黑龙江省乙型肝炎血清流行病学调查分析

为了掌握黑龙江省乙型肝炎(乙肝)病毒(HBV)流行现状和人群免疫水平,评价我省儿童乙肝疫苗预防接种效果,为制订乙肝预防控制策略提供依据。采用横断面调查方法,选择全省7个国家级疾病监测点,在每个监测点随机抽取2个乡级单位,1～59岁作为目标人群共调查3337名人群。黑龙江省1～59岁人群乙肝病毒表面抗原(HBsAg)阳性率、乙肝病毒表面抗体(抗-HBs)阳性率和乙肝病毒核心抗体(抗-HBc)阳性率经标化后为5.65%、55.45%、30.50%,1～3岁人群乙肝表面抗原阳性率明显低于15～59岁人群。1～3岁、4～10岁和11～14岁人群乙肝疫苗全程接种率为99.43%、89.40%和64.81%;首针及时接种率分别为86.64%、75.57%和49.87。城市和农村HbsAg阳性率分别为3.26%和5.04%。医院出生儿童乙肝疫苗首针及时接种率高于在家出生儿童。结果显示接种乙肝疫苗可明显提高抗-HBs阳性率,提高人群对HBV的免疫保护能力,降低HBsAg携带率。     

高密市2014年人群乙型病毒性肝炎血清流行病学调查

目的了解高密市乙型病毒性肝炎(乙肝)流行现状,为完善乙肝疫苗策略提供依据。方法采用分层多阶段随机抽样方法,抽取高密市1~<5岁、5~<15岁、15~<30岁和30~<60岁常住人口497人进行乙肝血清流行病学调查,采用酶联免疫吸附试验标本进行乙肝病毒(Hepatitis B virus,HBV)血清学标志物(HBsAg、抗-HBs、抗-HBc、HBe Ag和抗-HBe)检测。结果共采集血清494份,HBV流行率为12.55%、HBsAg阳性率为1.42%、抗-HBs阳性率为52.02%、抗-HBc阳性率为12.55%,男、女性别差异无统计学意义(P>0.05);5~14岁组HBV流行率和抗-HBc阳性率均最低,且随年龄增长呈现升高趋势。各年龄组间差异均有统计学意义(P<0.01);HBsAg阳性率各年龄组间差异均无统计学意义(P>0.05);抗-HBs阳性率随年龄增长呈下降趋势,各年龄组间差异均有统计学意义(P<0.01);HBV流行率、HBsAg阳性率、抗-HBs阳性率在城乡之间差异均无统计学意义(P>0.05),但抗-HBc阳性率乡镇高于城市(P<0.05);7名HBsAg阳性患者中,15~<30岁组和30~<60岁组HBe Ag阳性各1人;15~<30岁组和30~<30岁组抗-HBe阳性分别为1人和4人。结论高密市为乙肝中度流行区,青少年和成人中HBV流行强度高于儿童,高密市实施以"新生儿Hep B接种"为主的乙肝控制策略取得了显著成效。     

乙型肝炎病毒感染血清流行病学规律的研究

1984～1987年,在湖南、河南、河北、黑龙江4个试点区,整群抽样采血10 484人,采血率达80％以上。HBsAg、抗-HBs和抗-HBc均用RIA法检测。结果4个点乙型肝炎病毒(HBV)标化感染率为58.2％。HBV感染率随年龄增长而升高,7岁时为51.6％,25岁时达63.7％,接近高峰值。HBsAg标化阳性率为10.1％。HBsAg阳性率显示两个高峰,一个在2～8岁时,即儿童峰。从零岁的3.8％至2周岁时的12.5％,已达高峰。湖南的儿童峰值较其它3个试点区高。故HBsAg阳性率南高北低的现象仍然存在(P<0.01)。另一个峰在20～45岁,即成人峰。 抗-HBs标化阳性率为32.2％。HBsAg:抗-HBs之比值,5岁以内为1:1,10岁以后上升为l:3.3～5.9。抗-HBc标化阳性率为45.5％。此结果表明,调查地区均为HBV高感染区,感染主要发生在儿童期。故新生儿是预防乙型肝炎的重点人群。     

