人腺病毒感染的病原学研究现状

[摘要]　人腺病毒（humanadenovirus, HAdV）是人类重要的病毒性致病原，可被划分为7个亚属（A～G）和至少113个型别，由于不同型别HAdV的组织嗜性不同，可导致多种疾病，主要包括急性呼吸道感染、眼结膜炎、胃肠道疾病等。2022年1月以来，全球多个国家相继报道了不明原因儿童严重急性肝炎病例，截至5月3日，WHO已接收到20个国家报告的228例病例。目前认为，HAdV感染是引起此次儿童严重急性肝炎的可能病因之一。我国由于缺乏系统的监测和研究而对HAdV感染所致肝炎的疾病负担认识不足，应尽快通过医防合作，开展以HAdV为主的非嗜肝病毒的病原学监测，为我国儿童严重急性肝炎的防控提供支持。     

上海市杨浦区急性病毒性肝炎住院病例未定型原因分析

上海市病毒性肝炎监测方案要求肝炎病原学分型率达到95％以上,上海市病毒性肝炎防制工作要求急性肝炎住院病例病原学分型率达99％以上,未定型率低于20％。2005-2006年杨浦区急性肝炎住院病例未定型率分别为30．45％、35．88％,为全市最高（2005--2006年全市未定型率分别为20％、16．14％）。为降低杨浦区急性肝炎住院病例未定型率,     

不明原因儿童严重急性肝炎的临床研究进展和挑战 和免疫无应答相关研究进展

[摘要]　2022年4月以来，多个国家或地区相继报告了新发不明原因儿童严重急性肝炎病例，因其可致患儿肝功能恶化等严重后果而引起全球范围内广泛关注。不明原因儿童严重急性肝炎的临床特点、实验室指标检测结果等已有部分报道，但具体致病机制还有待进一步明确。进一步提高应对新突发不明原因疾病的处理能力仍是临床工作者面临的一大挑战。     

上海市闸北区1956—2007年急性病毒性肝炎流行病学分析

数十年来，急性病毒性肝炎（以下简称急性肝炎）一直占闸北区传染病发病率的前2、3位，近20多年来，甲、乙肝疫苗的广泛应用，甲、乙型肝炎在闸北区的发病趋势已发生明显改变。52年的监测资料客观地反映了闸北区急性肝炎的流行规律和趋势，通过对这些变化的分析，可为今后建立新的预防控制策略提供依据。     

2013～2015年五华县乙型病毒性肝炎流行特征分析

目的了解五华县乙型病毒性肝炎流行病学特征,评价乙肝流行状况,为乙肝防控工作提供科学依据。方法对2013~2015年五华县通过病例信息收集、实验室检测、急性乙肝病例流行病学调查的乙肝监测结果进行流行病学分析。结果 2013年1月至2015年6月全县共报告乙肝448例,年均发病率13.21/10万,占病毒性肝炎总病例数的79.86%;急性病例占3.57%（16例）,慢性病例占89.06%（399例）,未分型病例占7.37%（33例）;全县16个乡镇均有病例报告;男性发病率18.28/10万,女性发病率7.84/10万;发病年龄3月龄~89岁、30~59岁人群占54.24%（243例）;职业以农民最多,占82.37%（369例）;2013~2014年每个月均有病例报告,发病无明显季节性。结论五华县通过实施儿童乙肝疫苗免疫规划后,有效控制了儿童发病,急性感染病例得到遏制。     

2004-2011年安徽省丙型病毒性肝炎流行特征分析

目的对2004-2011年安徽省丙型病毒性肝炎（hepatitis C virus,HCV）的流行特征进行分析,为其防治工作提供理论依据。方法通过中国疾病预防控制信息系统,检索2004-2011年安徽省丙型病毒性肝炎网络报告病例情况,并进行统计分析。结果 2004-2011年安徽省丙型病毒性肝炎发病率呈逐年上升趋势,2011年安徽省丙型病毒性肝炎发病率为5.55/10万人;发病以成人为主,男性高于女性,男女性别比为1.35∶1;安徽南方地区近年来发病率升高较为明显。移动阈值分析提示,2011年安徽省丙型病毒性肝炎网报病例数在往年基础上持续增加,与实际发病情况吻合。结论近年来,丙型病毒性肝炎感染呈上升趋势,低年龄组儿童病例报告增多,提示要做好丙型病毒性肝炎的日常监测工作,提高监测系统的敏感性;加强对血源的管理,尤其是增强对不安全注射的监管力度。     

