散发性急性病毒性肝炎的血清学分型

本文报告９６例散发性急性病毒性肝炎的血清学分型，其中甲型２９例（３０．２１％），乙型４９例（５１．０４％），丙型４例（４．１７％），戊型３例（３．１３％），甲、乙型混合感染１例（１．０４％），另有１０例（１０．４１％）不能分型。甲型肝炎病人发烧、食欲不振、呕吐、腹泻、尿黄、巩膜黄、肝大的发生率高于乙型肝炎。戊型肝炎的临床表现类似甲肝、丙型肝炎类似乙型。     

江苏省甲肝空间分布特征GIS分析

目的 了解江苏省2003-2009年甲型肝炎(简称甲肝)的空间分布规律及其影响因素,为相关部门制定科学的预防控制措施提供理论依据。方法 收集江苏省2003-2009年甲肝的发病资料,应用ArcGIS 10.0软件分析江苏省甲肝的区域分布特点,并将甲肝发病率与其可能的发病影响因素进行相关分析。结果 江苏省甲肝的高危地区主要分布于中部和东南部地区;甲肝发病率与距铁路的远近呈负相关[y=1.189-(1.2E-5)x³,R²=0.977,F=209.245,P<0.001],、距铁路越近,甲型肝炎发病率越高;洪泽湖和骆马湖附近甲肝的发病率相对较高。结论 江苏省甲肝的流行有明显的地域分布规律,应根据不同地区的流行强度、针对甲肝的流行原因采取有效的预防控制措施。     

检测唾液IgM抗-HAV诊断甲型肝炎的研究

本文采用检测唾液IgM抗-HAV来诊断甲型病毒性肝炎(甲肝)进行了研究。结果表明,IgM抗-HAV能可靠地在血清学证实的58例急性甲肝和9例甲乙混合感染的患者唾液中检出,而不能在非甲肝患者其中包括84例急性乙肝和30例非甲非乙肝及10例健康人唾液中检出。证明采用唾液标本来诊断甲肝是特异的。唾液比血清更易获得,这就为今后甲肝的诊断和流行病学调查提供了更有利的条件。     

杭州市病毒性肝炎分布特征及其防制对策的研究

本文报道了应用前瞻性调查方法，对1987年杭州市城区、水网区、半山区和山区确诊的急性病毒性肝炎1248例血清病原学分型及流行病学调查，结果甲肝占69．71％，乙肝占7．13％，非甲非乙肝占21．96％，甲、乙肝混合感染占1．20％。城、乡均以甲肝占首位，非甲非乙肝次之。甲肝流行的主要危险因素有：①家庭使用马桶、坐坑；②接触肝炎病人；③喝生水。非甲非乙肝以肠道外传播型为主，看牙病（拔牙）是主要危险因素，在此基础上提出相应对策。     

Effectiveness of a hepatitis A vaccination program for migrant children in Amsterdam, The Netherlands (1992-2004)

OBJECTIVE: To evaluate the impact and effectiveness of risk-group vaccination against hepatitis A targeted at migrant children living in a country with low endemicity of hepatitis A. METHODS: Retrospective population based data analysis. Routinely collected data on hepatitis A incidence in migrant children and other risk groups in Amsterdam from 1 January 1992 to 2004 were analyzed and related to exposure, immunity and vaccination coverage in migrant children. RESULTS: The overall hepatitis A incidence in Amsterdam declined after a pediatric vaccine was introduced in 1997. This decline was seen in migrant children traveling to hepatitis A-endemic countries, contacts with hepatitis A patients, primary school students, injecting drug users, and persons with unknown source of infection, but not in men who have sex with men (MSM) or in travelers to endemic countries other than migrant children. CONCLUSION: The hepatitis A vaccination campaigns are effective: they reduce both import and secondary HAV cases. The campaigns could be more efficient and cost-effective if the hepatitis B vaccinations currently given to these groups were replaced by a combined hepatitis A and B vaccine. This would increase the hepatitis A vaccination coverage considerably and further reduce the hepatitis A incidence.     