广州市1992-2007年出生新生儿接种乙型肝炎疫苗免疫效果评估

为评估广州市新生儿乙型肝炎疫苗(HepB)接种纳入计划免疫管理后免疫效果。对1992-2007年出生并接种HepB的新生儿2877人,按1992-2001年和2002-2007年出生新生儿分为计划免疫管理前(Ⅰ组)、计划免疫管理后(Ⅱ组)2组,采血检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)和乙肝病毒核心抗体(抗-HBc)。Ⅱ组HBsAg阳性率为0.48%比Ⅰ组的4.54%阳性率下降了80.65%,在统计学意义上有显著差异。抗-HBc阳性率也由36.07%下降为26.73%,Ⅱ组的抗-HBs阳性率为75.19%,高于I组水平。新生儿乙型肝炎疫苗纳入计划免疫管理后群体免疫效果良好,使用不同种类乙肝疫苗效果没有统计学差异。重组(酵母)乙型肝炎疫苗有较好的近期保护效果和免疫原性,与以前使用血源乙型肝炎疫苗效果相当。     

上海地区人类免疫缺陷病毒/艾滋病合并乙型、丙型肝炎病毒感染的临床流行病学研究

目的 研究人类免疫缺陷病毒1型(HIV-1)感染者中乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(HCV)感染的流行现状及其特点。方法 对上海市(复旦大学附属)公共卫生中心就诊的170例HIV-1感染者采集血标本,使用微粒子酶联免疫法(MEIA)检测HIV-1感染者血清的乙型肝炎二对半(HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc),应用酶联免疫吸附试验(ELISA)检测HCV抗体。结果 170名HIV-1感染者中,男性146人,女性24人,最小年龄16岁,最大年龄74岁,平均年龄41±13岁;HBsAg阳性患者19人(11．2％),抗-HBs阳性者87人(51．2％),HBeAg阳性者7人(4．1％)．抗-HBe阳性者49人(28．8％),抗-HBc阳性者111人(65．2％);抗-HCV阳性者77人(45．3％)。HIV-1、HBV和HCV三重感染者9人,约占5．3％。结论 HIV-1感染者HBsAg阳性率与普通人群相近,但HIV-1与HCV混合感染的比例显著高于普通人群。     

新生儿国产重组(酵母)乙型肝炎疫苗免疫效果考核

为了考核新生儿接种国产重组(酵母)乙型肝炎(乙肝)疫苗后的免疫效果,并与血源乙肝疫苗效果比较。对1997年出生并接种重组(酵母)乙肝疫苗的新生儿隔年随访一次,采血检测乙肝病毒表面抗原(HBsAg),乙肝病毒表面抗体(抗-HBs)和乙肝病毒核心抗体(抗-HBc),1998年以后对乙肝免疫人群开展急性乙肝发病监测。显示五年期间3次随访检测HBsAg阳性率平均为1.5%,较免前本底的HBsAg阳性率呈较大幅度下降,疫苗保护率为83%(95%可信区间为76.97%~89.02%),无论母亲HBsAg阳性或阴性,使用不同乙肝疫苗的儿童HBsAg阳性率没有统计学差异。接受重组(酵母)乙肝疫苗免疫的对象中,无一例急性乙肝病例报告。重组(酵母)乙肝疫苗有较好的近期保护效果和免疫原性,与以前使用血源乙肝疫苗效果相当。     

HBV感染中抗-(抗-HBs)独特型抗体的研究

1.75％聚乙二醇(MW6000)沉淀血清免疫复合物后,采用ELISA法检测上清中抗独特型抗体〔抗-(抗-HBs)〕。56例急性HBV感染患者血清IgM抗-(抗-HBs),第一周检出率最高(60.00％),1个月后大部分阴性,IgG抗-(抗-HBs)维持时间略长。IgM抗-(抗-HBs)较HBsAg/IgM和IgM抗-HBc消失早,将有利于急性HBV感染的诊断。27例CAH和29例CPH,IgM和IgG抗-(抗-HBs)阳性率约为38～52％,两型间无显著差异(p>0.5)。3例无症状HBsAg携带者和12例HBsAg血清疫苗接受者血清,抗-(抗-HBs)阴性。115例HBV感染者中,IgM抗-(抗-HBs)阳性者HBsAg阳性率(93.62)显著高于IgM抗-(抗-HBs)阴性者(52.31％),p<0.005;反之,HBsAg阳性血清IgM抗-(抗-HBs)阳性率(55.5S％)显著高于HBsAg阴性血清(9.68％),p<0.005;IgM抗-(抗-HBs)阳性和阴性血清的HBVDNA阳性率有显著差异(p<0.025),IgG反应到类似的结果。以上资料表明,抗-(抗-HBs)提示了一些HBV感染患者体内可能存在一种缺陷的反馈机制,导致抗-HBs产生不足而容许更活跃的HBV复制。本文证明了HBV感染患者血清中存在的抗-(抗-HBs)可能是共同决定簇“a”特异性的,还表明抗-HBs人抗-Id反应可能被纯化人血清HBsAg抑制,提示人抗-(抗-HBs)与抗-HBs结合的位点可能在HBsAg与抗-HBs结合位点内或在其附近,这和一些动物抗-(抗-HBs)的研究结果是一致的。     

