Transmission of hepatitis B virus by a surgeon

A Dutch surgeon transmitted hepatitis B virus (HBV) to several of his patients (8 certain cases, 2 probable cases and 18 possible cases). To view this accident in the proper context, we estimated the incidence of HBV transmission in the Netherlands from surgeons to patients (1/37,000 surgical procedures) and from patients to non-immune surgeons (0.8%/surgeon/year). The incident as such is alarming because of the high frequency of HBV transmission that occurred. However, the number of infections involved was lower than the expected number of iatrogenic HBV infections in the Netherlands during the given period. It is advisable to quickly implement the WHO guidelines, demanding universal HBV vaccination of infants, and to organize vaccination of risk groups (including medical personnel) in the Netherlands.     

Horizontal transmission of hepatitis B virus from siblings and intramuscular injection among preschool children in a familial cohort

The authors followed 147 children from 113 families who were susceptible to hepatitis B virus infection for a total of 275 person-years. Among these children, 19 became infected with the hepatitis B virus and thus became new subclinical cases. In this cohort study, parents played a minor role in hepatitis B virus horizontal transmission. On the other hand, the estimated incidence rate ratio of hepatitis B virus infection for siblings of a hepatitis B e antigen (HBeAg) carrier was 2.8 (95% confidence interval 1.1-7.4) when compared with those children without a HBeAg sibling carrier as analyzed by multiple logistic regression. The adjusted incidence rate ratio among siblings increased with increased number of HBeAg carriers. In addition, intramuscular injections played an important role in hepatitis B virus transmission in children. It was found that 61.8% (170/275 person-years) of the children had received intramuscular injections. Most of the injections were administered at private clinics over a 2-year period. Hepatitis B virus infection showed a correlation with injection (adjusted incidence rate ratio = 3.3, 95% confidence interval 1.1-9.5) and with frequency of injections. The authors concluded that HBeAg was a valuable marker for infectivity in hepatitis B virus horizontal transmission. Furthermore, the authors found that hepatitis B virus infection is independently transmitted from sibling to sibling, and by iatrogenic injections because improperly sterilized syringes were shared in areas where hepatitis B is prevalent and intramuscular injection is common.     

乙肝疫苗免疫人群乙肝病毒感染和发病状况研究

目的了解上海市儿童乙肝疫苗免疫后乙肝病毒感染和发病情况。方法采用多阶段随机抽样方法,于2000年和2006年共计抽取1 904份接种人群血液标本,用酶联免疫吸附试验（ELISA）检测HBsAg、抗-HBs和抗-HBc。结果新生儿乙肝疫苗接种率和及时率均保持较高水平。20岁以下人群乙肝发病率明显下降;HBsAg携带率降幅为78.34%。儿童乙肝患者中84.35%（124/147）未接种过乙肝疫苗;23例接种乙肝疫苗但患病的儿童中,12例患儿的母亲或父亲HB-sAg阳性。结论儿童接种乙肝疫苗是预防和降低乙肝感染的有效措施。需加强母（父）婴阻断和家庭内传播机制的研究。     

中国11城市乙型肝炎病毒慢性感染者中乙型肝炎病毒基因型分布

目的了解中国乙型肝炎病毒（HBV）慢性感染者中HBV基因型的分布情况。方法收集北京、清远、深圳、石家庄、汉川、南京、长春、济南、聊城、宁波和温州市共1214份HBV DNA阳性的慢性HBV感染者血清样本,用型特异性引物聚合酶链反应法（PCR）进行基因型测定,并对其中部分样本以PCR产物直接测序验证。结果在1214份血清中,检测到A基因型9例,占0．7%;B基因型345例,占28．4%;C基因型709例,占58．4%;B、C混合基因型（B＋C）151例,占12．4%。未检测到其他基因型。北方地区（长春、北京、石家庄市等）慢性HBV感染者中,C基因型比例较高,分别为58．2%、67．5%和63．6%,山东省聊城和济南市的C基因型比例分别高达90．2%和87．9%。随地理位置南移,B基因型比例逐渐增加,广东省清远和深圳市的B基因型比例分别为71．4%和63．6%。结论HBV基因型分布有明显地区差异。在中国慢性HBV感染者中,HBV C和B基因型为主要流行株。北方地区以C基因型为优势株,而南方地区则B基因型较为多见。     

