西藏自治区2014年和2020年1~69岁人群乙型肝炎血清流行病学调查分析

Comparative analysis of seroepidemiological survey results of hepatitis B among people aged 1-69 years in Tibet Autonomous Region in 2014 and 2020

目的对比2014年和2020年西藏自治区(西藏)两次乙型肝炎(乙肝)血清流行病学调查结果, 评价西藏乙肝防控效果。方法两次调查均以1~、5~、15~、30~69岁常住人口HBsAg阳性率估计值计算所需样本量, 2014年和2020年所需样本量分别为7 163和4 802人。采用多阶段分层整群随机抽样方法抽取调查对象, 开展问卷调查并对每名调查对象采集5 ml静脉血, 检测HBsAg、抗-HBs、抗-HBc, 对HBsAg阳性标本进行复核。使用SPSS 22.0软件对调查结果进行分析, 计算各指标阳性率及其95%CI。结果 2014年共调查7 069人, 2020年共调查4 913人。2020年HBsAg、抗-HBs和抗-HBc阳性率分别为9.20%(452/4 913)、37.11%(1 823/4 913)和32.75%(1 609/4 913), 较2014年分别下降22.95%、15.54%、1.92%。1~、5~、15~、30~69岁人群HBsAg阳性率分别为2.23%(8/358)、2.85%(20/701)、6.86%(69/1 006)和12.46%(355/2 848), 较2014年分别下降61.82%、62.75%、54.81%和24.21%。1~4岁人群抗-HBs阳性率为52.79%(189/358), 较2014年上升10.30%, 5~、15~和30~69岁人群分别为32.67%(229/701)、37.67%(379/1 006)、36.03%(1 026/2 848), 较2014年分别下降20.84%、14.13%和16.52%。1~、5~、15~、30~69岁人群抗-HBc阳性率分别为4.19%(15/358)、6.42%(45/701)、21.07%(212/1 006)、46.95%(1 337/2 848), 较2014年分别下降59.63%、58.93%、50.49%、12.10%。结论西藏乙肝防控工作取得一定成效, 1~69岁人群HBsAg阳性率2020年较2014年有所下降, 但现阶段仍处于高流行水平。1~69岁人群抗-HBs水平较低, HBV感染风险较大, 需进一步加强乙肝疫苗接种工作, 有效落实HBV母婴阻断策略。

Objective To evaluate the effectiveness of hepatitis B prevention and control in Tibet Autonomous Region by comparative analysis of the results of seroepidemiological surveys of hepatitis B in 2014 and 2020.Methods The required sample size was calculated based on the estimated HBsAg positivity rates of permanent residents aged 1-4,5-14,15-29,and 30-69 years.A total of 7163 people and 4802 people were required in 2014 and 2020,respectively.The subjects were selected by stratified multistage cluster random sampling method,using questionnaires to obtain basic information,and 5 ml of venous blood was collected from each subject to detect HBsAg,anti-HBs,and anti-HBc,and rechecked the HBsAg positive samples.SPSS 22.0 software was used to analyze the survey results,calculate the positive rate and 95%confidence interval.Results A total of 7069 people were investigated in 2014 and 4913 people in 2020.In 2020,the positive rate of HBsAg,anti-HBs,and anti-HBc was 9.20%(452/4913),37.11%(1823/4913),and 32.75%(1609/4913),respectively,and decreased by 22.95%,15.54%,and 1.92%as compared with the rate in 2014.The positive rate of HBsAg of people aged 1-,5-,15-and 30-69 years in 2020 was 2.23%(8/358),2.85%(20/701),6.86%(69/1006)and 12.46%(355/2848),respectively,decreased by 61.82%,62.75%,54.81%and 24.21%as compared with the rate in 2014.The positive rate of anti-HBs of people aged 1-4 years was 52.79%(189/358),10.30%increased compared with 2014;for people aged 5-,15-,and 30-69 years was 32.67%(229/701),37.67%(379/1006)and 36.03%(1026/2848),respectively,decreased by 20.84%,14.13%and 16.52%as compared with the rate in 2014.The positive rate of anti-HBc of people aged 1-,5-,15-,30-69 years was 4.19%(15/358),6.42%(45/701),21.07%(212/1006),and 46.95%(1337/2848),respectively,decreased by 59.63%,58.93%,50.49%,and 12.10%as compared with the rate in 2014.Conclusions The prevention and control of hepatitis B in Tibet have made partial achievements.The prevalence of HBsAg among people aged 1-69 years in 2020 had declined compared with 2014,but it is still at a high epidemic level.People have a high risk of HBV infection for a low level of anti-HBs.It is necessary to strengthen the vaccination of hepatitis B further and effectively implement the strategy of blocking mothers and children of the hepatitis B virus.