海南省人群乙型肝炎血清流行病学调查研究

Sero-epidemiological survey of hepatitis B in different populations in Hainan Province.

目的了解海南省人群乙型肝炎病毒（HBV）感染现状，评价乙肝疫苗纳入儿童免疫策略后的效果。方法采取整群抽样方法，按照经济水平、民族、地理位置，选择被调查市县。在被选市县中随机抽取2个乡镇，每个乡镇随机抽取1个村．以家庭为单位对全部人群采集静脉血用ELISA检测HBsAg、抗-HBs和抗-HBc，并完成个案调查。结果共采集3945人血清进行检测，人群中HBsAg阳性率为13.18％、抗-HBs阳性率为52.72％、HBV流行率为56．96％。HBsAg阳性率最高年龄组为20—29岁组（21．52％）。最低为0-4岁组（4，02％），10岁以下儿童为6．21％；HBV流行率最高为50～59岁组（83．43％），最低是0—4岁（29．99％），10岁以下组为30．69％。HBsAg阳性率和HBV流行率：城市低于农村。差异有非常显著性（x^2=13．66，P〈0．01；x^2=12．56，P〈0．01）。富裕地区、经济欠发达地区、贫困地区三者间比较。差异也存在显著性（x^2=50．13，P〈0．01；x^2=13．17，P〈0．01）。HBsAg阳性率，男性高于女性（x^2=11．97，P〈0．01）；HBV流行率男性低于女性（x^2=7．74．P〈0．01），差异均存在显著性。结论海南省人群HBV流行率是高的，人群HBsAg携带率仍远高于全国平均水平，但人群中乙肝流行病学特征已发生了改变，乙肝疫苗纳入儿童免疫规划后效果显著，降低了人群HBsAg携带率和HBV流行率，特别是10岁以下儿童下降幅度更为明显。

Objective To understand the current infectious status of hepatitis B virus in Hainan Province and evaluate the effect of immunization with hepatitis B vaccine after implementation of the Expanded Programme on Immunization （ EPI）. Methods Cluster random sampling method was used to select surveyed counties or cities according to economic level, nationality and geographical position. 2 townships were selected in random in every county or city and 1 village was selected in random in every township. Vein blood samples were colleeted from everyone in surveyed families and the Case Survey Form was completed. HBsAg, anti- HBs and anti - HBe antibodies were tested with ELISA reagents. Results The total 3 945 serum samples were tested, the positive rates of HBsAg and anti - HBs were 13.18 %, 52.72 %, respectively. The prevalence rate was 56.96 %. The highest positive rate of H BsAg was 21.52% in 20 - 29 years old group, the lowest rate was 4.02% in 0 - 4 years old group. The positive rate of HBsAg was 6.21 % for less than 10 years old group. The highest prevalence rate of HBV was 83.43% in 50 - 59 years old group and the lowest was 29.99% in 0 - 4 years old group and 30.69% in less than 10 years old group. The HBsAg positive rate and HBV prevalence rate of urban populations were significantly lower than that of rural populations （x^2 = 13.66, P 〈 0.01 ;x^2 = 12.56, P 〈 0.01）, and the above rates were significantly different in areas with diverse economical levels （ P 〈 0.01）. There were significant difference within prosperous area, undeveloped area and poor area （x^2 = 50.13, P 〈 0.01;x^2 = 13.17, P 〈 0.01 ）. The H BsAg positive rate of the males was significant higher than that of the females （x^2 = 11.97, P 〈 0.01）, but the HBV prevalence rate of the male was lower than that of the female and the differences were significant （x^2 = 7.74, P 〈 0.01 ）. Conclusion The prevalence rate of HBV is high in Hainan province. The current HBsAg carrying rate in Hainan Province is still higher than the national average level. But the epidemiologic characteristics of HBV have been changed. The effect of immunization with HBV vaccine through EPI is remarkable. The HBsAg carrying rate and HBV prevalence rate are reduced significantly, especially the age group of less than 10 years old.