甘肃省大学生乙型病毒性肝炎知识态度行为调查

目的了解在校大学生乙型病毒性肝炎(简称乙肝)相关知识、态度和行为(KAP)状况,为制定有效的乙肝预防控制和健康教育措施提供科学依据。方法分层整群抽取甘肃省46所高校2 877名在校大学生,对其进行乙肝KAP及信息获取情况问卷调查。结果在校大学生对乙肝传播途径的知晓率较低(31.4%),对其他乙肝相关知识知晓率相对较高(63.9%～85.1%)。在态度方面,74.8%的大学生认为乙肝是一种严重疾病。当得知身边的同学是乙肝病毒携带者以后,只有18.4%的大学生认为不会影响两人之间交往,29.3%的大学生认为不介意和乙肝病毒携带者共同进餐。76.5%的大学生接种过乙肝疫苗,而仅有27.3%的大学生完成了全程接种。结论在校大学生乙肝相关知识了解不全面,对乙肝病毒携带者的排斥心理较强。大学生乙肝疫苗全程接种率较低。     

乙型肝炎疫苗长期免疫对人群乙型肝炎病毒流行状况的影响

目的探讨乙型肝炎（乙肝）疫苗长期免疫接种后整体人群乙肝病毒（HBV）感染状况及其变化趋势。方法采用整群抽样结合横断面调查方法，共收集资料完整的调查对象4686名，采集静脉血并分离血清，用固相放射免疫法检测HBV感染标志。结果整体人群平均HBsAg阳性率为7．5％，抗-HBs为44．5％，抗-HBc为47．8％；0～19岁人群HBsAg和抗-HBc阳性率较≥20岁人群显著下降。乙肝疫苗免疫组的HBsAg阳性率为2．8％，抗-HBc阳性率为12．0％，HBV感染率为12．5％，未免疫组分别为10．2％、69．8％和71．2％。男性平均HBsAg阳性率比女性高，抗-HBc和抗-HBs阳性率男女性别间无差异。0～19岁人群的HBsAg阳性率为2．4％，而20～30岁人群阳性率达到13．6％～17．7％，到60岁开始下降；0～19岁人群的抗-HBs阳性率随年龄增长而明显下降，≥20岁人群的抗-HBs、抗-HBc阳性率均随着年龄增长而呈升高趋势。结论长期开展新生儿乙肝疫苗免疫使人群HBV流行状况发生变化，感染高峰年龄段后移。     

乙型肝炎母婴传播阻断成功儿童乙型肝炎病毒突破性感染的特征

目的了解乙型肝炎(乙肝)母婴传播阻断成功儿童乙肝病毒(HBV)突破性感染及其影响因素。方法选取江苏省淮安市淮安区2009年9月-2011年1月乙肝表面抗原(HBsAg)阳性母亲所生儿童,且乙肝母婴传播阻断成功。阻断成功定义为儿童按国家免疫程序在完成出生时乙肝疫苗(HepB)和乙肝免疫球蛋白以及1、6月龄HepB接种后7-12月龄HBsAg阴性,HBV突破性感染定义为阻断成功儿童在12月龄后HBsAg阳性或24月龄后乙肝核心抗体(HBcAb)阳性。至2019年9月进行5次随访并检测HBV血清标志物,分析HBV突破性感染及其影响因素。结果本研究共纳入儿童390名,其中12名29-117月龄儿童发生HBV突破性感染,发生率为3.08%(12/390),均为乙肝核心抗体(HBcAb)阳性和HBsAg阴性。乙肝疫苗(HepB)初次免疫无、低、正常、高应答儿童HBV突破性感染率分别为25.00%、6.67%、2.61%、0.95%;母亲HBeAg阳性、阴性的儿童分别为9.76%、0.00%;母亲高、低HBV病毒载量的儿童分别为11.96%、0.34%。儿童HBV突破性感染发生密度为0.36/100人年;多因素Cox回归分析显示,HepB初次免疫低或无应答、母亲高病毒载量是儿童HBV突破性感染的危险因素(HR=5.91,95%CI:1.87-18.71;HR=45.81,95%CI:5.88-356.96)。结论乙肝母婴传播阻断成功儿童的HBV突破性感染发生率较低;母亲HBeAg阳性、母亲高HBV病毒载量、HepB初次免疫低或无应答的儿童更易发生突破性感染。     

乙肝疫苗接种后儿童乙型肝炎流行特征变化

肥城市自1992年乙肝疫苗被纳入计划免疫管理后，尤其1995年以来，新生儿乙肝疫苗的接种率一直保持在95％以上，乙型肝炎的发病率则逐渐下降。为了解儿童乙型肝炎流行特征的变化，现对肥城市1995～2002年0～14a儿童乙型肝炎的发病资料和HBsAg携带情况调查的结果作一分析，以指导今后防治工作的开展。     