江苏省海安县2007—2008年病毒性肝炎分型监测分析

目的了解海安县病毒性肝炎（简称肝炎）发病的实际水平,为制订肝炎防治策略提供依据。方法对该县李堡和角斜2镇常住人口在2007年3月1日—2008年2月29日期间达到＂可疑肝炎病例＂标准的病人采集血样送辖区内医院检测ALT。ALT阳性者,在15～20d内采集第2份血样,及时将2份血样送海安县疾病预防控制中心,用ELISA方法检测抗-HAVIgM、HBsAg、抗-HBslgM、抗-HCV、抗-HEVIgM。同时对全县其他镇报告的急性肝炎病人进行分型诊断。结果监测期间2镇共报告急性肝炎监测病例338例,急性肝炎监测病例发病率为260.73/10万。甲、乙、丙、戊型肝炎比例分别为8.06%、37.10%、16.13%、38.71%。结论肝炎防治工作仍是今后该县疾病预防控制工作的重点之一,其中乙、戊型肝炎防治工作将是肝炎防制的重中之重。     

贵州省流行性乙型脑炎病例监测的研究

目的通过对贵州省2004-2005年流行性乙型脑炎（乙脑）病例监测的研究，了解乙脑实验室确诊病例占报告病例的比例，掌握贵州省乙脑真实流行状况，为乙脑防治提供科学依据。方法根据疫情信息监测管理系统、个案调查资料、实验室结果及2个国家级监测县的病例监测进行综合分析。结果2004、2005年分别报告乙脑病例1230和1038例，15岁以下病例分别占总病例数的96．58％（1188／1230）和97．69％（1014／1038），男性与女性病例之比分别是1．58：1和1．57：1；发病主要集中在7-8月，分别占78．21％（962／1230）和79．09％（821／1038）。监测县7-8月病例占88．36％（319／361）。发病有明显季节性，且为高度散发；有免疫史的分别为6．90％（26／377）和8．86％（32／361）；实验室乙脑IgM抗体阳性率分别为74．90％（188／251）和71．74％（259／361）。监测县乙脑IgM抗体阳性率为71．88％（23／32）。乙脑病例监测：2005年比2004年下降15．61％。监测县2005年乙脑发病数比2004年下降39．47％。结论贵州省实验室确诊乙脑病例数占总报告病例数的71．88％-74．90％。应进一步加强乙脑专项监测和提高实验室诊断技术，使非乙脑报告病例得到明确诊断；继续对15岁以下儿童实施乙脑疫苗预防接种为主的综合防治措施。     

2007--2012年新疆阜康市手足口病流行特征分析

目的根据2007--2012年新疆阜康市手足口病（HFMD）病例诊疗信息,分析阜康市HFMD病例流行病学特征。方法病例信息来源于《中国疾病预防控制信息系统》,采用SPSS16．0软件描述阜康市HFMD病例流行病学特征。结果2007--2012年阜康市累计报告HFMD病例321例,无死亡病例。病例年龄0～32岁（中位数17）,以男性为主（男女性别比1．5：1）,患者以0～5岁以下儿童为主,该年龄段患儿占总病例数的85．0％（273／321）。病例职业以散居及幼托儿童（89．0％,286／321）为主,其次为中小学生（10．0％,32／321）。2007--2012年阜康市HFMD流行呈周期性趋势。近郊乡镇和城乡接合部报告例数较多,中心城区、远郊乡镇报告病例数较少。结论5岁及以下儿童为阜康市HFMD高发人群,应针对高危及早采取控制措施,同时应加强全市疫情监测。     

北京市西城(南)区病毒性肝炎流行病学分析

目的探讨北京市西城（南）区病毒性肝炎的流行病学特征,为今后病毒性肝炎的防控提供科学依据。方法整理2010—2014年西城（南）区报告的病毒性肝炎病例资料,通过描述流行病学方法对其进行统计分析。结果 2010—2014年,西城（南）区共报告病毒性肝炎病例512例,平均发病率为16.63/10万,且主要以乙型肝炎和丙型肝炎为主;发病年龄最高在40～59岁,最低在0～19岁,在各种职业中,离退人员、家务及待业及干部职员发病较多。结论该区应在继续加强儿童甲、乙型肝炎疫苗免疫接种工作的同时,进一步加强高危人群的疫苗接种将是今后工作重点;规范病毒性肝炎的规范化诊断与治疗,减少慢性病毒性肝炎病例的发生。     

