小学生接种乙肝疫苗前筛检策略的优化

采用决策树法，通过费用—效益分析对小学生接种乙肝疫苗前是否需要筛检及对１６种筛检方案进行分析优化。结果表明，在全面推广使用乙肝疫苗时，小学生接种前进行筛检是必要的；但无需同时进行ＨＢｓＡｇ、抗－ＨＢｓ和抗－ＨＢｃ的检测，仅检测抗－ＨＢｃ指标即可，阴性时接种疫苗。此方安不仅可收到与其它方案相同的预防效果，而且可减少大量预防费用。     

乙肝疫苗接种前最佳方案的筛选与确定

为筛选出部队乙肝疫苗接种前最佳筛检方案,以减少部队乙型病毒性肝炎（乙肝）预防的费用,在收集有关参数的基础上,应用决策学方法,建立决策树模型。资料的分析与处理通过ＳＰＳＳ完成。结果提示根据有的疫苗和ＨＢＶＭ筛选试验的费用情况,新兵或整个部队人群接种前最佳筛选方案为选测的抗－ＨＢｓ,对抗－ＨＢｓ阴性者再测抗－ＨＢｃ阴性者接种疫苗。表明在部队中开展筛选后接种乙肝疫苗,可考虑只测两荐指标,这与同时检测乙肝     

基因乙肝疫苗免疫效果随访2年报告

１９９５年９月对本校新生中的“乙肝易感者”（本文指经检测ＨＢｓＡｇ、抗－ＨＢｓ及抗－ＨＢｃ均为阴性者）４５０例采用基因乙肝疫苗接种，于接种第１剂后的第６个月（Ｔ６）采血检测抗－ＨＢｓ，有３７０例抗－ＨＢｓ为阳性，其阳转率为８２．８０％（７９．６９％～８５．７５％），２年（Ｔ２４）后再次采血检测ＨＢｓＡｇ，抗－ＨＢｓ及抗－ＨＢｃ，未发现ＨＢｓＡｇ阳性者。而抗－ＨＢｓ的阳性保持率为７３％（６９．０１％～７７．２１％），说明本文采用基因乙肝疫苗对青年“乙肝易感者”接种有良好的免疫效果，作者建议，对大学生群体中的“乙肝易感者”应将基因乙肝疫苗接种列有常规预防接种对象。     

乙肝疫苗免疫后效果观察

为了解乙肝疫苗免后效果，我们按年龄随机抽取了２３７名儿童用ＲＩＡ检测法对乙肝两对半进行观察，其中母亲ＨＢｓＡｇ阴性儿童免后抗－ＨＢｓ、ＧＭＴ（Ｓ／Ｎ）均随年龄增长呈递减趋势，ＨＢｓＡｇ阳性率１．０８％，抗－ＨＢｃ阳性率为１３．９８％。母亲ＨＢｓＡｇ阳性率为７．８９％，抗－ＨＢｃ阳性率为３４．２１％，说明免疫效果肯定。     

乙肝疫苗免后效果观察

为了解乙肝疫苗免后效果，我们按年龄随机抽取了２３７名儿童用ＲＩＡ检测法对乙肝两对半进行观察，其中母亲ＨＢｓＡｇ阴性儿童免后抗－ＨＢｓ、ＧＭＴ（Ｓ／Ｎ）均随年龄增长呈递减趋势，ＨＢｓＡｇ阳性率１．０８％，抗－ＨＢｃ阳性率为１３．９８％。母亲ＨＢｓＡｇ阳性儿童抗－ＨＢｓ随年龄增长呈递减趋势，免后ＨＢｓＡｇ阳性率为７．８９％，抗－ＨＢｃ阳性率为３４．２１％，说明免疫效果肯定     

幼儿园学龄前儿童HBV感染标志的血清学研究

幼儿园学龄前儿童ＨＢＶ感染标志的血清学研究张树修，封太昌，王桂芝，邓长英为了解学龄前儿童的ＨＢＶ感染率，加强对病毒性乙型肝炎（乙肝）的综合防治，我们对北京市朝阳区五所幼儿园７１２名儿童进行了ＨＢｓＡｇ、抗－ＨＢｓ、抗－ＨＢｃ三项血清学研究。结果报道如...     

