波斯尼亚和黑塞哥维那图兹拉地区乙型肝炎的家庭内传播。

Intrafamilial transmission of hepatitis B in Tuzla region of Bosnia and Herzegovina.

作者信息

Salkic Nermin N, Zildzic Muharem, Muminhodzic Kasim, Pavlovic-Calic Nada, Zerem Enver, Ahmetagic Sead, Mott-Divkovic Slavica, Alibegovic Ervin

机构信息

Department of Gastroenterology, Internal Medicine Hospital, Bosnia and Herzegovina.

出版信息

Eur J Gastroenterol Hepatol. 2007 Feb;19(2):113-8. doi: 10.1097/MEG.0b013e32801290f7.

DOI:10.1097/MEG.0b013e32801290f7

PMID:17272995

Abstract

OBJECTIVE

To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection.

METHODS

A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls.

RESULTS

Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05).

CONCLUSION

In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.

摘要

目的

确定（i）确诊慢性携带者家庭中乙肝病毒（HBV）感染的患病率；（ii）家庭内传播的可能途径及危险因素；（iii）慢性携带者家庭成员的疫苗接种率；（iv）感染风险最高的家庭成员。

方法

对67名乙肝表面抗原慢性携带者的172名家庭成员进行乙肝标志物检测；将来自同一地区的716名首次献血者作为对照。

结果

索引病例家庭成员中乙肝表面抗原的患病率（12.2%；21/172）高于对照组（3.6%；26/716）（P<0.001），相对风险为3.3（95%置信区间=1.9 - 5.8；P<0.05）。家庭成员中的暴露率为37.8%（65/172）；仅8.7%（15/172）接种过乙肝病毒疫苗。家庭成员之间的暴露存在差异（P<0.001）；暴露率随年龄增加（rho s = 0.34；P<0.001）。索引病例的父母（P<0.005）及女性索引病例的子女（P<0.001）中乙肝表面抗原阳性和乙肝病毒暴露的患病率更高。与索引病例有母子关系的家庭成员中乙肝表面抗原阳性的比例（13/31；41.9%）高于父子关系（19/85；22.4%）及水平关系（兄弟姐妹和配偶）（2/56；3.6%）（P<0.001）。在仅母亲为乙肝表面抗原阳性的家庭中，发现乙肝表面抗原阳性和乙肝病毒暴露的子女明显更多（P<0.001）。在HBeAg阳性病例的家庭成员中，发现更多乙肝表面抗原阳性病例和乙肝病毒暴露病例（P<0.001）。索引病例HBeAg阳性且为女性，显著增加了家庭成员慢性携带的风险（相对风险=24.06；95%置信区间=8.88 - 65.21；P<0.05）。