Cost-effectiveness of hepatitis A vaccination for individuals with chronic hepatitis C

The incidence of hepatitis A infection in the United States has decreased dramatically in recent years because of childhood immunization programs. A decision analysis of the cost-effectiveness of hepatitis A vaccination for adults with hepatitis C was conducted. No vaccination strategy is cost-effective for adults with hepatitis C using the recent lower anticipated hepatitis A incidence, private sector costs, and a cost-effectiveness criterion of $100,000/QALY. Vaccination is cost-effective only for individuals who have cleared the hepatitis C virus when Department of Veterans Affairs costs are used. The recommendation to vaccinate adults with hepatitis C against hepatitis A should be reconsidered.     

2004-2014年西安市甲型和戊型肝炎流行特征分析

目的 分析西安市2004-2014年甲型和戊型肝炎的发病情况和流行趋势,为有效指导两型肝炎防控提供依据。 方法 采用描述性流行病学方法对2004-2014年间报告的甲型和戊型肝炎病例的流行特征进行分析,采用的统计学方法有χ2检验和集中度M值等。 结果 西安市共报告甲肝1 740例,年均发病率1.98/10万;戊肝930例,年均发病率1.05/10万。甲肝发病率较高,戊肝发病率较低,两者均呈逐年下降趋势。甲肝和戊肝总体上发病均无明显季节性特征,年均发病率城区均高于郊县,发病率均随年龄增加而上升且男性均高于女性。职业分布上,甲肝以农民（27.76%）为主;戊肝以离退休人员（29.92%）为主。甲肝实验室诊断率逐年上升,戊肝则在90%左右波动。 结论 近11年来西安市甲肝和戊肝发病率均呈逐年下降趋势,高发地区均是城区。10岁以下和60岁以上男性人群是甲肝发病的重点人群;60岁以上男性人群是戊肝发病的重点人群。甲肝诊断质量逐年上升,而戊肝则一直维持在高水平。     

Prevalence of indications for adult hepatitis A vaccination among hepatitis A outbreak-associated cases,Three US States, 2016–2019

BackgroundSafe and effective hepatitis A vaccines have been recommended in the United States for at-risk adults since 1996; however, adult vaccination coverage is low.MethodsAmong a random sample of adult outbreak-associated hepatitis A cases from three states that were heavily affected by person-to-person hepatitis A outbreaks, we assessed the presence of documented Advisory Committee on Immunization Practices (ACIP) indications for hepatitis A vaccination, hepatitis A vaccination status, and whether cases that were epidemiologically linked to an outbreak-associated hepatitis A case had received postexposure prophylaxis (PEP).ResultsOverall, 74.1% of cases had a documented ACIP indication for hepatitis A vaccination. Fewer than 20% of epidemiologically linked cases received PEP.ConclusionsEfforts are needed to increase provider awareness of and adherence to ACIP childhood and adult hepatitis A vaccination and PEP recommendations in order to stop the current person-to-person hepatitis A outbreaks and prevent similar outbreaks in the future.     

五河县甲型病毒性肝炎发病升高原因回顾性与分析

目的　探讨蚌埠市五河县 1999年 1～ 4月份甲型肝炎发病升高原因及防治对策。方法　根据相关疫情资料结合统一调查表 (问卷 )收集的免疫史等甲肝发病信息资料 ,健康人群HAV -IgG抗体水平调查结果 ,进行流行病学回顾性分析。结果　 1998年 10月～ 1999年 4月、1997年 10月～ 1998年 4月甲肝发病均以10岁以下散居儿童为主 ;男性明显高于女性。病例主要分布在水网密集地区和交通相对发达的地区 ;仅 5 .4 1% (34/ 6 2 9)及时隔离治疗 ,乡以下诊断的病例中仅 4 3.77% (130 / 2 97)是通过临床和特异性复合诊断 ;HAV-IgG抗体阳性率有随年龄增长而升高的趋势。结论　五河县甲肝爆发流行与水网密集、交通发达的地理特征引起的爆发和扩散 ,10以下儿童甲肝易感人群积累、传染源管理的失控、误诊等主观因素有关。建议防治中注重根据具体情况采取针对性措施 ,且考虑措施综合性。     