用EIA微板法直接检测血清HBcAg的临床应用

用ＥＩＡ微板法直接检测血清ＨＢｃＡｇ，在乙肝ＨＢｃＡｇ阳性者中，ＨＢｃＡｇ阳性检出率为３２．４９％，在乙肝ＨＢｃＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ阳性者中，ＨＢｃＡｇ阳性检出率为８２．０８％，在乙肝ＨＢｓＡｇ、抗－ＨＢｅ、抗－ＨＢｃ阳性者中，ＨＢｃＡｇ阳性检出率为８．１２％。ＨＢｃＡｇ与Ｐ＾ｒｅ－Ｓ１有良好的相关性，ＨＢｃＡｇ与ＨＢＶ－ＤＮＡ探针的阳性符合率为９２．６８％，特异性与ＨＢＶ－ＤＮＡ探针一致     

医学干扰对医院职工HBVm影响的观察

医学干扰前后医院职工ＨＢＶｍ检测分析，结果为抗－ＨＢｓ阳性率显著升高，感染性ＨＢＶｍ阳性率显著下降，ＨＢＶｍ类型变化为ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｅ及抗ＨＢｃ的阳性率显著下降，ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ的阳性率无变化，但ＨＢｓＡｇ、抗－ＨＢｅ、抗－ＨＢｃ的阳性率显著上升。分析结果提示医学干扰显著降低了ＨＢＶ感染率，同时也反映了乙肝携带者较难转阴。     

内蒙古自治区城镇新生儿乙型肝炎疫苗接种率及免疫效果调查

为了解内蒙古自治区城镇新生儿乙型肝炎（乙肝）疫苗的接种率及免疫效果，１９９５年４月，采用批质量保证抽样法（ＬＱＡＳ）进行了抽样调查。抽检的２２个城镇中，乙肝疫苗接种率≥８５％的１４个，８０％的４个，７０％的１个，６５％的３个；及时接种率偏低，仅赤峰市的２个区达到８５％。６３３名儿童乙肝疫苗全程３针免疫１个月后采血，放射免疫法测定，ＨＢｓＡｇ阳性率为１９０％，抗－ＨＢｓ阳性率８９２６％，抗－ＨＢｃ阳性率８０６％。说明抗－ＨＢｓ显著上升，ＨＢｓＡｇ和抗－ＨＢｃ明显下降。     

中小学生HBVM血清流行病学研究

随机选取福田区中小学校各一所，对在校的６～１８岁学生２７０４名进行了ＨＢＶＭ阳性率及其影响因素研究。ＨＢｓＡｇ、抗－ＨＢｓ和抗－ＨＢｃ阳性率分别为９．４３％、４９．５６％和１８．７９％；ＨＢＶＭ总阳性率为６１．９１％，单项抗－ＨＢｓ阳性者高达４１．７２％，ＨＢｓＡｇ或／和抗－ＨＢｃ阳性率为１２．３５％，该人群所呈现出的高保护性、低感染率特征主要由于乙肝疫苗接种造成，说明乙肝疫苗计划免疫管理已改变了人群乙肝自然感染模式。研究还发现，该年龄组人群中ＨＢＶ易感者为３８％，表明乙肝疫苗接种率尚需进一步提高     

外来青年工人乙肝疫苗接种前最优筛检方案的研究

确定东莞市外来青年工人乙肝疫苗接种前最优筛检方案。方法以整群抽样的方法抽取东莞市某外资企业3122名外来青年工人为研究对象，对其进行乙肝三项指标的检测。以该人群乙肝病毒标志物阳性率为基本参数，采用费用一效果分析法和决策树法确定外来青年工人乙肝疫苗接种前的最优筛检方案；采用灵敏度分析法探讨引入模型的参数对方案优化的贡献和阈值分析法检验参数的阳性率阈值。结果东莞市外来青年工人乙肝疫苗接种前最优筛检方案为仅检测抗-HBc；HBsAg、抗-HBs、抗-HBc检测的阳性率阈值分别为0.40、0.40、0.40。结论外来青年工人乙肝疫苗接种前可只检测抗-HBc，这与同时检测乙肝三项指标的预防效果相同。     