急性病毒性肝炎住院患者血清学分型与流行病学分布研究

本文收集了西安市住院急性病毒性肝炎患者血清标本２９３份，用ＥＬＩＳＡ进行分型检测，并作流行病学调查。结果发现：甲肝占６５．１９％，乙肝占１０．９２％，丙肝占４．７８％，丁肝占３．７５％，戊肝占４．４４％，诊断不明者占１０．９２％。结果表明，在西安市住院的急性病毒性肝炎中，甲肝为主要类型；与以往结果比较，甲肝患者的发病年龄明显后移；除乙肝外，各型肝炎中男性均多于女性，尤以丁肝和戊肝为著；甲肝有明显的     

Role of TT virus in pathogenesis of liver diseases--the prevalence of TTV in patients and healthy individuals

Primarily TTV has been thought as an etiologic agent of post transfusion non-A to -G hepatitis. TTV can replicate in liver and bone marrow cells. The presence of TTV has been found in the serum of patients with acute as well as chronic hepatitis of known etiology. Patients with acute hepatitis A, B, C and hepatitis caused by EBV or CMV all have TTV viremia in a frequency up to 60%. In chronic viral hepatitis TTV was present in a wide range of 7-94.4%. Treatment of viral hepatitis patients with interferon alfa and rybawiryn leads to eradication of TTV viremia in 50% cases. TTV infection in hepatocellular carcinoma ranged from 8.1% up to 100% patients. In hepatitis of unknown etiology TTV infection was observed in 26% to 71% cases. In liver cirrhosis TTV infection has been evidenced in 10% to 66% patients. Some authors postulated that the frequency of TTV increased with the number of blood or blood products transfusions. Coinfection of TTV has been found in 34.9%-76% of HIV positive persons. The study of medical staff revealed no difference in TTV viremia with healthy individual control. TTV is widespread in healthy general population. Therefore based on so far published results the association between TTV infection and hepatitis is questionable.     

2006 - 2017年青岛市急性乙型病毒性肝炎流行趋势及特征分析

目的 分析青岛市急性乙型病毒性肝炎（乙肝）发病趋势和流行特征,为乙肝防控工作提供科学依据。方法 采用描述性流行病学方法对2006 - 2017年青岛市急性乙肝发病特征进行分析,发病率的趋势性检验采用直线回归分析,自变量为年份,因变量为发病率的自然对数值。结果 2006 - 2017年青岛市共报告急性乙肝病例2 415例,年均发病率为2.29/10万,发病率呈逐年下降趋势（t = -8.306,P＜0.001）。病例季节分布不明显,发病率较高地区为黄岛区、李沧区、市北区,发病率分别为3.38/10万、2.82/10万、2.70/10万。男性发病率高于女性,男性为3.28/10万,女性为1.30/10万,男女性别比为2.52∶1,发病年龄集中在20～49岁,农民、工人、家务及待业发病较多,分别占总病例数的36.44%,16.27%和12.38%。结论 青岛市急性乙肝发病率逐年下降,男性15岁以上人群为重点防控人群,应在提高儿童乙肝疫苗接种率的基础上加强对其他易感人群的免疫接种,并将健康教育与人群免疫结合起来。     

Hepatitis B in children in Italy: Incidence and risk factors

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12–13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0–14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.     

温岭市病毒性肝炎的病原学与临床类型

了解温岭市散发性病毒性肝炎的病原和临床特征,为制定科学的预防措施提供依据。方法对2000年1月至2009年12月在温州医学院附属温岭医院住院的3317例病毒性肝炎患者资料进行回顾性分析。结果在3317例患者中,甲、乙、丙、丁、戊、庚型病毒性肝炎分别占1.63％、64.97％、0.66％、0.12％、9.52％、0.06...     

Acute hepatitis B among children and adolescents--United States, 1990-2002

Since the 1991 adoption of a comprehensive strategy to eliminate hepatitis B virus (HBV) transmission in the United States, the incidence of acute hepatitis B cases has declined steadily. Declines have been greatest among children born after the 1991 recommendations for universal infant hepatitis B vaccination were implemented. In 1995, the elimination strategy was expanded to include routine vaccination of all adolescents aged 11-12 years and, in 1999, to include children aged < or =18 years who had not been vaccinated previously. To describe the epidemiology of acute hepatitis B in children and adolescents in the United States, CDC analyzed notifiable disease surveillance data collected during 1990-2002 and data collected during 2001-2002 through enhanced surveillance of reported cases of acute hepatitis B in children born after 1990. This report summarizes the results of that analysis, which indicated that the rate of acute hepatitis B in children and adolescents decreased 89% during 1990-2002 and that racial disparities in hepatitis B incidence have narrowed. Many confirmed cases in persons born after 1990 occurred among international adoptees and other children born outside the United States. Continued implementation of the hepatitis B elimination strategy and accurate surveillance data to monitor the impact of vaccination are necessary to sustain the decline of acute hepatitis B among children.     

