Mol Marcos Paulo Gomes, Cairncross Sandy, Greco Dirceu Bartolomeu, Heller Leo
Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, MG, Brasil.
Departamento de Engenharia Sanitária e Ambiental, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Rev Soc Bras Med Trop. 2017 Nov-Dec;50(6):756-763. doi: 10.1590/0037-8682-0010-2017.
This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.
这项荟萃分析基于先前发表的系统评价，旨在推动关于接触家庭和医疗废物的工作人员感染乙型肝炎病毒（HBV）的科学讨论。我们检索了截至2013年12月已使用的数据并更新至2016年12月的相关出版物。根据Loney等人关于健康问题患病率或发病率研究的批判性评价指南，对纳入研究的质量进行评估。为了验证各论文之间是否存在异质性，我们使用基于Q统计量的卡方检验。采用漏斗图检验发表偏倚。所有纳入研究均采用横断面研究设计。接触废物与乙型肝炎表面抗原（HBsAg）血清学阳性之间的关联显示出显著相关性[比值比（OR）1.89，95%置信区间（CI）1.27 - 2.86；p = 0.0019]。HBsAg和抗-HBc血清阳性率分别为0.04（95%CI 0.03 - 0.05）和0.21（95%CI 0.14 - 0.28）（p <0.0001）。我们未发现发表偏倚的证据。这项荟萃分析的结果表明，无论是医疗废物还是家庭废物，接触固体废物与HBV感染阳性标志物之间存在统计学上的显著关联。因此，应更密切地分析废物收集者的工作条件。建议对所有固体废物处理工人进行乙肝疫苗接种，作为主要预防措施。
