2017年马鞍山市60岁以下人群乙型病毒性肝炎血清流行病学调查
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摘要
目的了解马鞍山市现阶段人群乙肝流行和免疫状况,对比乙肝疫苗免疫策略调整后的防控效果。方法采用多阶段单纯随机抽样方法抽取马鞍山市10个调查点,按照城乡分层随机抽取3 460名60岁以下人群样本,开展问卷调查并采集静脉血标本,用国产酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)试剂进行检测。结果乙肝病毒表面抗原(hepatitis B virus surface antigen,HBs Ag)总阳性率为3. 32%,乙肝病毒表面抗体(hepatitis B virus surface antibody,HBs Ab)总阳性率为51. 21%,乙肝病毒(hepatitis B virus,HBV)总感染率为29. 16%。城市人群HBs Ab阳性率高于农村(X~2=28. 204,P <0. 001)。医护人员HBs Ab阳性率与其他职业人群间差异有统计学意义(X~2=22. 772,P <0. 001)。乙肝疫苗(hepatitis B vaccine,Hep B)抗原含量调整前后儿童HBs Ab阳性率差异有统计学意义(X~2=90. 331,P <0. 001)。Hep B接种率随年龄增长呈下降趋势(X~2趋势=1 984. 342,P <0. 001)。结论自乙肝疫苗纳入免疫规划以来,马鞍山市适龄儿童乙肝防控工作取得成绩显著。学生人群HBs Ab阳性率较低和成年人Hep B接种率低应重点关注。
Objective To understand the current epidemic and immunity status of hepatitis B virus in Ma'anshan City,and to compare the prevention and control effect after the adjustment of hepatitis B vaccine immunization strategy. Methods Multi-stage random sampling method was used to select 10 investigation points in the whole city,a random sample of 3 460 people under 60 years old was included according to urban and rural stratification. questionnaires and blood were collected from the subjects,and domestic enzyme linked immunosorbent assay( ELISA) was used for hepatitis B immunoglobulins detection. Results The total positive rate of hepatitis B virus surface antigen( HBs Ag),hepatitis B virus surface antibody( HBs Ab) and Hepatitis B virus( HBV) infection was 3. 32%,51. 21% and 29. 16%respectively. The positive rate of HBs Ab in urban area was higher than that in rural area( X~2= 28. 204,P < 0. 001). The positive rate of HBs Ab was significantly different between the medical and nursing staff and other occupational groups( X~2= 22. 772,P < 0. 001). The difference of HBs Ab positive rate before and after Hep B vaccine content adjustment was statistically significant( X~2= 90. 331,P < 0. 001). The rate of Hep B decreased with age( X~2 trend= 1 984. 342,P < 0. 001). Conclusions Since Hep B was incorporated into the immunization program,hepatitis B prevention and control in school-age children has achieved remarkable results. More attention should be paid on the low positive rate of HBs Ab in students and the low immunization rate of Hep B in adults.
Objective To understand the current epidemic and immunity status of hepatitis B virus in Ma'anshan City,and to compare the prevention and control effect after the adjustment of hepatitis B vaccine immunization strategy. Methods Multi-stage random sampling method was used to select 10 investigation points in the whole city,a random sample of 3 460 people under 60 years old was included according to urban and rural stratification. questionnaires and blood were collected from the subjects,and domestic enzyme linked immunosorbent assay( ELISA) was used for hepatitis B immunoglobulins detection. Results The total positive rate of hepatitis B virus surface antigen( HBs Ag),hepatitis B virus surface antibody( HBs Ab) and Hepatitis B virus( HBV) infection was 3. 32%,51. 21% and 29. 16%respectively. The positive rate of HBs Ab in urban area was higher than that in rural area( X~2= 28. 204,P < 0. 001). The positive rate of HBs Ab was significantly different between the medical and nursing staff and other occupational groups( X~2= 22. 772,P < 0. 001). The difference of HBs Ab positive rate before and after Hep B vaccine content adjustment was statistically significant( X~2= 90. 331,P < 0. 001). The rate of Hep B decreased with age( X~2 trend= 1 984. 342,P < 0. 001). Conclusions Since Hep B was incorporated into the immunization program,hepatitis B prevention and control in school-age children has achieved remarkable results. More attention should be paid on the low positive rate of HBs Ab in students and the low immunization rate of Hep B in adults.