乙肝疫苗对中小学生的保护效果

为进一步了解中小学生乙肝病毒的感染率及乙肝疫苗的保护效果,用固相放免方法检测1 134名小学生和358名中学生的HBsAg和抗-HBs。判定:S/N≥2.1;以≥10 mIU/mL为阳性。乙肝疫苗接种率,市区小学生高于郊区学生(χ2=54.58,P<0.01),HBsAg的阳性率呈下降趋势,检测到的1 134名小学生中,抗-HBs阳性率平均在89.2%。HBsAg阳性率随乙肝疫苗接种率的增高而下降,但市区学生(2.65%)与郊区学生(2.76%)差异无显著意义(χ2=1.35,P>0.05)。近期加强接种了重组乙肝疫苗的中学生,抗HBS-抗体阳性率97.7%。随着乙肝疫苗接种率和抗-HBs阳性率的增高,HBsAg阳性率呈下降趋势。在乙肝高发区,尽管推行了乙肝疫苗全程免疫规划,但从长远的免疫策略考虑,有必要制定加强免疫计划。     

钦南区1～6岁儿童乙肝及白喉疫苗免疫效果分析

目的分析钦南区儿童乙肝及白喉疫苗接种后的免疫效果,为该地区儿童免疫规划工作提供科学依据。方法采用整群随机抽样方法,选取5个乡镇1~6岁常住儿童151名为调查对象,进行病毒性乙型肝炎(乙肝)、白喉血清学检测,并对结果进行分析。结果 HBsAg阳性2人,阳性率1.32%;抗-HBs阳性112人,阳性率74.17%。白喉IgG阳性142人,阳性率94.04%。抗-HBs中位数21.32 mIU/mL,白喉IgG中位数0.14 mIU/mL,乙肝疫苗首针及时接种率83.44%;男女抗-HBs阳性率、白喉IgG阳性率、抗体中位数差异均无统计学意义(P0.05),抗-HBs阳性率、白喉IgG阳性率随年龄的增长而下降(P0.01)。结论钦南区1~6岁儿童乙肝疫苗接种率、首针及时接种率均达到了国家免疫规划的目标,白喉IgG阳性率维持较高的水平,但HBsAg阳性率略高于国家免疫规划的目标,儿童免疫规划工作仍需进一步加强。     

哈尔滨市部分人群乙型肝炎病毒血清标志的流行病学调查

为了解哈尔滨地区乙型肝炎的免疫状况和流行趋势及HBV感染者的血清标志模式与谷丙转氨酶(ALT)的关系 ,采用ELISA法检测血清中乙肝病毒感染标志物 ,酶法测定谷丙转氨酶。结果在 10 47份血清中 ,HBV感染率为 6 .5 9% ,HBsAg阳性率为 4.5 8% ,HBsAb阳性率为 5 9.41%。在年龄分布上 ,5 0岁以上人群HBV感染率为最高 ( 13 .0 4% ,P <0 .0 5 ) ;在职业分布上 ,户外作业人群HBV感染率最高 ( 13.49% ,P <0 .0 0 5 ) ,HBsAb阳性率最低 ( 46 .6 3 % ,P <0 .0 0 5 ) ,五项指标全阴者百分率最高 ( 40 .87% ,P <0 .0 5 )。此外 ,大三阳和HBsAg ,HBcAb两项阳性者多数伴有血清中ALT的异常。了解了哈尔滨地区部分人群乙型肝炎流行情况 ,并证明HBV感染与年龄、职业、疫苗接种有一定相关性。     