Hepatitis A,B, and C in Canada. Results from the National Sentinel Health Unit Surveillance System, 1993-1995

OBJECTIVES: To estimate the incidence of and to describe the risk factors that were associated with the acquisition of hepatitis A, B, and C in well-defined Canadian populations from the Sentinel Health Unit Surveillance System (SHUSS). METHODS: We used the 1993 to 1995 data on hepatitis A, B, and C infection in Canada, collected by SHUSS, a national surveillance system established by the Laboratory Centre for Disease Control in Health Canada in 1993, through consultation and collaboration with provincial partners. We calculated the rates of, and described and discussed the risk factors that were associated with, hepatitis A, B, and C infection, based on the SHUSS surveillance data. RESULTS: From 1993 to 1995, SHUSS reported 92 cases of hepatitis A, 89 hepatitis B, and 720 hepatitis C, yielding a rate of 3.9, 3.8, and 30.3 per 100,000, respectively. The reported rates varied substantially among participating health units, ranging from 0.8 to 8.1 per 100,000 for hepatitis A, 0.0 to 9.0 for hepatitis B, and 5.4 to 73.3 for hepatitis C. The most frequently reported risk factor for hepatitis A was a history of street drug use, followed by recent international travel and household contact with a hepatitis A case, household crowding, and a history of raw or undercooked shellfish consumption. The most frequently reported risk factors for the acquisition of hepatitis B included history of street drug use and occupational exposure. The most frequently reported risk factor for the acquisition of hepatitis C was a history of street drug use, followed by health care exposure and occupational exposure. Only 5% of persons with hepatitis B infection had a history of hepatitis B immunization. INTERPRETATION: Despite the limitations of possible bias due to selective participation of SHUSS and the lack of information on risk factors among controls, the high exposure to known risk factors and the low rate of vaccination among hepatitis patients can provide useful information for the development of public health policies to control hepatitis A, B, and C infection in Canada.     

The first experimental study on a candidate combined vaccine against hepatitis A and hepatitis E

To test the possibility of developing a combined vaccine against hepatitis A and E, groups of mice were immunized with different formulations containing different dosages of a commercially inactivated hepatitis A vaccine and a candidate recombinant hepatitis E vaccine. Monovalent vaccine components were used as controls. The experimental results showed that the combined vaccine could induce neutralizing antibodies against both hepatitis A virus (HAV) and hepatitis E virus (HEV) effectively in mice. Moreover, the inactivated hepatitis A vaccine could increase the immunogenicity of the recombinant HEV protein, and the recombinant HEV protein had no adverse effects on the immunogenicity of the inactivated HAV vaccine. Thus, the present study demonstrates an important first step for the further development of a combined hepatitis A and E vaccine.     

Travel-associated hepatitis A: effect of place of residence and country visited.

The association between hepatitis A and domestic or international travel from Italy was investigated. Data from a nationwide surveillance system (SEIEVA) for type-specific acute viral hepatitis were used to compare 1102 hepatitis A cases with 3671 hepatitis B cases. An association between hepatitis A and travel was found in northern Italy, where most young and adult people are susceptible. Estimates of odds ratios vary dramatically according to geographical area of travel. Travellers to Mediterranean countries, Eastern Europe, Africa, Asia, and South and Central America had the highest education and age-adjusted odds ratios for hepatitis A, ranging from 6 to 25. Prophylaxis against hepatitis A for such travellers is recommended.     

A prospective study of acute viral hepatitis with particular reference to hepatitis A.

