Department of Medical Laboratory Science and Biotechnology, College of Biomedical Science and Technology, Yuanpei University, No. 306, Rd. Yuanpei, Hsinchu (300), Taiwan.
J Clin Virol. 2011 Sep;52(1):11-6. doi: 10.1016/j.jcv.2011.06.012. Epub 2011 Jul 20.
BACKGROUND: Taiwan launched a nationwide infant vaccination program for hepatitis B (HB) in 1984. OBJECTIVES: This study evaluated the seroprevalence of hepatitis B virus (HBV) and the incidence of high alanine aminotransferase (ALT) level among young adults prior to, during, and since the introduction of the nationwide HBV vaccination program. STUDY DESIGN: Researchers recruited 101,584 freshmen (male:female=1.114:1; mean age, 18.5±0.5 years) from 21 universities between 1995 and 2009 (birth cohorts 1977-1991) in Taiwan, testing for serum hepatitis B surface antigens (HBsAg), hepatitis e antigens (HBeAg), antibodies against HBsAg (anti-HBs), and liver function tests, including ALT and aspartate aminotransferase (AST). RESULTS: The results showed that the prevalence of HBsAg decreased significantly from 14.3% in 1995 to 1.1% in 2009 and the seroprevalence of HBeAg decreased significantly from 5.9% in 1995 to 0.3% in 2009. Seroconversion to anti-HBs maintained a steady rate above 50% between 1995 and 2007, but declined considerably to 36.6% and 36.4% in 2008 and 2009, respectively. Subject with HBeAg seropositivity was in 43.94% of HBV carriers. Double seronegativity for HBsAg and anti-HBs was observed in 2007 (47.8%), 2008 (62.3%), and 2009 (62.5%). High ALT level was observed in 5.74% of the subjects, particular among HBV-carriers (16.5% of HBV carrier vs. 5.0% of non-HBV carrier; ORs, 3.733; 95% CIs, 3.463-4.023, p<0.0001). Subjects with high ALT level were significantly positively associated with HBeAg (10.5% of HBeAg seropositive vs. 1.9% of HBeAg seronegative; ORs, 6.195; 95%CI, 5.629-6.818; p<0.0001). Male subjects were more easily infected by HBV than female subjects were (HBsAg, ORs, 1.355, 95% CI, 1.283-1.431; HBeAg, ORs, 1.324, 95% CI, 1.218-1.439, p<0.0001), and significantly more male subjects had high ALT levels than female subjects did (ORs, 4.087; 95% CI, 3.819-4.375, p<0.0001). CONCLUSIONS: The mass vaccination program successfully reduced the HBV carrier rate and prevalence of chronic hepatitis B in Taiwan. However, the low percentage of anti-HBV in 2008 and 2009 remains unresolved.
背景：台湾于 1984 年启动了全国性乙型肝炎（HB）婴儿疫苗接种计划。
目的：本研究评估了在全国性乙型肝炎疫苗接种计划实施前、实施中和实施后，年轻成年人中乙型肝炎病毒（HBV）的血清流行率和高丙氨酸氨基转移酶（ALT）水平的发生率。
研究设计：研究人员于 1995 年至 2009 年间（1977-1991 年出生队列）从台湾 21 所大学招募了 101584 名新生（男：女=1.114:1；平均年龄 18.5±0.5 岁），检测血清乙型肝炎表面抗原（HBsAg）、乙型肝炎 e 抗原（HBeAg）、抗 HBsAg 抗体（抗-HBs）和肝功能试验，包括 ALT 和天门冬氨酸氨基转移酶（AST）。
结果：结果显示，HBsAg 的流行率从 1995 年的 14.3%显著下降至 2009 年的 1.1%，HBeAg 的血清流行率从 1995 年的 5.9%显著下降至 2009 年的 0.3%。抗-HBs 的血清转化率在 1995 年至 2007 年之间保持在 50%以上的稳定水平，但在 2008 年和 2009 年分别显著下降至 36.6%和 36.4%。HBeAg 阳性的 HBV 携带者中有 43.94%为 HBV 携带者。HBsAg 和抗-HBs 双重阴性在 2007 年（47.8%）、2008 年（62.3%）和 2009 年（62.5%）观察到。5.74%的受试者出现高 ALT 水平，特别是在 HBV 携带者中（HBV 携带者为 16.5%，非 HBV 携带者为 5.0%；ORs，3.733；95%CI，3.463-4.023，p<0.0001）。高 ALT 水平的受试者与 HBeAg 显著正相关（HBeAg 阳性者为 10.5%，HBeAg 阴性者为 1.9%；ORs，6.195；95%CI，5.629-6.818；p<0.0001）。男性比女性更容易感染 HBV（HBsAg，ORs，1.355，95%CI，1.283-1.431；HBeAg，ORs，1.324，95%CI，1.218-1.439，p<0.0001），且男性出现高 ALT 水平的比例显著高于女性（ORs，4.087；95%CI，3.819-4.375，p<0.0001）。
结论：大规模疫苗接种计划成功降低了台湾的 HBV 携带率和慢性乙型肝炎的流行率。然而，2008 年和 2009 年抗-HBV 百分比较低的问题仍未得到解决。
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