Evaluation of methods of pre-vaccination screening for markers of hepatitis B infection

The prevalence of serologic evidence of hepatitis B virus infection in various populations in Greece was examined to provide data for formulating cost-effective strategies for prevaccination screening. Markers were detected in 17.5% of 320 healthy persons, 73.3% of 273 multiply transfused patients and 61.0% of 146 haemodialysis patients. In multiply transfused patients, antibody to hepatitis B surface antigen (anti-HBs) was significantly more common than antibody to core antigen (anti-HBc) (67.0%, 44.3%), while the opposite was true for haemodialysis patients (43.8%, 57.5%). These data suggest that it maybe most cost-effective to screen only for anti-HBs in multiply transfused patients and only anti-HBc in haemodialysis patients. Vaccination without screening may be more cost-effective for healthy persons. Anti-HBs and anti-HBc were detected with similar frequencies (14.7%, 15.9%), thus neither offers an advantage in screening healthy persons, although use of anti-HBc may facilitate detection of chronic carriers. These data indicate that the choice of marker for pre-vaccination screening should depend on the population under consideration.Corresponding author.     

2 274名HBsAg阴性献血员抗-HBs、抗-HBc、HBV-DNA检测结果分析

[目的]检测2274名HBsAg阴性献血员血清抗-HBs、抗-HBc、HBV-DNA,探讨献血员筛查中检测抗-HBs、抗-HBc的必要性。[方法]对2274名HBsAg阴性献血员血清ELISA法检测抗-HBs、抗-HBc,用PCR法检测HBV-DNA。[结果]检测者2274名中①抗-HBs阳性/抗-HBc阴性59.3%,HBV-DNA阳性率0.2%;②抗-HBs阴性/抗-HBc阴性17.4%,HBV-DNA阳性率0.3%;③抗-HBs阴性/抗-HBc阳性1.4%,HBV-DNA阳性率6.3%;④抗-HBs阳性/抗-HBc阳性21.9%,HBV-DNA阳性率0.2%。[结论]抗-HBs阴性/抗-HBc阳性群体中HBV-DNA阳性率最高(6.3%),提示献血员筛查中检测抗-HBs、抗-HBc,可以降低通过输血途径的感染率。     

我国乙型肝炎疫苗接种前筛检策略的优化

By means of decision tree model and cost-effectiveness analysis 15 kinds of programmes which may be used for hepatitis B virus markers screening in vaccination were evaluated. The results showed that the most cost-effective alternative was to identify the negatives for anti-HBc again after testing for anti-HBs and vaccinating all test negatives. That is to say it must not be adopted for persons to be tested for HBsAg, anti-HBs and anti-HBc before being vaccinated. Sensitivity and threshold analysis were also done to determine the effects of changes in the costs of vaccine and screening tests.     

血站供合格血液中HBV标志物检测结果分析

目的检测并分析血站供合格血液中乙型肝炎病毒（HBV）标志物,探讨对献血员进行抗．HBc（IgM）筛查的必要性。方法应用酶联免疫方法检测HBsAg、抗-HBs、HBeAg、抗．HBe、抗-HBc（IsM）。结果3757袋血液标本中,HBsAg均阴性;抗-HBs阳性1181袋,占31．43％;HBeAg阳性3袋,抗．HBe阳性6袋;抗．HBc（IgM）阳性218袋,占5．80％;其中抗．HBc（IgM）与抗-HBs双重阳性185袋,单项抗．HBc（IgM）阳性32袋,抗-HBc（IgM）与HBeAg双重阳性1袋,单项抗．HBe阳性5袋。结论采供血机构对献血者HBV血清标志物仅进行HBsAg检测,对于血液质量和安全输血存在隐患。应对献血员进行抗-HBc（IgM）项目筛查,尽可能降低HBV引起的输血风险,减少医疗纠纷。     

