中国某县既往有偿供血者HIV感染追踪监测

The follow up surveillance of HIV infection among former paid blood donors in a county of China

目的了解某县单采血浆供血者艾滋病病毒(HIV)感染状况。方法 (1)对某县全部人口进行逐户调查有偿供血者,采集血标本分离血清检测HIV抗体。(2)利用监测系统,开展动态监测,发现漏筛HIV感染者和AIDS病人;(3)采用快速蛋白印迹方法 (RWB)或酶联免疫吸附试验方法 (ELISA)初筛,阳性者用Western-blot确认。用套式聚合酶链反应(Nest-PCR)扩增产物并进行序列分析,对HIV型别和亚型进行鉴定。结果 1995-2009年,全县共发现有偿供血者HIV/AIDS病人226例,其中1995年3月有偿供血者中普查到HIV感染者111例,感染率为5.53%(111/2008),单采血浆供血者感染率为15.05%(79/525),既供全血又供血浆者感染率为8.06%(32/397),供全血者无感染者发现(0/1086)。1996-2009年追踪监测发现115例HIV感染者,发现的方式包括血液中心的HIV抗体筛查、VCT、医院就诊、孕妇筛查和术前检查等。结论在爆发初期,由于恐惧和歧视等原因,人们隐瞒了有偿供血史而被漏筛,经过15年的追踪监测,显现出了这起有偿供血者HIV/AIDS爆发的全貌。

Objective To investigate HIV infection status among former paid blood donors in a county of Hebei province,China.Methods 1）A household survey was conducted in the whole county to screen former paid blood donors in March of 1995 and blood specimens were taken for HIV antibody test.2）Dynamic surveillance was followed by the local surveillance system to identify missing HIV infectors/AIDS patients.3）RWB or ELISA was used as screening assay,and the HIV positive specimens were confirmed by WB.Nest-PCR was used as sequence analysis to identify HIV types and subtypes.Results From 1995 to 2009,226 HIV infectors were detected among former paid blood donors in the whole county,of whom 111 cases were identified just in March of 1995.The overall infection rate was 5.53%（111/2008）among the blood donors,which included：15.05%（79/525）among plasmapheresis donors,8.06%（32/397）among plasma and whole blood donors,and 0%（0/1086）among whole blood donors.Another 115 cases were detected by follow up surveillance from 1996 to 2009.HIV infections were detected in the following ways：screening in blood centers,VCT,consulting a doctor,screening for pregnant woman,testing before surgical operation and so on.Conclusion In the early days of HIV/AIDS outbreak,the history of paid blood donation was hidden for fear of social discrimination,and as a result a large numbers of paid blood donors were not identified in 1995 HIV screening.It was only owing to 15 year surveillance that the whole picture of HIV/AIDS outbreak was clarified.