某大学新生乙肝病毒感染情况分析

高校学生相互接触十分密切,受乙肝病毒感染机会多。为进一步采取措施,有效预防与控制大学生乙肝的感染与传播,我们对某大学1997-2006年新生乙肝病毒检测资料进行分析,现将结果报告如下。     

深圳市居民乙型肝炎病毒感染危险因素分析

目的 了解广东省深圳市居民乙肝病毒(HBV)感染现状,分析HBV感染的相关危险因素.方法 于2010年在深圳市采用多阶段系统随机抽样方法抽取10个社区、1000户家庭,进行入户个案调查乙肝感染相关危险因素,并采集血样.用酶联免疫吸附试验(ELISA)检测乙肝血清标志物:乙肝表面抗原(HBsAg)、乙肝表面抗体(抗-HBs)和乙肝核心抗体(抗-HBc).结果 HBsAg、抗-HBs、抗-HBc阳性率和HBV感染率分别为6.68%(252/3771)、71.92%(2712/3771)、37.39%(1564/3771)和45.98%(1734/3771);≤15岁人群乙肝疫苗接种率为93.62%(1752/1872),>15岁人群接种率为79.48%(1509/1899),差异有统计学意义(χ²=160.89,P<0.01);接种乙肝疫苗者与未接种者的HBV感染率分别为32.45%(1508/3261)和87.24%(445/510),差异有统计学意义(χ²=552.72,P<0.01);HBsAg阳性率与HBV感染率均随年龄上升有增加的趋势;多因素Logistic回归分析结果显示,家中有乙肝患者、内窥镜史、手术史及有偿献血史是深圳市居民乙肝感染的危险因素.结论 深圳市乙肝感染情况低于全国平均水平;乙肝感染具有家庭聚集性;医疗卫生因素对乙肝感染的影响较大.     

Transmission of hepatitis B virus in correctional facilities--Georgia, January 1999-June 2002

Incarcerated persons have a disproportionate burden of infectious diseases, including hepatitis B virus (HBV) infection. Among U.S. adult prison inmates, the overall prevalence of current or previous HBV infection ranges from 13% to 47%. The prevalence of chronic HBV infection among inmates is approximately 1.0%-3.7%, two to six times the prevalence among adults in the general U.S. population. Incarcerated persons can acquire HBV infection in the community or in correctional settings. This report summarizes the results of 1) an analysis of hepatitis B cases among Georgia inmates reported to the Georgia Department of Human Resources, Division of Public Health (DPH) during January 1999-June 2002, including a retrospective investigation of cases reported during January 2001-June 2002; and 2) a prevalence survey conducted in prison intake centers during February-March 2003. These efforts identified cases of acute hepatitis B in multiple Georgia prisons and documented evidence of ongoing transmission of HBV in the state correctional system. The findings underscore the need for hepatitis B vaccination programs in correctional facilities.     

Time trends of the prevalences of hepatitis B e antigen positives among hepatitis B virus carriers in Japan

In order to examine time trends of the prevalences of HBeAg positives among HBV carriers in Japan, we analysed data on HBeAg of HBsAg positive voluntary blood donors (23,560 males, and 8659 females) at the Osaka Red Cross Blood Centre between January 1977 and March 1984. Age-specific prevalences of HBeAg positives decreased year by year for both sexes, especially for those in their teens and twenties. The prevalences of HBeAg positives decreased with age, but at any given age it was lower for the later than for the earlier birth cohorts. Although reasons for the secular declines are unknown, the findings suggest that the prevalence of HBeAg positives among HBV carriers will continue to decrease in Japan. This, together with the immunization programme implemented this year, may lead to a future reduction in the risk of HBV related liver diseases in Japan.     

医学院教职工乙肝感染指标检测结果

我国为乙型肝炎流行高发区 ,其患病率以青壮年为高。本文根据我院教职工 2 0 0 0年乙肝五项感染指标及肝功能检测结果 ,分析医学院教职工中乙型肝炎病毒感染状况 ,以便在教职工中开展乙肝防治工作。1　对象与方法1.1　对象　为 2 0 0 0年我院在编教职工受检者共 6 96人 ,男 415人 ,女 2 81人 ,年龄 2 0～ 73岁。1.2　检测项目及方法　每个受检者均于早上空腹抽静脉血待检 ,查血清乙肝五项指标和肝功能 ,即表面抗原 (ＨＢｓＡｇ)和表面抗体 (抗 -ＨＢｓ) ,ｅ抗原 (ＨＢｅＡｇ)和ｅ抗体 (抗 -ＨＢｅ)以及核心抗体 (抗 -ＨＢｃ)。方法用酶免疫…     