引文
[1]戴志澄.中国病毒性肝炎血清流行病学调查(上卷)[M].北京:科学技术文献出版社,1997:39-59.Dai ZC.Viral hepatitis in China seroepidemiological survey in Chinese people(part one)[M].Beijing:China Science and Technology Press,1997:39-59.
[2]苏颖,唐继海,柴瑜.2014年安徽省1-29岁人群乙型病毒性肝炎血清流行病学调查[J].现代预防医学,2017,44(9):1553-1556,1560.Su Y,Tang JH,Chai Y.Sero epidemiological survey of hepatitis B virus among people aged 1-29 in Anhui Province,2014[J].Mod Prev Med,2017,44(9):1553-1556,1560.
[3]张国民,孙校金,王富珍,等.中国18~59岁人群乙型病毒性肝炎流行病学特征分析及乙型肝炎疫苗免疫策略探讨[J].中国疫苗和免疫,2013,19(3):266-270.Zhang GM,Sun XJ,Wang FZ,et al.Analysis of epidemiological characteristics of hepatitis B among the population of 18-59 yearold and Hep B immunization strategies[J].Chinese Journal Vaccines and Immunization,2013,19(3):266-270.
[4]武桂英,赵新平,赵耐青,等.成人乙肝基因疫苗接种效果Meta分析与成人接种的必要性[J].中国卫生统计,2005,22(6):359-361.DOI:10.3969/j.issn.1002-3674.2005.06.002.Wu GY,Zhao XP,Zhao NQ,et al.Meta-analysis of the immunization with hepatitis B gene vaccine on adults and vaccination necessity of adult[J].Chin J Health Stat,2005,22(6):359-361.DOI:10.3969/j.issn.1002-3674.2005.06.002.
[5]中华预防医学会,中国疾病预防控制中心免疫规划中心.中国成人乙型肝炎免疫预防技术指南[J].胃肠病学和肝病学杂志,2012,21(3):197-201.DOI:10.3969/j.issn.1006-5709.2012.03.001.Chinese Prevention Medicine Association,National Immunization Program,Chinese Center for Disease Control and Prevention.Technical guide for adult hepatitis B immunization in China[J].Chin J Gastroenterol Hepatol,2012,21(3):197-201.DOI:10.3969/j.issn.1006-5709.2012.03.001.
[6]邓秋云.成人乙肝疫苗接种及免疫效果概述[J].现代预防医学,2017,44(14):2647-2650.Deng QY.Summary of hepatitis B vaccination and immune effect on adult[J].Mod Prev Med,2017,44(14):2647-2650.
[7]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志,2015,9(5):570-589.DOI:10.3877/cma.j.issn.1674-1358.2015.05.001.Wang FG,Wang FS,Cheng J,et al.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].Chin JExp Clin Infect Dis,2015,9(5):570-589.DOI:10.3877/cma.j.issn.1674-1358.2015.05.001.
[8]程锦泉,马汉武,谢旭,等.深圳市常住人口乙型肝炎血清流行病学调查[J].中华流行病学杂志,2013,34(12):1179-1182.DOI:10.3760/cma.j.issn.0254-6450.2013.012.006.Cheng JQ,Ma HW,Xie X,et al.Sero-epidemiological investigation on hepatitis B among permanent residents in Shenzhen area[J].Chin J Epidemiol,2013,34(12):1179-1182.DOI:10.3760/cma.j.issn.0254-6450.2013.012.006.
[9]范晨璐,姜立坤,杨淑云,等.哈尔滨市乙型病毒性肝炎血清流行病学分析[J].实用预防医学,2017,24(12):1495-1498.DOI:10.3969/j.issn.1006-3110.2017.12.024.Fan CL,Jiang LK,Yang SY,et al.Seroepidemiological survey of hepatitis B virus infection in Harbin City[J].Pract Prev Med,2017,24(12):1495-1498.DOI:10.3969/j.issn.1006-3110.2017.12.024.
