乙型肝炎防治示范区社区儿童HBV感染情况的调查

Children hepatitis B virus infection in the community of HBV prevention and control demonstration area

目的了解甘肃省武威市乙肝防治示范区社区儿童乙型肝炎病毒（hepatitisBvirus，HBV）实际感染情况，为阻断HBV的传播、控制儿童中乙肝的流行提供科学依据。方法在乙肝防治示范区社区人群中选择12岁及以下儿童作为研究对象，采集血清标本并进行流行病学调查。采用酶联免疫吸附试验（enzyme—linkedimmunesorbentassay，ELISA）方法检测血清中乙肝表面抗原（hepatitisBsurfaceantigen，HBsAg）和抗-HBs，乙肝e抗原（hep—atitisBeantigen，HBeAg）阳性者进行HBeAg、肝功能及HBVDNA的定量检测。结果参加本次调查的12岁及以下社区儿童共4159名，HBsAg阳性儿童52例，HBsAg阳性率为1．25％（52／4159）。各年龄组间HBsAg阳性率无统计学意义（x^2=2．90，P=0．407），以1-3岁组最高为2．23％（6／269）。儿童乙肝疫苗接种率为98．68％（4104／4159），儿童抗-HBs阳性率达到59．05％（2456／4159），各年龄组间抗-HBs阳性率差异有统计学意义（x^2=216．81，P〈0．001），以10-12岁组最高为73．57％（1116／1517）。52例HBsAg阳性儿童中，抗-HBs阳性者占15．38％（8／52），HBeAg阳性者占28．85％（15／52），HBVDNA〉1×10^3IU／mL者占51．92％（27／52），肝功异常者占5．77％（3／52）。结论乙肝防治示范区社区儿童中存在一定比例的HBV感染，4-6岁儿童抗-HBs阳性率较低，敦促我们应进一步加强母婴传播的阻断，同时建议对4～6岁儿童开展乙肝疫苗的加强免疫接种工作。

Objective To investigate children hepatitis B virus （HBV） infection in the community, evaluate the effects of immunization after HBV vaccination and provide scientific basis for the national HBV prevention and control dem- onstration areas of Wuwei City. Methods Children under 12 years old from 4 communities of Wuwei City were selected as study subjects. Epidemiological investigations were conducted in the parents or guardians of children for collecting the infor- mation of HBV infection and vaccination. Serum samples of children were collected and used for hepatitis B surface antigen （HBsAg） and anti-HBs enzyme-linked immunosorbent assay detection, only the HBsAg positive samples were tested for hepatitis B e antigen（HBeAg） alanine aminotransferase（ALT） and HBV DNA. Results Among the 4 159 children under 12 years old, 52（ 1.25% ） HBsAg positive were determined. No significant differences were found for positive rate of HB- sAg in different age groups （ x^2 = 2.90, P = 0. 407 ）. The highest HBsAg positive rate was 2. 23% （ 6/269 ） in 1-3 age group. The coverage rate of HB~ vaccination was 98.68% （4 104/4 159） , the anti-HBs positive rate was 59.05 % （2 456/ 4 159）. The Chi-square test showed that the anti-HBs positive rates were significantly different among different age groups （x^2 = 216. 81, P 〈 0. 001 ）. The highest anti-HBs positive rate was 73.57% （ 1 116/1 517） in 10-12 age group. Of the 52 HBsAg positive children,8 （ 15.38% ）, 15 （28. 85% ） and 27 （51.92%） were positive for anti-HBs, HBeAg and HBV DNA, respectively. And 3 （5.77%） were described as abnormal ALT levels. Conclusions With high level coverage rate of HBV vaccine in the community, Anti-HBs positive rate of 4-6 years old children was not satisfied. We should further strengthen the prevention of mother-to-child transmission of HBV. After primary vaccination, booster vaccinations of hepati- tis B vaccine should be given for non-responders specially in 4-6 years old children.