Prevalence of hepatitis B viral markers in Vietnamese blood donors

Serum samples were assayed using radioimmunoassay in 573 Vietnamese blood donors living in Hano? (North Viet Nam). 66 (11.5%) subjects were HBsAg-positive. Of these 66 HBsAg carriers, 17 (25,8%) were positive for hepatitis B e antigen (HBeAg) and 43 (65.1%) for antibody to HBeAg (anti-HBe). 22 (3.8%) subjects were positive for antibody to hepatitis B core antigen (anti-HBc) alone. 402 (70.2%) subjects were positive for antibody to HBsAg (anti-HBs). This anti-HBs percentage increased with age. Only 83 (14.5%) subjects were negative for all hepatitis B viral (HBV) markers. This no HBV markers percentage decreased with age. The chi 2 test showed a non significant difference for frequencies of HBsAg, anti-HBc alone, anti-HBs but a significant one for frequencies of no HBV markers in men and women.     

Seropositivity for hepatitis B virus, vaccination coverage, and vaccine response in dentists from Campo Grande, Mato Grosso do Sul, Brazil

This study investigated the seropositivity for hepatitis B virus (HBV), the vaccination index, and the vaccine response index in dentists from Campo Grande, MS. Blood samples from 474 dentists (63.7% women and 36.3% men), with a mean age of 38.5 +/- 10.5 years were analyzed by enzyme-linked immunosorbent assay to detect the serological markers: HBsAg, anti-HBs, and anti-HBc. The HBsAg positive samples were tested for anti-HBc IgM, HBeAg, and anti-HBe. A total of 51 (10.8%) dentists showed seropositivity for HBV. Three (0.6%) were HBsAg/anti-HBc/anti-HBe positive, 43 (9.1%) were anti-HBc/anti-HBs positive, and 5 (1.1%) had only anti-HBc. Viral DNA was detected by polymerase chain reaction in 9 (17.6%) out of 51 HBV seropositive samples. A vaccination index of 96.6% (458/474) was observed, although 73.1% (335/458)completed the three-dose schedule. Excluding 46 HBV seropositive individuals from 458 that reported vaccination, 412 were analyzed for vaccine response index. It was observed that 74.5% (307/412) were anti-HBs positive; this percentage increased to 79.1% when three doses were administered. The results showed a high vaccination index and a good rate of vaccine response; however, the failure in completing the three-dose schedule and the occurrence of HBV infection reinforce the need for more effective prevention strategies.     

A case of hepatitis B reactivation in an anti-HBs positive, anti-HBc positive non-Hodgkin’s lymphoma patient

Dear Editor, We report a case of HBV reactivation in an anti-HBs positive,anti-HBc positive non-Hodgkin's lymphoma patient.Hepatitis B virus (HBV) reactivation is a well-recognized complication of patients undergoing chemotherapy or immunosuppressive therapy for lymphomas.The presence of antibodies to the hepatitis B surface antigen (anti-HBs) has been identified to be a factor preventing HBV reactivation in patients with occult HBV infection receiving chemotherapy.In this paper,we present a non-Hodgkin Lymphoma patient who,before immunosuppressive therapy,displayed positive anti-HBs and positive antibodies to hepatitis B core antigens (anti-HBc),as markers of resolved HBV infection,and developed hepatitis B surface antigen (HBsAg) and high viraemia with an HBV escape mutant after rituximabbased administration.The sequencing data revealed HBV genotype D with two known escape mutations,P120S.     

Hepatitis B infection among patients attending a sexually transmitted diseases clinic in Rio de Janeiro, Brazil

Hepatitis B virus (HBV) has a low endemicity in Rio de Janeiro, Brazil. Sexual transmission must play an important role in this virus, but the prevalence and risk factors have never been properly investigated. The aim of this paper is to determine the prevalence and risk factors for HBV infection in patients attending a Sexually Transmitted Diseases Clinic of the Universidade Federal Fluminense, from the State of Rio de Janeiro, Brazil. In a retrospective study, HBV seroprevalence was investigated in 440 patients. Serum of each patient was assayed for antibodies against hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B surface antigen (anti-HBs). Demographic and risk factor data were extracted from clinic notes. The overall seroprevalence of exposure markers for HBV (anti-HBc, HBsAg and anti-HBs) were 13%, 3.4% and 8.5% respectively. Homo/bisexual behaviour, anal intercourse, HIV infection, positive serology for syphilis and blood transfusion were predictors of the HBV exposure. Among demographic data, age and place of birth were associated with the anti-HBc seropositivity.     