In order to investigate the relationship of hepatitis A antigen to viral hepatitis, a prospective study was carried out on 97 patients admitted to Fairfield Hospital, Melbourne, with suspected viral hepatitis, and 3 of their family contacts. Evidence of infection with hepatitis A virus was obtained by detecting hepatitis A antigen in stools, and/or antibody to it in sera, by immune electron microscopy. Infection with hepatitis B virus was determined by testing for hepatitis B surface antigen and antibody in serum, by solid phase radioimmunoassay. Sixteen patients were found to have diseases other than viral hepatitis and 2 patients (child contacts) suffered no illness. There was clinical and/or biochemical evidence compatible with viral hepatitis in 82 patients, of whom 35 were confirmed as having hepatitis A and 31 as having hepatitis B infections. In the remaining 16 patients there was no evidence of infection with either hepatitis A or B virus. It is possible that some of these patients may have been infected with viral agents as yet unidentified.     

Prospects for vaccination against hepatitis A and B in Catalonia (Spain)

Catalonia is in an area of intermediate endemicity for hepatitis A virus (HAV) infection. An Expert Committee has recently proposed the implementation of universal hepatitis A vaccination for 12-year-olds, based on the fact that no risk factors can be identified for hepatitis A in 50% of cases, and also that selective vaccination targeted at high-risk groups has a limited potential to reduce the incidence of hepatitis A. The well-established programme of hepatitis B vaccination of pre-adolescents in Catalonian schools has high levels of vaccination coverage. This will provide a means to introduce hepatitis A vaccination in a cost-effective way in schools, by replacing the single vaccine with the combined hepatitis A and B vaccine. High-risk groups will also continue to be targeted. A pilot programme has commenced in the 1998/1999 school year and will be evaluated after 3 years. If it is successful, it will be extended indefinitely.     

Infection with hepatitis A and B viruses in French volunteers working in tropical Africa

The risks of developing hepatitis A and B virus infections were studied in 233 French volunteers working for 18 to 35 months in the field in West and Central Africa. During their stay in Africa, the seroconversion rates to antibody to hepatitis A virus of the immunoglobulin G (IgG) class and hepatitis B marker(s) were 48.1% and 10.5%, respectively; 21.5% of the volunteers developed jaundice, and 78.0% of the jaundice cases were associated with hepatitis A seroconversion, 14.0% with hepatitis B seroconversion, 4.0% with seroconversion to both, and 4.0% without seroconversion. Male health workers were at lower risk than other male occupations for hepatitis A infection. Female health workers were at higher risk than other female occupations for hepatitis A infection. Health workers were at a lower risk of hepatitis B infection, but the significance was borderline. Populations such as these volunteers should receive immunoprophylaxis against hepatitis A and B infections.     

The shifting epidemiology of hepatitis A following routine childhood immunization program in Israel

OBJECTIVES: In 1999 Israel became the first country to introduce immunization against hepatitis A to its national childhood vaccination program. The study objectives were to assess the uptake of hepatitis A vaccine following the new policy and to examine the incidence of hepatitis A and the number of prevented cases. METHODS: Data on incidence of hepatitis A and vaccination rates were obtained from a large health maintenance organization in Israel covering 1.6 million members. We identified all members that were diagnosed by a primary care physician as suffering from hepatitis A, had a positive hepatitis A virus-IgM test result, or were hospitalized due to hepatitis A between 1998 and 2004. RESULTS: The results indicate that 5 years following its inclusion in the national childhood immunization program, vaccination coverage levels with at least one dose of hepatitis A vaccine for children aged under 5 years and 5-14 years were 87% and 51%, respectively. During this period the annual incidence rates declined by 88% from 142.4 to 17.3 per 100,000. The most significant reduction in morbidity was observed among children. CONCLUSIONS: In endemic areas, vaccination of infants and children against hepatitis A may be efficient to greatly reduce the total burden of the disease.     

