2000 - 2010年不安全医疗注射导致的全球病毒感染负担演变
Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010.
作者信息
Pépin Jacques, Abou Chakra Claire Nour, Pépin Eric, Nault Vincent, Valiquette Louis
机构信息
Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada.
出版信息
PLoS One. 2014 Jun 9;9(6):e99677. doi: 10.1371/journal.pone.0099677. eCollection 2014.
BACKGROUND
In 2000, the World Health Organization estimated that, in developing and transitional countries, unsafe injections accounted for respectively 5%, 32% and 40% of new infections with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Safe injection campaigns were organized worldwide. The present study sought to measure the progress in reducing the transmission of these viruses through unsafe injections over the subsequent decade.
METHODS
A mass action model was updated, to recalculate the number of injection-related HIV, HCV and HBV infections acquired in 2000 and provide estimates for 2010. Data about the annual number of unsafe injections were updated. HIV prevalence in various regions in 2000 and 2010 were calculated from UNAIDS data. The ratio of HIV prevalence in healthcare settings compared to the general population was estimated from a literature review. Improved regional estimates of the prevalence of HCV seropositivity, HBsAg and HBeAg antigenemia were used for 2000 and 2010. For HIV and HCV, revised estimates of the probability of transmission per episode of unsafe injection were used, with low and high values allowing sensitivity analyses.
RESULTS
Despite a 13% population growth, there was a reduction of respectively 87% and 83% in the absolute numbers of HIV and HCV infections transmitted through injections. For HBV, the reduction was more marked (91%) due to the additional impact of vaccination. While injections-related cases had accounted for 4.6%-9.1% of newly acquired HIV infections in 2000, this proportion decreased to 0.7%-1.3% in 2010, when unsafe injections caused between 16,939 and 33,877 HIV infections, between 157,592 and 315,120 HCV infections, and 1,679,745 HBV infections.
CONCLUSION
From 2000 to 2010, substantial progress was made in reducing the burden of HIV, HCV and HBV infections transmitted through injections. In some regions, their elimination might become a reasonable public health goal.
背景
2000年，世界卫生组织估计，在发展中国家和转型国家，不安全注射分别占艾滋病毒、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）新感染病例的5%、32%和40%。全球开展了安全注射运动。本研究旨在衡量在随后十年中通过不安全注射减少这些病毒传播方面取得的进展。
方法
更新了一个大规模行动模型，以重新计算2000年因注射感染艾滋病毒、丙肝病毒和乙肝病毒的病例数，并对2010年进行估计。更新了有关每年不安全注射次数的数据。根据联合国艾滋病规划署的数据计算了2000年和2010年各地区的艾滋病毒流行率。通过文献综述估计了医疗机构中艾滋病毒流行率与一般人群流行率的比率。采用了2000年和2010年改进后的丙型肝炎病毒血清阳性率、乙肝表面抗原（HBsAg）和乙肝e抗原血症流行率的区域估计值。对于艾滋病毒和丙肝病毒，使用了每次不安全注射传播概率的修订估计值，并采用了低值和高值进行敏感性分析。
结果
尽管人口增长了13%，但通过注射传播的艾滋病毒和丙肝病毒绝对病例数分别减少了87%和83%。对于乙肝病毒，由于疫苗接种的额外影响，减少更为显著（91%）。2000年，注射相关病例占新感染艾滋病毒病例的4.6%-9.1%，到2010年这一比例降至0.7%-1.3%，当时不安全注射导致16939至33877例艾滋病毒感染、157592至315120例丙肝病毒感染以及1679745例乙肝病毒感染。
结论
从2000年到2010年，在减少通过注射传播的艾滋病毒、丙肝病毒和乙肝病毒感染负担方面取得了重大进展。在一些地区，消除这些感染可能成为一个合理的公共卫生目标。
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