Seroepidemiology of hepatitis B virus infection and high rate of response to hepatitis B virus Butang vaccine in adolescents from low income families in Central Brazil

In order to evaluate the seroepidemiology and response to Butang vaccine in adolescents from low income families in Central Brazil, blood samples of 664 adolescents were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs) markers, and multiple logistical regression analysis was carried out to determine variables associated with hepatitis B virus (HBV) infection markers. further, three 20 microg Butang vaccine doses were offered to all susceptible individuals (n = 304). Among those who accepted them (n = 182), the seroresponse was evaluated in 170 individuals by quantitative anti-HBs. an overall hbv prevalence of 5.9% was found: four adolescents were HBsAg positive, 24 were anti-HBc, anti-HBs-reactive, and 11 were anti-HBc only. The analyse of risk factors showed that age 16-19 years, place of birth outside Goiás, school B and body piercing were statistically associated with HBV infection markers (p < 0.05). All 170 adolescents responded to Butang, and a geometric mean titer (gmt) of 4344 mUI/ml was obtained. these results reinforce the importance of hepatitis b vaccine in adolescents despite of the hbv regional endemicity, and suggest that three doses of 20 microg of the Butang should guarantee protective anti-hbs levels to individuals at a critical time for hepatitis b acquiring such as latter adolescence and adulthood.     

Modulation of hepatitis B infection by intravenous application of an immunoglobulin preparation that contains antibodies to hepatitis B e and core antigens but not to hepatitis B surface antigen.

Repeated administration of an intravenous immunoglobulin containing antibody to hepatitis B e antigen (anti-HBe) and antibody to hepatitis B core antigen (anti-HBc) but free of antibody to hepatitis B surface antigen (anti-HBs) before and after the inoculation of 10(4.9) 50% chimpanzee infective doses of hepatitis B virus (HBV) markedly prolonged the incubation period of HBV in experimentally infected chimpanzees. Similar administration of an immunoglobulin preparation containing anti-HBc but free of anti-HBe and anti-HBs or intramuscular administration of a single dose of immunoglobulin containing anti-HBe and anti-HBc 3 days before or after inoculation with HBV did not appear to modulate HBV infection. These observations suggested that anti-HBe, or an unidentified antibody associated with it, may have biological activity in the modulation of HBV replication.     

输血后乙型肝炎的研究

对204例首次受血(1～2单位)的外科手术患者进行了随访,以观察输血后HBV的感染和发病。血源来自224例HBsAg阴性(RPHA法检测)的献血员,受血者于受血前及受血后6～7个月各采血1次,连同献血员献血前的血清,用同一批RIA试剂检测HBsAg、抗-HBs和抗-HBc。发现用RPHA筛选的HBsAg阴性献血员,用RIA检测时,仍有2.2％(5/224)HBsAg阳性。70例HBV易感者中,受血后13例发生HBV感染,其中2例输入HBsAg阳性血液者发生急性肝炎(2.86％),1例为黄疸型乙型肝炎,另一例为NANB肝炎;11例发生HBV感染,其中8例为输入HBV-DNA阳性血液。以上结果表明,RPHA筛选献血员仍不能杜绝输血后肝炎,RIA筛选献血员后不能杜绝亚临床感染。部分HBV感染不能排除医院内感染的可能性。     

A seroepidemiologic study of hepatitis B virus infection among barbers in Huangshi City, Hubei, China

Between March and August 1986 in Huangshi City, serum samples were collected from 316 apparently healthy barbers as a study group, as well as from 361 healthy employees of department stores as a control group. They were tested for hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc) by enzyme-linked immunoadsorbent assays. Barbers showed a prevalence higher than that in controls for HBsAg (16.8 vs. 9.2%, P less than 0.01), anti-HBs (67.1 vs. 45.9%, P less than 0.001), and anti-HBc (39.2 vs. 21.2%, P less than 0.001). The prevalence of at least one marker of hepatitis B virus (HBV) infection was significantly higher in barbers than in controls (86.1 vs. 61.7%, P less than 0.001). Although the socioeconomic status and education level did not correlate with the frequency of HBV markers, the prevalence of HBsAg increased in parallel with the duration of practice. Because of their high risk for HBV infection, barbers need to be screened for markers of HBV infection on a routine basis, and are prime candidates for immunoprophylaxis with hepatitis B vaccine.