MMWR Morb Mortal Wkly Rep. 2011 Oct 14;60(40):1385-90.
Hepatitis A is thought to infect almost all persons living in Pakistan by age 15 years, and hepatitis E is responsible for sporadic infections and outbreaks. The prevalence of hepatitis B virus (HBV) infection is estimated at 2.5% and the prevalence of hepatitis C virus (HCV) infection, estimated at 4.8%, is one of the highest rates in the world. Hepatitis surveillance in Pakistan has been syndromic, failing to confirm infection, distinguish among viruses, or collect information on risk factors. To understand the epidemiology of viral hepatitis in Pakistan more clearly, the Ministry of Health (MOH) asked the Pakistan Field Epidemiology and Laboratory Training Program (FELTP) to establish a hepatitis sentinel surveillance system in five large public hospitals in four provinces and Islamabad Capital Territory. This report describes the implementation of the viral hepatitis surveillance system in Pakistan and summarizes major findings from June 2010 through March 2011. A total of 712 cases of viral hepatitis were reported; newly reported HCV infection accounted for 53.2% of reported cases, followed by acute hepatitis A (19.8%), acute hepatitis E (12.2%), and newly reported HBV infection (10.8%). A history of health-care--related exposures, particularly receipt of therapeutic injections and infusions, commonly were reported by persons infected with HBV and HCV, and most patients reported drinking unboiled water. These findings point to the need for improved provider and community education about risks associated with unsafe injections, strengthening infection control practices in health facilities, increasing hepatitis B vaccination coverage, and improving access to clean drinking water in Pakistan.
甲型肝炎被认为几乎感染了所有生活在巴基斯坦的 15 岁以下人群，戊型肝炎则导致了散发性感染和暴发。乙型肝炎病毒（HBV）感染的流行率估计为 2.5%，丙型肝炎病毒（HCV）感染的流行率估计为 4.8%，为世界上最高之一。巴基斯坦的肝炎监测一直是综合征监测，未能确认感染、区分病毒或收集危险因素信息。为了更清楚地了解巴基斯坦病毒性肝炎的流行病学情况，卫生部（MOH）要求巴基斯坦现场流行病学和实验室培训计划（FELTP）在四个省和伊斯兰堡首都特区的五家大型公立医院建立肝炎哨点监测系统。本报告描述了巴基斯坦病毒性肝炎监测系统的实施情况，并总结了 2010 年 6 月至 2011 年 3 月期间的主要发现。共报告了 712 例病毒性肝炎病例；新报告的 HCV 感染占报告病例的 53.2%，其次是急性甲型肝炎（19.8%）、急性戊型肝炎（12.2%）和新报告的乙型肝炎感染（10.8%）。接受治疗性注射和输液等卫生保健相关暴露的历史，通常是 HBV 和 HCV 感染者报告的原因，大多数患者报告饮用未煮沸的水。这些发现表明，需要加强提供者和社区对不安全注射相关风险的教育，加强卫生保健机构的感染控制措施，提高乙型肝炎疫苗接种覆盖率，并改善巴基斯坦清洁饮用水的获取。