[10]汪娟,董永海,葛阜阳,等.安徽省某市农村地区人群乙型肝炎流行现况及相关知识调查[J].中华疾病控制杂志,2010,14(8):697-700.Wang J,Dong YH,Ge FY,et al.A prevalence and knowledge survey on hepatitis B among population in rural areas in a city of Anhui Province[J].Chin J Dis Control Prev,2010,14(8):697-700.
[11]周美兰,李杏莉,周志华,等.衡阳市居民乙型病毒性肝炎HB-s Ag携带率及抗-HBs流行率调查[J].中华疾病控制杂志,2014,18(2):108-111.Zhou ML,Li XL,Zhou ZH,et al.Prevalence of the HBsAg and antibodies against HBV among residents in Hengyang City[J].Chin J Dis Control Prev,2014,18(2):108-111.
[12]周绍英,边国林,马瑞,等.不同乙型肝炎疫苗新生儿免疫应答的动态变化研究[J].浙江预防医学,2015,27(5):466-468,476.Zhou SY,Bian GL,Ma R,et al.A study on immunologic response at different periods with different hepatitis B vaccine in infants[J].Zhejiang Prev Med,2015,27(5):466-468,476.
[13]柯以弘.187例新生儿接种乙型肝炎疫苗3~4年后免疫效果观察[J].深圳中西医结合杂志,2016,26(1):151-152.DOI:10.16458/j.cnki.1007-0893.2016.01.078.Ke YH.Observation on immune effect of 187 neonates inoculated with hepatitis B vaccine 3-4 years later[J].Shenzhen Journal of Integrated Traditional Chinese and Western Medicine,2016,26(1):151-152.DOI:10.16458/j.cnki.1007-0893.2016.01.078.
[14]刘世科,黄美林,葛宝湘,等.新生儿基础免疫接种不同剂型乙型肝炎疫苗不同时间免疫水平比较[J].现代预防医学,2014,41(11):2001-2003.Liu SK,Huang ML,Ge BX,et al.Observation on immunogenicity of different formulation of hepatitis B vaccine in newborns[J].Mod Prev Med,2014,41(11):2001-2003.
[15]陈华,段晋超,邓建军,等.15岁以下儿童乙肝疫苗免疫效果分析[J].免疫学杂志,2013,29(11):1010-1012.DOI:10.13431/j.cnki.immunol.j.20130221.Chen H,Duan JC,Analysis of hepatitis B vaccine immune effect in aged 15 and below children[J].Immunol J,2013,29(11):1010-1012.DOI:10.13431/j.cnki.immunol.j.20130221.
[16]陈永弟,梁晓峰,姚军,等.5岁以上儿童5μg重组乙型肝炎疫苗(酵母)加强免疫效果评价[J].中国预防医学杂志,2012,13(2):84-87.DOI:10.16506/j.1009-6639.2012.02.004.Chen YD,Liang XF,Yao J,et al.Evaluation on booster immunization efficacy of 5 ug hepatitis B vaccine made by recombinant deoxyribonucleic acid(DNA)techniques in polymorpha yeast of variant dosage in children aged over 5 years old[J].Chin Prev Med,2012,13(2):84-87.DOI:10.16506/j.1009-6639.2012.02.004.
[17]罗献伟,王建军.安徽省2006年1~59岁人群乙型病毒性肝炎感染状况的血清流行病学调查[J].中华疾病控制杂志,2013,17(2):156-159.Luo XW,Wang JJ.Seroepidemiologic study on the infectious status of the hepatitis B virus in people aged from 1 to 59 in Anhui Province in 2006[J].Chin J Dis Control Prev,2013,17(2):156-159.