HBV pre-vaccination screening in hospital personnel: Cost-effectiveness analysis

The purpose of this study was to identify the most cost effective method for screening subjects for hepatitis B vaccination. Such a method would ideally permit detection of all susceptible individuals at the lowest possible cost.Two-hundred-five hospital workers from the Piedmont region of Italy participated in the study. The sero-epidemiological conditions of this group with regard to hepatitis B markers was representative of hospital workers in this region as a whole. All subjects, excluding carriers, persons with anti-HBs titers 10 mIU and subjects positive for anti-HBc at a 1/100 dilution, were vaccinated. Their responses were evaluated 15 days and 1 month after vaccination. The presence of a booster effect following vaccination was correlated with the immunological status of the subject at the time of pre-vaccination screening.In the light of the results obtained, 5 screening procedures and the procedure of vaccination without screening were evaluated. The most cost effective screening strategy proved to be that of sequential testing for anti-HBc, anti-HBs and finally HBsAg and vaccination of the following subjects: those who were negative for anti-HBc, those who were anti-HBc-positive with anti-HBs titers 10相似文献   

Community-based research: cost of the tests used for anti-HBc total seropositivity only and hepatitis B screening

Our study aimed to determine anti-HBc total (IgG+IgM) seroprevalence in the adult population aged ≥15 and to compare the cost of testing for HBsAg and anti-HBs in only anti-HBc positive (+) subpopulation to that in the whole population for HBV screening. The study involved a face-to-face survey and peripheral blood sampling from 452 adult subjects for HBV tests. HBV-DNA PCR was studied only in anti-HBc(+)subjects. Of the 452 subjects anti-HBc total was positive in 192 (42.47%), of which: (a) 27 (14.06%) were HBsAg(+), anti-HBs negative (-), (b) 126 (65.62%) were HBsAg(-), anti-HBs(+), (c) 39 were HBsAg(-), anti-HBs(-). This last group (c) were tested for HBV-DNA PCR and six (15.38%) were positive. When we perform HBsAg and anti-HBs tests in all 452 subjects as in routine practice in blood banks, the cost is 3320 Euros. However, when all subjects are tested for anti-HBc total at first and then only anti-HBc total(+) ones are tested for HBsAg and anti-HBs, the cost is 2929 Euros. The cost difference between the two methods is 391 Euros for 452 subjects. Accordingly, our HBV screening algorithm brings a financial saving of 11.78% and helps to identify the isolated anti-HBc total(+) subjects who carry potential risk for spreading HBV.     

Decrease in the prevalence of hepatitis B and a low prevalence of hepatitis C virus infections in the general population of the Seychelles

A serological survey of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections was carried out on a random sex- and age-stratified sample of 1006 individuals aged 25-64 years in the Seychelles islands. Anti-HBc and anti-HCV antibodies were detected using commercially available enzyme-linked immunosorbent assays (ELISA), followed by a Western blot assay in the case of a positive result for anti-HCV. The age-adjusted seroprevalence of anti-HBc antibodies was 8.0% (95% CI: 6.5-9.9%) and the percentage prevalence among males/females increased from 7.0/3.1 to 19.1/13.4 in the age groups 25-34 to 55-64 years, respectively. Two men and three women were positive for anti-HCV antibodies, with an age-adjusted seroprevalence of 0.34% (95% CI: 0.1-0.8%). Two out of these five subjects who were positive for anti-HCV also had anti-HBc antibodies. The seroprevalence of anti-HBc was significantly higher in unskilled workers, persons with low education, and heavy drinkers. The age-specific seroprevalence of anti-HBc in this population-based survey, which was conducted in 1994, was approximately three times lower than in a previous patient-based survey carried out in 1979. Although there are methodological differences between the two surveys, it is likely that the substantial decrease in anti-HBc prevalence during the last 15 years may be due to significant socioeconomic development and the systematic screening of blood donors since 1981. Because hepatitis C virus infections are serious and the cost of treatment is high, the fact that the prevalence of anti-HCV antibodies is at present low should not be an argument for not screening blood donors for anti-HCV and eliminating those who are positive.     

