上海市社区居民乙型肝炎血清流行病学分析

Seroepidemiological analysis on hepatitis B virus infection among community residents in Shanghai

目的系统分析上海市自然人群乙肝病毒(HBV)感染状况,初步评价乙型肝炎(以下简称乙肝)疫苗免疫策略效果。方法采用多阶段分层随机抽样和知情同意原则,在上海市30个社区随机抽取2 835人进行调查,采用ELISA法检测上海市社区健康居民乙肝表面抗原(HBsAg)、乙肝表面抗体(抗-HBs)和乙肝核心抗体(抗-HBc)等HBV感染指标,计算标准化阳性率;使用描述性统计方法分析HBV感染指标的三间分布特征,社区居民乙肝疫苗接种率及其影响因素。结果 2012年上海市社区健康居民HBsAg、抗-HBs和抗-HBc的标化阳性率分别为6.86%、42.82%和21.33%,男性抗-HBc阳性率为16.77%,低于女性的19.22%(χ2=2.85,P<0.05);中心城区居民HBsAg阳性率为4.99%,低于郊区的7.04%(χ2=5.21,P<0.05),抗-HBc阳性率为20.25%,高于郊区的16.15%(χ2=8.02,P<0.001);医务人员HBsAg阳性率为22.22%,餐饮服务行业人员抗-HBc阳性率为28.34%;社区居民乙肝疫苗接种率随年龄增长呈下降趋势(χ2趋势=65.96,P<0.001)。结论上海市社区居民乙肝疫苗保护效果明显,但乙肝保护性抗体衰减现象和高危职业人群的疫苗接种工作有待进一步加强。

Objective To systemically analyze the serological characteristics of hepatitis B virus（HBV） infection in the general population and preliminarily assess the effectiveness of immunization strategy of hepatitis B vaccine in Shanghai.Methods We enrolled 2 835 residents from 30 communities with multistage stratified random sampling method and principle of informed consent.Enzyme-linked immunosorbent assay method was used to detect serum samples.We used descriptive statistics tools to estimate standardized seroprevalence rate of HBV and analyze the epidemic distribution of HBV infection,vaccination rate and its related factors in Shanghai.Results The age standardized positive rates of hepatitis B surface antigen（HBsAg）,antibody to hepatitis B surface antigen（anti-HBs）,and antibody to hepatitis B core antigen（anti-HBc） in Shanghai were 6.86%,42.82%,and 21.33%,respectively,which had magnificent relationship with age,sex,occupation,living residence,and vaccination history.The seroprevalence rate of anti-HBc in the males was 16.77%,which was significantly higher than that of the females（19.22%,χ2=2.85;P〈0.05）.The seroprevalence rate of HBsAg of urban population was 4.99%,which was lower than that of rural population（7.04%,χ2=5.21;P〈0.05）.The rate of anti-HBc in rural population was 20.25% and was higher than that of urban population（16.15%）,with statistical significance（χ2=8.02,P〈0.001）.The seroprevalence rate of HBsAg for health care workers was 22.22% and the rate of anti-HBc for food service personnel was 27.78%.Additionally,the vaccination rate of community residents decreased significantly with age（trend χ2=65.96,P〈0.001）.Conclusion The protective effect of hepatitis B vaccine is efficient in community residents in Shanghai.However,the situation of antibody attenuation and HBV vaccination in high risk population should be intensely concerned among community population in Shanghai.