[18]方大春,朱宏斌,王婷婷,等.马鞍山市16年乙型肝炎防治效果评价[J].职业与健康,2009,25(10):1061-1063.DOI:10.13329/j.cnki.zyyjk.2009.10.042.Fang DC,Zhu HB,Wang TT,et al.Evaluation of the Effect of Hepatitis B Prevention and Control for 16 years in Maanshan[J].Occup and Health,2009,25(10):1061-106.DOI:10.13329/j.cnki.zyyjk.2009.10.042.
[2]苏颖,唐继海,柴瑜.2014年安徽省1-29岁人群乙型病毒性肝炎血清流行病学调查[J].现代预防医学,2017,44(9):1553-1556,1560.Su Y,Tang JH,Chai Y.Sero epidemiological survey of hepatitis B virus among people aged 1-29 in Anhui Province,2014[J].Mod Prev Med,2017,44(9):1553-1556,1560.
[3]张国民,孙校金,王富珍,等.中国18~59岁人群乙型病毒性肝炎流行病学特征分析及乙型肝炎疫苗免疫策略探讨[J].中国疫苗和免疫,2013,19(3):266-270.Zhang GM,Sun XJ,Wang FZ,et al.Analysis of epidemiological characteristics of hepatitis B among the population of 18-59 yearold and Hep B immunization strategies[J].Chinese Journal Vaccines and Immunization,2013,19(3):266-270.
[4]武桂英,赵新平,赵耐青,等.成人乙肝基因疫苗接种效果Meta分析与成人接种的必要性[J].中国卫生统计,2005,22(6):359-361.DOI:10.3969/j.issn.1002-3674.2005.06.002.Wu GY,Zhao XP,Zhao NQ,et al.Meta-analysis of the immunization with hepatitis B gene vaccine on adults and vaccination necessity of adult[J].Chin J Health Stat,2005,22(6):359-361.DOI:10.3969/j.issn.1002-3674.2005.06.002.
[5]中华预防医学会,中国疾病预防控制中心免疫规划中心.中国成人乙型肝炎免疫预防技术指南[J].胃肠病学和肝病学杂志,2012,21(3):197-201.DOI:10.3969/j.issn.1006-5709.2012.03.001.Chinese Prevention Medicine Association,National Immunization Program,Chinese Center for Disease Control and Prevention.Technical guide for adult hepatitis B immunization in China[J].Chin J Gastroenterol Hepatol,2012,21(3):197-201.DOI:10.3969/j.issn.1006-5709.2012.03.001.
[6]邓秋云.成人乙肝疫苗接种及免疫效果概述[J].现代预防医学,2017,44(14):2647-2650.Deng QY.Summary of hepatitis B vaccination and immune effect on adult[J].Mod Prev Med,2017,44(14):2647-2650.
[7]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志,2015,9(5):570-589.DOI:10.3877/cma.j.issn.1674-1358.2015.05.001.Wang FG,Wang FS,Cheng J,et al.The guideline of prevention and treatment for chronic hepatitis B:a 2015 update[J].Chin JExp Clin Infect Dis,2015,9(5):570-589.DOI:10.3877/cma.j.issn.1674-1358.2015.05.001.
[8]程锦泉,马汉武,谢旭,等.深圳市常住人口乙型肝炎血清流行病学调查[J].中华流行病学杂志,2013,34(12):1179-1182.DOI:10.3760/cma.j.issn.0254-6450.2013.012.006.Cheng JQ,Ma HW,Xie X,et al.Sero-epidemiological investigation on hepatitis B among permanent residents in Shenzhen area[J].Chin J Epidemiol,2013,34(12):1179-1182.DOI:10.3760/cma.j.issn.0254-6450.2013.012.006.
[9]范晨璐,姜立坤,杨淑云,等.哈尔滨市乙型病毒性肝炎血清流行病学分析[J].实用预防医学,2017,24(12):1495-1498.DOI:10.3969/j.issn.1006-3110.2017.12.024.Fan CL,Jiang LK,Yang SY,et al.Seroepidemiological survey of hepatitis B virus infection in Harbin City[J].Pract Prev Med,2017,24(12):1495-1498.DOI:10.3969/j.issn.1006-3110.2017.12.024.
