河南省2012-2016年乙型肝炎监测试点数据分析

目的 规范河南省乙型肝炎（乙肝）病例报告方法，提高乙肝病例监测工作质量。方法 选取郑州市新郑市、安阳市林州市、焦作市山阳区、漯河市召陵区、商丘市永城市和信阳市平桥区6个乙肝监测试点（监测点），通过国家法定传染病报告系统，2012-2016年河南省报告的乙肝病例作为研究对象，2011年数据作为对照数据，分别对不同年份报告法定传染病报告系统的乙肝病例分类情况、HBsAg阳性时间、ALT值报告情况等进行描述性统计分析，对疑似急性乙肝病例进行抗-HBc IgM检测。以2016年监测点数据为基础，估算河南省2016年急性乙肝报告发病率。结果 河南省6个监测点乙肝报告病例从2011年的17 436例下降到2016年2 632例，下降了84.90%（14 804/17 436）；乙肝未分类病例从36.87%（6 370/17 275）下降至0.08%（2/2 632）。2012-2016年，河南省CDC共收到初筛抗-HBc IgM阳性血清777份，经过复核，29.34%（228/777）的疑似急性乙肝病例血样抗-HBc IgM阳性。依据2016年6个监测点急性乙肝报告发病率，估算河南省急性乙肝报告发病率为1.13/10万（95% CI：0.81/10万~1.45/10万）。结论 2012-2016年河南省监测点乙肝病例报告质量和临床诊断病例的准确性均不断提高。监测点应该进一步提高急性乙肝报告病例的血样采集率，改进检测方法。

Data analysis on hepatitis B through pilot surveillance reporting system in Henan province, 2012-2016

Objective To standardize the reporting system on hepatitis B in order to improve the quality of monitoring program in Henan province. Methods A total of 6 sites of Hepatitis B pilot surveillance were selected in Xinzheng of Zhengzhou city, Linzhou of Anyang city, Shanyang district of Jiaozuo city, Shaoling district of Luohe city, Yongcheng of Shangqiu city, Pingqiao district of Xinyang city in Henan province. Subjects under study were those reported hepatitis B cases, from 2012 to 2016. Cases diagnosed in 2011 were chosen as controls. Data on classification of hepatitis B, time that HBsAg became positive and ALT value of the cases were analyzed annually. 5 ml venous blood was collected and anti-HBc IgM confirmed test was made for those suspected acute cases on hepatitis B. Based on the 2016 data from the monitoring system, the incidence of acute hepatitis B in Henan province was estimated. Results The number of reported hepatitis B cases had declined in 6 sites of Hepatitis B pilot surveillance substantially. A total of 17 436 hepatitis B reported in 2011 but only 2 632 cases were reported in 2016, with a reduction of 84.90%(14 804/17 436) in these six monitoring sites. The number of unclassified hepatitis B cases also dropped sharply. In 2011, 36.87% of the cases were unclassified, but the figure reduced to 0.08% in 2016, from the six sites. The rate on ALT detection also gradually improved. The rate of misdiagnosis on HBV carrier from hepatitis B almost disappeared. From 2013 to 2016, 777 blood samples were collected from six pilot sites. 29.34% (228/777) of the blood samples were tested positive for anti-HBc IgM after confirmed by the hepatitis laboratory of the China Center for Disease Control and Prevention. Conclusions Since the development of the pilot surveillance program, the quality of reporting system on hepatitis B had been improved, as well as the accuracy of diagnosis. Rate on the accuracy of reporting on hepatitis B and the methods of testing should be improved at the monitoring sites.