围生期产妇血清、乳汁、唾液乙肝病毒标志物间的关联性

目的:研究围产期产妇血清、乳汁、唾液中乙肝病毒标志物及核酸DNA载量关联性,为科学指导新生儿母婴喂养、母婴接触方式提供循证医学证据。方法:在知情同意的原则下选择住院分娩产妇612例作为乙肝研究对象,根据产妇乙肝五项不同模式分为A、B、C、D、E 5组,采用ELISA法检测各组产妇血清、乳汁、唾液中HBV标志物HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,同时应用实时荧光定量PCR检测其HBV-DNA载量。结果:各组的产妇血清、乳汁、唾液HBV-DNA阳性率分别是A组99.33%、89.15%、96.49%;B组20.00%、3.11%、54.24%;C组65.52%、27.66%、29.41%;D组13.56%、3.45%、0.00%;E组1.16%、0.00%、0.00%。A组与B组间血清与乳汁HBV-DNA差别有统计学意义(χ2=237.45,P<0.01);血清与唾液间HBV-DNA差别有统计学意义(χ2=289.49,P<0.01)。产妇乳汁、唾液HBV-DNA载量与其血液HBV-DNA载量呈正相关;研究证实A组产妇经母乳乙肝病毒传染性是乙肝"小三阳"产妇的87.45倍,乙肝病毒其他模式者乳汁传染性与乙肝"小三阳"产妇乳汁传染性相近。结论:①携带乙肝病毒的产妇乳汁、唾液有潜在传染性,其HBV-DNA载量远低于产妇血液HBV-DNA含量;②产妇乳汁、唾液中乙肝病毒DNA阳性率与母血中HBV-DNA载量呈正相关;③产妇血液HBV DNA≥1.00×103 copies/ml,建议人工喂养;④携带乙肝病毒的产妇不要对婴儿口对口喂食,亲吻等亲密接触方式,以防血液、唾液等途径传染乙肝病毒;⑤检测唾液可代替乳汁检查,唾液取材方便,唾液乙肝传染性比乳汁略强,孕期检测唾液HBV DNA载量,可提前为婴儿喂养方式、母婴接触方式、优生优育等提供循证医学证据;⑥携带乙肝病毒者哺乳期要定期检测产妇唾液、乳汁。     

Transmission of hepatitis B virus from adopted Asian children to their American families.

In 1985, 6,991 Asian children were adopted by Americans. To estimate the risk that such children may transmit hepatitis B virus to their adoptive families, we conducted a cumulative-incidence follow-up study in the State of Washington. We examined the association between having adopted a hepatitis B surface antigen (HBsAg)-seropositive Asian child and serologic evidence of past or present hepatitis B virus infection in adoptive family members. Seven (9 per cent) of 77 family members exposed to an HBsAg-seropositive child had evidence of past or present infection compared with four (2 per cent) of 232 nonexposed (relative risk = 5.3; 90% confidence limits [CL] = 2.0-13.9). The risk was higher for those with prolonged exposure and was entirely restricted to parents.     

乙型肝炎病毒基因型与感染临床表型的相关性研究

目的 调查乙型肝炎病毒(HBV)基因型分布,并探讨其与感染临床表型的相关性.方法 采用PCR扩增后测序的方法,对150例乙型肝炎病毒感染者进行HBV基因型的分析,应用x2检验和t检验法分析HBV基因型与临床表型的相关性.结果 150例样本中,B基因型90例占60.0％,C基因型60例占40.0％,不同性别之间HBV基因型分布,差异无统计学意义;B基因型患者年龄(29.4±10.2)岁显著低于C基因型患者(35.1±11.5)岁(P＜0.05);肝硬化和肝细胞癌组C基因型的比例,分别为59.1％和60.0％,显著高于慢性乙型肝炎患者(32.0％)和HBV无症状携带者(30.0％)(P＜0.05);C基因型HBeAg阳性率(71.7％)显著高于B基因型(55.6％)(P＜0.05);C基因型患者血清的HBV-DNA含量(5.98±0.76)log值显著高于B基因型组(5.62±0.92)log值,差异有统计学意义(P＜0.05).结论 HBV基因型与临床病情密切相关,C基因型患者平均年龄、病毒水平、HBeAg阳性率显著高于B基因型,可能是导致C基因型患者更易发展为肝硬化和肝癌的原因.