[10]汪娟,董永海,葛阜阳,等.安徽省某市农村地区人群乙型肝炎流行现况及相关知识调查[J].中华疾病控制杂志,2010,14(8):697-700.Wang J,Dong YH,Ge FY,et al.A prevalence and knowledge survey on hepatitis B among population in rural areas in a city of Anhui Province[J].Chin J Dis Control Prev,2010,14(8):697-700.
[11]周美兰,李杏莉,周志华,等.衡阳市居民乙型病毒性肝炎HB-s Ag携带率及抗-HBs流行率调查[J].中华疾病控制杂志,2014,18(2):108-111.Zhou ML,Li XL,Zhou ZH,et al.Prevalence of the HBsAg and antibodies against HBV among residents in Hengyang City[J].Chin J Dis Control Prev,2014,18(2):108-111.
[12]周绍英,边国林,马瑞,等.不同乙型肝炎疫苗新生儿免疫应答的动态变化研究[J].浙江预防医学,2015,27(5):466-468,476.Zhou SY,Bian GL,Ma R,et al.A study on immunologic response at different periods with different hepatitis B vaccine in infants[J].Zhejiang Prev Med,2015,27(5):466-468,476.
[13]柯以弘.187例新生儿接种乙型肝炎疫苗3~4年后免疫效果观察[J].深圳中西医结合杂志,2016,26(1):151-152.DOI:10.16458/j.cnki.1007-0893.2016.01.078.Ke YH.Observation on immune effect of 187 neonates inoculated with hepatitis B vaccine 3-4 years later[J].Shenzhen Journal of Integrated Traditional Chinese and Western Medicine,2016,26(1):151-152.DOI:10.16458/j.cnki.1007-0893.2016.01.078.
[14]刘世科,黄美林,葛宝湘,等.新生儿基础免疫接种不同剂型乙型肝炎疫苗不同时间免疫水平比较[J].现代预防医学,2014,41(11):2001-2003.Liu SK,Huang ML,Ge BX,et al.Observation on immunogenicity of different formulation of hepatitis B vaccine in newborns[J].Mod Prev Med,2014,41(11):2001-2003.
[15]陈华,段晋超,邓建军,等.15岁以下儿童乙肝疫苗免疫效果分析[J].免疫学杂志,2013,29(11):1010-1012.DOI:10.13431/j.cnki.immunol.j.20130221.Chen H,Duan JC,Analysis of hepatitis B vaccine immune effect in aged 15 and below children[J].Immunol J,2013,29(11):1010-1012.DOI:10.13431/j.cnki.immunol.j.20130221.
[16]陈永弟,梁晓峰,姚军,等.5岁以上儿童5μg重组乙型肝炎疫苗(酵母)加强免疫效果评价[J].中国预防医学杂志,2012,13(2):84-87.DOI:10.16506/j.1009-6639.2012.02.004.Chen YD,Liang XF,Yao J,et al.Evaluation on booster immunization efficacy of 5 ug hepatitis B vaccine made by recombinant deoxyribonucleic acid(DNA)techniques in polymorpha yeast of variant dosage in children aged over 5 years old[J].Chin Prev Med,2012,13(2):84-87.DOI:10.16506/j.1009-6639.2012.02.004.
[17]罗献伟,王建军.安徽省2006年1~59岁人群乙型病毒性肝炎感染状况的血清流行病学调查[J].中华疾病控制杂志,2013,17(2):156-159.Luo XW,Wang JJ.Seroepidemiologic study on the infectious status of the hepatitis B virus in people aged from 1 to 59 in Anhui Province in 2006[J].Chin J Dis Control Prev,2013,17(2):156-159.
[18]方大春,朱宏斌,王婷婷,等.马鞍山市16年乙型肝炎防治效果评价[J].职业与健康,2009,25(10):1061-1063.DOI:10.13329/j.cnki.zyyjk.2009.10.042.Fang DC,Zhu HB,Wang TT,et al.Evaluation of the Effect of Hepatitis B Prevention and Control for 16 years in Maanshan[J].Occup and Health,2009,25(10):1061-106.DOI:10.13329/j.cnki.zyyjk.2009.10.042.