B型肝炎與德國麻疹病毒的感染是世界性的問題，這兩種病毒，因為會引起新生兒的垂直感染，所以特別受到關注。疫苗注射是有效防制這兩種病毒感染的重要工具之一，台灣於1984及1986年，開始實施B型肝炎與德國麻疹相關的疫苗注射。本研究的目的是調查疫苗政策實施後的B型肝炎及德國麻疹發生狀況。研究結果顯示，在實施B型肝炎疫苗注射政策後，在青少年族群B型肝炎表面抗原陽性盛行率大幅下降，由4.9%降到0.7%。B型肝炎表面抗體陽性率也隨著年紀增長而下降，在16歲的五專醫護新生的陽性率低於50%。在孕齡婦女方面，本國籍孕齡婦女，在實施B型肝炎疫苗注射以後，B型肝炎表面抗原陽性盛行率大幅下降，由15.7%降到8.8%，而為數眾多的外籍孕齡婦女，B型肝炎表面抗原陽性盛行率卻由8.4%上升到13.1%，且相較於本國籍，有較高的e抗原陽性盛行率 (52.4% vs. 32.1%)。德國麻疹抗體的陰性盛行率，本國籍孕齡婦女，也由政策實施前的20.1% 下降到實施後的6.7%。而外籍孕齡婦女，德國麻疹抗體陰性平均盛行率則為20.9%。而所有孕齡婦女的追加疫苗注射率偏低，在本國籍為11.5%，外國籍為30.7%。而我們的研究也顯示RA 27/3疫苗，所產生的抗體持久性良好。所以，綜合本研究結果，我們建議B型肝炎抗體陰性的醫護學生，應該在實習前，接受疫苗注射，以免除受感染的風險。而國家政策應提供所有孕齡婦女免費的德國麻疹抗體檢驗，及疫苗追加注射。對於產前德國麻疹檢驗結果為陰性的婦女，在生產後，離院前，應提供免費的德國麻疹疫苗注射，以防止德國麻疹及先天性德國麻疹的發生。

Hepatitis B and rubella virus infections are worldwide problems. It is of particular concern because these two viruses may vertically infect newborns. Vaccination is an effective instrument to prevent these infections. Taiwan has lunched the national vaccination programs for hepatitis B and rubella since 1984 and 1986, respectively. The purpose of this study was to investigate the seroepidemiology status of hepatitis B and rubella after the national vaccination programs. The results showed that the seroprevalence of hepatitis B surface antigen dropped significantly, from 4.9% to 0.7%, in teenage students. Hepatitis B surface antibody positive rate declined with age, the positive rate was less than 50% in 16-year-old teenage students. In Taiwanese women of childbearing age born after the implementation of national vaccination program, the seropositivity of hepatitis B surface antigen dropped significantly, from 15.7% to 8.8%. On the other hand, the seropositivity of hepatitis B surface antigen in foreign-born women of childbearing age increased from 8.4 % to 13.1%. These foreign-born women had a higher prevalence of e antigen positive rate compared to the Taiwanese women (52.4% vs. 32.1%). The seronegativity of rubella antibody in Taiwanese women of childbearing age decreased from 20.1%, before the implementation of national vaccination program, to 6.7%, after the implementation of national vaccination program. On the contrary, foreign-born women of childbearing age, the seronegativity of Rubella antibody was about 20.9%, regardless of their age. The catch-up immunization rate was low in women of childbearing age; the rates were 11.5% in Taiwanese women and 30.7% in foreign-born women, respectively. Our study also showed that RA 27/3 vaccine produced a good antibody persistence. We therefore suggest that the students in medical related fields with negative hepatitis B surface antibody should receive hepatitis B vaccination in order to avoid hepatitis B infection in clinical practice. In order to lower the incidence of rubella and congenital rubella, there should be a policy that provides free rubella antibody test to all women of childbearing age and vaccination as required. Lastly, there should be a policy to immunize all postpartum women who are susceptible to rubella infection before they leave the hospital.

第1章： 緒論 -------------------------------------- 1
第2章： 台灣出生與非台灣出生的婦女B型肝炎盛行率比較 10
第3章： 五專醫護學生的B型肝炎表面抗原、抗體盛行率分析及不同疫苗種類在追加疫苗後的表現差異 -------------------29
第4章： 屏東地區懷孕婦女的德國麻疹抗體盛行率及追加疫苗之研究 ---------------------------------------53
第5章： 台灣地區懷孕婦女的德國麻疹抗體陰性率和追加疫苗及抗體效價持久性調查研究 --------------------------71
第6章： 接受RA27/3德國麻疹疫苗的婦女抗體持久性及其效價分析 ---- 93
第7章： 總結 ---------------- 110
附錄： 研究成果------------- 113

[1] Kao JH, Chen DS. Global control of hepatitis B virus infection. Lancet Infect Dis 2002;2(7):395-403.
[2] 行政院衛生署2009年報.
[3] Chen DS, Sung JL. Hepatitis B virus infection and chronic liver disease in Taiwan. Acta Hepatogastroenterol (Stuttg) 1978;25(6):423-30.
[4] Beasley RP. Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer 1988;61(10):1942-56.
[5] Stevens CE, Beasley RP, Tsui JT, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975; 292: 771-4
[6] Lee CY, Huang LM, Chang MH, Hsu CY, Wu SJ, Sung JL, Safary A. The protective efficacy of recombinant hepatitis B vaccine in newborn infants of hepatitis B e antigen-positive B surface antigen carrier mothers. Pediatr Infect Dis J 1991; 10: 299-303
[7] Poovorawan Y, Sanpavat S, Pongpunglert W, Chumdermpadetsuk S, Sentrakul P, Vandepapeliere P, Safary A. Long term efficacy of hepatitis B vaccine in infants born to hepatitis B e antigen-positive mothers. Pediatr Infect Dis J 1992; 11: 816-21
[8] Hsu HY, Chang MH, Ni YH, Chen HL. Survey of hepatitis B surface variant infection in children 15 years after a nationwide vaccination programme in Taiwan. Gut 2004;53(10):1499-503.
[9] Chang MH, Shau WY, Chen CJ, Wu TC, Kong MS, Liang DC, et al. Hepatitis B vaccination and hepatocellular carcinoma rates in boys and girls. Jama 2000;284(23):3040-2.
[10] Best JM. Rubella. Semin Fetal Neonatal Med 2007;12:182-92.
[11] Dontigny L, Arsenault MY, Martel MJ, Biringer A, Cormier J, Delaney M, et al. Rubella in pregnancy. J Obstet Gynaecol Can. 2008;30:152-68.
[12] WHO Global Immunization Data. Available at http://www.who.int/immunization_monitoring/data/en/. Accessed April 1, 2010.
[13] Taiwan’s CDC. Rubella and congenital rubella in Taiwan. Oct, 2007 http://www.cdc.gov.tw (Accessed March 28, 2008).