Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Centers for Disease Control, Taipei, Taiwan.
J Hepatol. 2015 Aug;63(2):354-63. doi: 10.1016/j.jhep.2015.03.013. Epub 2015 Mar 17.
BACKGROUND & AIMS: Hepatitis B virus (HBV) infection poses a global public health threat. HBV vaccination has proven highly effective in preventing the infection; however, its long-term impact on the general population has not been addressed. We conducted analysis to determine the total and changing burden of chronic HBV infection and evaluate the serological status between vaccinated and unvaccinated in Taiwan.
Participants in "The Taiwanese Survey on Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension" in 2002 (n=6602), and 4088 with follow-up survey in 2007 were included. HBsAg (including titers), anti-HBs, anti-HBc, HBeAg, anti-HBe, HBV genotypes and viral loads were assayed. Prevalence and evolving patterns of these seromarkers was compared between vaccinated and unvaccinated cohorts and predictors of persistent HBsAg positivity and negativity were examined.
The overall prevalence of chronic HBV infection was 13·7% (95% CI, 12.9% to 14.5%) and about two thirds had past exposure (anti-HBc: 68·46%) in 2002. The vaccinated cohort tended to have lower prevalence of HBsAg and anti-HBc, and a higher proportion of anti-HBs and HBeAg positivity, genotype C and high viral load. The majority (85·42%) were consistently HBsAg negative while 12·65% were consistently positive, and 8·98% achieved seroclearance in a five-year period. In the vaccinated cohort, no subjects had acquired new exposure and became HBsAg positive, and only one (0.54%) cleared HBsAg, demonstrating the durability of vaccination through teenage and young adulthood.
This comprehensive, population-representative-survey shows that 20 years after universal vaccination, the backlog still composed a substantial burden of chronic HBV infections in Taiwan.
乙型肝炎病毒（HBV）感染对全球公共卫生构成威胁。HBV 疫苗接种已被证明在预防感染方面非常有效；然而，其对普通人群的长期影响尚未得到解决。我们进行了分析，以确定慢性 HBV 感染的总负担和变化，并评估台湾疫苗接种和未接种人群的血清学状态。
纳入 2002 年“台湾地区高血糖、高血脂和高血压流行情况调查”中的参与者（n=6602），并对其中 4088 人进行了 2007 年的随访调查。检测 HBsAg（包括滴度）、抗-HBs、抗-HBc、HBeAg、抗-HBe、HBV 基因型和病毒载量。比较疫苗接种和未接种队列之间这些血清标志物的流行率和变化模式，并检查持续 HBsAg 阳性和阴性的预测因素。
2002 年，慢性 HBV 感染的总体流行率为 13.7%（95%CI，12.9%至 14.5%），约三分之二有既往暴露（抗-HBc：68.46%）。疫苗接种队列的 HBsAg 和抗-HBc 流行率较低，抗-HBs 和 HBeAg 阳性率、基因型 C 和高病毒载量较高。大多数（85.42%）人群始终为 HBsAg 阴性，而 12.65%始终为阳性，8.98%在五年内实现了血清学清除。在疫苗接种队列中，没有新的暴露且 HBsAg 阳性的新发病例，只有 1 人（0.54%）清除了 HBsAg，表明青少年和成年期接种疫苗的持久性。
这项全面的、具有代表性的人群调查表明，在普遍接种疫苗 20 年后，台湾的慢性 HBV 感染仍然构成了一个相当大的负担。
