Alter M J, Hadler S C, Margolis H S, Alexander W J, Hu P Y, Judson F N, Mares A, Miller J K, Moyer L A
Division of Viral and Rickettsial Diseases, Centers for Disease Control, Atlanta, Ga 30333.
JAMA. 1990 Mar 2;263(9):1218-22.
To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100,000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease.
为确定美国急性乙型肝炎的发病率和流行病学趋势，我们于1981年10月1日至1988年9月30日在四个哨点县对病毒性肝炎进行了强化监测。在整个研究期间，乙型肝炎的总体发病率保持相对稳定（平均每10万人中有13.2例），但疾病传播模式发生了显著变化。由同性恋活动和医疗保健工作导致的乙型肝炎病例比例分别下降了62%和75%；由静脉注射吸毒和异性接触导致的病例比例分别上升了80%和38%。未发现危险因素的患者比例（30%至40%）未随时间变化。这些患者往往属于少数族裔，社会经济水平较低。同性恋男性中乙型肝炎病例数的下降可能是由于高危性行为的改变；医护人员中病例数的下降主要归因于乙型肝炎疫苗接种。当前针对高危人群进行免疫接种的乙型肝炎预防策略未能对疾病发病率产生显著影响。