Integrated epidethiological system for acute viral hepatitis in Italy (SEIEVA): Description and preliminary results

An integrated epidemiological system for the surveillance of acute viral hepatitis SEIEVA which linked notifications to available serology results and used a standard risk factor questionnaire is described. Results of over 1300 cases reported by 35 participating local health units (USL's) during the first 18 months of the programme are presented. Overall the annual reported incidence of acute viral hepatitis was 70 per 100,000. There were marked regional and age specific differences in the incidence of each type of viral hepatitis. The annual incidence per 100,000 of hepatitis A in southern children was 133 while in northern young adults the incidence of hepatitis B was 88 and hepatitis non-A non-B was 43. The possible roles of shellfish consumption in the transmission of non-A non-B hepatitis at all ages were highlighted.     

Hepatitis E virus

Hepatitis E virus (HEV) is responsible for major outbreaks of acute hepatitis in developing countries where it was first described as a waterborne disease, transmitted by drinking water contaminated with feces. Attention was focused on HEV in developed countries and its associated diseases in recent years as a result of increasing reports of autochthonous infections. Hepatitis E is the zoonotic cause of these acute infections, and mainly in men over 50 years of age. The clinical manifestations and laboratory abnormalities of hepatitis E infections in immunocompetent patients cannot be distinguished from those caused by other hepatitis viruses. HEV is a major public health concern in immunocompromised patients because their infections can become chronic. The specific etiology of cases of hepatitis E infection can be diagnosed by serological testing and detecting viral RNA. Ribavirin is currently the reference treatment for HEV infections in immunocompromised patients. Several vaccines have proved safe and effective in clinical trials, but none have been approved for use in Europe yet.     

734例急性病毒性肝炎的病原学分析研究

目的研究急性病毒性肝炎病原学的特征,制定科学的预防措施。方法对2004年1月～2008年12月收治的734例急性病毒性肝炎患者,进行血清病原学分型及流行病学研究。结果 734例中,甲、乙、丙、戊型病毒性肝炎分别占15.7%、17.0%、2.4%和35.2%,未分型者占29.7%;发病年龄主要集中在30～69岁,占67.4%,甲型肝炎15～49岁为发病高峰期占62.7%,乙型肝炎发病年龄集中在15～69岁占96.0%,丙型肝炎发病年龄在15～69岁占94.5%,戊型肝炎30～69岁为疾病高发年龄段占61.3%,未分型年龄集中在50～69岁,占74.3%;男性患者519例,女性患者215例,男女性患者之比为2.4∶1,每年1～2季度为发病的高峰季节,分别占27.6%和36.4%;临床分型中急性黄疸型肝炎453例(61.7%),急性无黄疸型肝炎264例(36.0%),重型肝炎17例(2.3%)。结论急性病毒性肝炎以戊型和未分型肝炎类型为常见,急性黄疸型肝炎是主要的临床类型;注意个人卫生及改善卫生条件有助于预防甲型肝炎和戊型肝炎传播,接种甲型肝炎和乙型肝炎疫苗是有效的预防措施。     

Prevention of hepatitis B in Italy: lessons from surveillance of type-specific acute viral hepatitis. SEIEVA Collaborating Group

The relative contribution of various risk factors to the incidence of acute hepatitis B in Italy was estimated using a special surveillance system (SEIEVA) for type-specific acute viral hepatitis. At present 146 health departments (USLs) which contain 21% of the Italian population participate in SEIEVA out of the total of 650. Data on 2460 hepatitis B cases and 708 hepatitis A cases were compared. Hospitalization, surgical intervention, dental therapy, other percutaneous exposures, barber shop shaving, i.v. drug abuse and household contact with HBsAg carriers were associated with acute hepatitis B and a large number of cases were attributable to these risk factors. Because the control programme based on vaccination will not be effective in the short term at reducing hepatitis B incidence, other additional interventions are recommended.