18 (2000) 3059]. Several studies of hepatitis B vaccination programmes in endemic countries have identified the potential significance of surface gene mutants as a cause for failure of immunisation. In the study outlined in this paper, we screened infected children and their mothers for the emergence and prevalence of these variants in specimens collected from the four country evaluation. Although the opportunity for the emergence of HBV vaccine escape mutants in these populations was high due to the presence of a considerable amount of the virus in the population and the selection pressure from vaccine use, there were no "a" determinant vaccine escape mutants found. This suggests that vaccine escape variants are not an important cause for failure to prevent HBV transmission in this setting. Other HBsAg variants were detected, but their functional significance remains to be determined. The failure to provide satisfactory protection during such immunisation programmes reflects the need for achieving and sustaining high vaccine coverage, improving the timeliness of doses as well as improving 'cold-chain' support, rather than the selection of vaccine-escape mutants of HBV.
机译：太平洋岛国的乙型肝炎病毒（HBV）感染率是世界上最高的国家之一。乙肝免疫接种已在不同时期被纳入国家计划，通常供应和覆盖范围不稳定，直到1995年开始的区域协调计划确保了充足的供应。最近在四个国家（美拉尼西亚的瓦努阿图和斐济，波利尼西亚的汤加和密克罗尼西亚的基里巴斯）对这些计划的有效性进行了评估。该评估表明，该计划在预防慢性乙型肝炎感染方面具有重大的有益影响[Vaccine 18（2000）3059]。在流行国家对乙型肝炎疫苗接种计划的几项研究已经确定了表面基因突变体作为免疫失败原因的潜在重要性。在本文概述的研究中，我们从四个国家的评估中收集了样本中这些变异的出现和流行情况，从而对受感染的儿童及其母亲进行了筛选。尽管由于人群中大量病毒的存在以及疫苗使用的选择压力，在这些人群中出现HBV疫苗逃逸突变体的机会很高，但没有发现“ a”决定性疫苗逃逸突变体。这表明在这种情况下，疫苗逃逸变型不是未能阻止HBV传播的重要原因。检测到其他HBsAg变体，但其功能意义尚待确定。在此类免疫程序中未能提供令人满意的保护，反映出需要实现和维持较高的疫苗覆盖率，提高剂量的及时性以及改善“冷链”支持，而不是选择HBV疫苗逃逸突变体。

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