Efficiency of the incorporation of the hepatitis A vaccine as a combined A+B vaccine to the hepatitis B vaccination programme of preadolescents in schools

In 1998, the Department of Health of Catalonia (Spain) began universal vaccination of preadolescents against hepatitis A by replacing the simple hepatitis B vaccine with a combined hepatitis A+B vaccine. Economic analyses were made of the two alternative strategies: to continue with the simple hepatitis B vaccination or to replace the simple vaccine with a combined hepatitis A+B vaccine. The analysis was made from the societal perspective and the time horizon considered was 25 years. In the base case, (estimated annual hepatitis A incidence of 15 per 100,000 and incremental price of the hepatitis A+B vaccine over the simple hepatitis B vaccine of 1.98) the net present value of the programme was positive (+533,708) and the benefit-cost ratio was 2.58. If the estimated disease incidence were reduced by half, the programme would still be efficient.     

宁波市1991～2000年甲、乙型病毒性肝炎流行特征

目的 了解宁波市自1991年对病毒性肝炎进行分型报告以来，甲，乙型病毒性肝炎流行特征。方法 对1991-2000年甲，乙型肝炎疫情资料进行综合分析。结果 宁波市1991-2000年甲型肝炎平均报告发病率为52.63/10万，死亡率为0.03/10万，病死率为0.05%；甲型肝炎发病呈缓慢下降趋势，乙型肝炎平均报告发病率为42.55/10万，死亡率为0.17/10万，病死率为0.40%;10年间发病率相对平稳。结论 病毒性肝炎发病呈明显下降趋势，影响宁波市病毒性肝炎的发病高峰主要是甲型肝炎。     

Incidence of hepatitis among students at a university in Taiwan

The incidence of hepatitis in a general open population of Asian adults was estimated for the first time in this study. A group of 2445 students were first tested when they enrolled at National Taiwan University in 1977; approximately one third were susceptible to hepatitis A and another third to hepatitis B. Most of these students (92%) were retested shortly before their graduation in 1981 to determine the frequency of serologic conversions and clinical hepatitis which had occurred in the 3 1/2 years since they had entered the university. Among 704 susceptible to hepatitis A, 12 (1.7%) had undergone serologic conversions, 33% of which were associated with clinical illness diagnosed as hepatitis. Among 738 susceptible to hepatitis B, 39 (5.3%) had undergone serologic conversions, 12.8% of which were associated with clinical hepatitis. The annual incidence of new infections was 0.5% for hepatitis A and 1.5% for hepatitis B. An additional eight students among the 17 who had clinical hepatitis had no associated conversion of hepatitis A or hepatitis B markers, and were considered to have non-A, non-B hepatitis. No factors could be identified which were predictive of hepatitis risk. No difference in incidence was observed according to sex, type of residence, place of food consumption, or receipt of acupuncture or blood transfusion. Among the 39 students who experienced hepatitis B infections while at the university, there were 2.7% who became hepatitis B surface antigen (HBsAg) carriers. Thus the carrier frequency following hepatitis B infection among Chinese adults is the same or lower than that among Caucasian adults.     

Immunogenicity of a combined hepatitis A and B vaccine in healthy young adults

Combining several vaccines in a single formulation can change the potency of the vaccine antigens. Previous studies suggested a higher immunogenicity of a new combined hepatitis A and B vaccine compared with the monovalent hepatitis B vaccine. We investigated the immune response to hepatitis B surface antigen 1 month after the third vaccine dose in 282 healthy adults who had received either a monovalent hepatitis B vaccine (n=148) or the combined hepatitis A/B vaccine (n=134). A slight trend towards higher geometric mean titres of anti HBs was found at this point in time in the group immunised with the combined vaccine, especially in the few vaccinees with preexisting antibodies against hepatitis A virus. However none of these differences was statistically significant, arguing against an advantage of the combined vaccine regarding hepatitis B immunisation.