抗HBc阳性,HBsAg阴性献血者乙型肝炎病毒感染性研究

目的为预防输血后乙型肝炎，是否有必要在献血者中加做抗－ＨＢｃ筛查以及采取何种取舍标准？为此，对常规筛查合格的献血者血液进行了抗－ＨＢｃ滴度与ＨＢＶＤＮＡ相关性的研究。方法用免疫－套式ＰＣＲ法检测了２９７份不同滴度组抗－ＨＢｃ阳性血液的ＨＢＶＤＮＡ。结果在４份抗－ＨＢｃ滴度≥１１２８的血液中检出１例ＨＢＶＤＮＡ，而在另７５份抗－ＨＢｃ滴度＜１１２８的血液中未检出，ＨＢＶＤＮＡ与抗－ＨＢｃ滴度之间有显著相关性。在２１８份抗－ＨＢｃ／抗－ＨＢｓ双阳血液及５０份抗－ＨＢｃ阴性血液中未检出ＨＢＶＤＮＡ。结论仅含高滴度单项抗－ＨＢｃ的血液可能具有传染性；ＨＢＶＤＮＡ在抗－ＨＢｃ阳性血液中的总检出率低，仅为０．３４％（１／２９７）。建议将有限的资金首先用于进一步提高现有献血者ＨＢｓＡｇ检测试剂的灵敏度（目前为１ｎｇ／ｍｌ），或许更为有效。     

Occupational and non-occupational hepatitis B virus infection among hospital employees in Jerusalem: a basis for immunisation strategy.

The present study was designed to assess the risk of hepatitis B virus (HBV) infection among hospital employees, who often contract the infection before the beginning of their employment, and to suggest a prevention strategy. The study population consisted of 2518 subjects working or studying at the two Hadassah University hospitals, on Mount Scopus and at Ein Kerem in Jerusalem. The total prevalence for anti-HBc positivity as an indicator for past or present HBV infection was 17.6%. Several variables, including country of birth, age, and duration of employment significantly affected the rate of anti-HBc positivity. The highest rates for anti-HBc+ were found in personnel of selected departments such as haemodialysis (31.8%), haematology/oncology (28.3%), and the blood bank (24.0%), after adjustment for country of birth, age, and sex. Specific occupations in the hospital were associated with an increased rate of anti-HBc positivity. Thus the highest rate of HBV infection (after adjustment for country of birth, age, and sex) was shown for housekeepers (32.4%) and departmental secretaries (23.6%), who take care of waste products containing blood, or who transfer vials containing blood to the hospital laboratories. By comparison, anti-HBc was positive in 17.2% of nurses, 15.6% of physicians, and only 7.8% of administrative clerks. Israel is a country of immigration, and anti-HBc rates were four times higher in employees born in countries where HBV is more endemic--for example, in north Africa and Mediterranean countries--than in employees born in western Europe or the United States. However, rate of anti-HBc + increased significantly with age as well as duration of employment in the hospital, irrespective of country of birth. These data indicate that although HBV infection often occurs in Israel before commencement of employment in the hospital, hospital employees are at significant risk for contracting HBV infection during their professional lifetime regardless of where they were born. Moreover, paramedical personnel such as housekeepers and departmental secretaries are in the highest risk group for contracting HBV. Finally, as a result of the high background of anti-HBC positivity in selected ethnic groups, mandatory screening for anti-HBc before employment in medical institutions in Israel is recommended for them, then active vaccination against HBV for employees at risk. Employees who immigrated from western Europe and the United States should be immunised without pre-vaccination screening for HBV.