2001—2015年宜昌市乙型病毒性肝炎流行病学特征与免疫接种效果

Epidemiological characteristics of hepatitis B and effectiveness of hepatitis B vaccine in Yichang City from 2001-2015

目的全面了解宜昌市自然人群中乙型病毒性肝炎流行现状,分析2001—2015年宜昌市乙肝的流行趋势和实施GAVI项目(对2004年4月25日后出生新生儿实施乙肝疫苗免费接种)效果。方法收集宜昌市乙肝疫情资料,用描述流行病学方法对所获取资料进行乙肝发病率和死亡率流行特征分析。结果 15年宜昌市共报告乙肝病例52 390例,年均发病率为87.26/10万;死亡80例,年平均死亡率0.13/10万。发病无明显季节性,符合乙肝主要经血液及性传播的特点。各市县区均有病例报告,年平均发病率居前3位县市区为点军区255.96/10万、猇亭区197.06/10万和西陵区135.45/10万。报告病例中男性发病多于女性,男女比1.98:1;以农民为主,发病数占全部病例数的49.85%。15~69岁年龄组病例33 537例,占总数93.68%。实施GAVI项目前后5年15岁以下人群乙肝报告发病率分别为24.90/10万和9.55/10万,二者差异有统计学意义(χ~2=6.85,P<0.05),儿童乙肝的发病率得到有效控制。随着目标人群乙肝疫苗全程接种率的逐年提高,儿童乙肝发病呈现下降趋势,二者呈负相关,相关性检验分析差异有统计学意义(r=-0.764,P<0.05)。结论开展乙肝疫苗接种、乙肝母婴阻断及健康教育等工作对乙肝的预防效果明显,应在做好儿童乙肝接种工作同时,加强重点人群的乙肝预防接种工作及慢性乙肝长期健康管理;进一步规范病毒性肝炎的诊断与治疗,减少慢性肝炎、肝硬化和肝癌的发生。

[Objective]To systematically understand epidemic situation of hepatitis B among natural population in Yichang City,analyze the effectiveness of epidemic trend in Yichang City from 2001-2015,and explore the effectiveness of GAVI project（free hepatitis B vaccination in newborn born after April 25,2004）.[Methods] Epidemic data of hepatitis B in Yichang City were collected,and the incidence and mortality of hepatitis B were analyzed by descriptive epidemiological methods.[Results] A total of 52 390 hepatitis B cases were reported in the past 15 years with an annual incidence of 87.26/lakh,and there were 80 death cases with the annual average mortality of 0.13/lakh.The epidemic situation showed no obvious seasonality,which accorded with hepatitis B transmission characteristics（blood and sexually transmission）.The cases were reported in all cities/counties/districts,and top three cities/counties/districts of the annual incidence were Dianjun District（255.96/lakh）,Xiaoting District（197.06/lakh）and Xiling District（135.45/lakh）.The male cases were more than females,with the male-to-female ratio of 1.98∶1.Most of patients were farmers,accounting for 49.85% of total cases.There were 33 537 cases in 15-69 year-old group,accounting for 93.68%.The incidence of hepatitis B among people below 15 years old in five years before and after the implementation of the GAVI project was 24.90/lakh and 9.55/lakh respectively,and the difference was statistically significant（χ^2=6.85,P〈0.05）,which indicated that the incidence of hepatitis B in children has been controlled effectively.The incidence of hepatitis B in children was decreasing with the increase of the whole coverage rate of hepatitis B vaccine in the target population year by year,there was a negative correlation between them,and difference was statistically significant（r =-0.764,P〈0.05）.[Conclusion] Hepatitis B vaccination,mother to child interruption and health education are effective in preventing hepatitis B.It is necessary to improve the childhood immunization,strengthen immunization and long-term health management of high-risk people,and further standardize the diagnosis and treatment of viral hepatitis,to reduce the occurrence of chronic hepatitis,liver cirrhosis and liver cancer.