Scheutz F, Melbye M, Esteban J I, Aldershvile J, Ebbesen P, Alter H J
Department of Child Dental Health and Community Dentistry, Royal Dental College, Aarhus C, Denmark.
Am J Epidemiol. 1988 Jul;128(1):190-6. doi: 10.1093/oxfordjournals.aje.a114940.
The authors determined the seroprevalence of hepatitis B virus markers among Danish dentists in 1985 in an effort to assess occupational risk factors. A case-control study approach was applied using pedodontists as zero-exposure controls. The study further allowed serologic and epidemiologic follow-up of dentists who participated in a similar study in 1976. The authors sought to determine whether exposure to hepatitis B virus in this population sometimes leads to immunization without infection (antibody to hepatitis B surface antigen (anti-HBs) positivity only). A total of 922 dentists (22% of all Danish dentists) gave blood; of these, 254 (28%) participated in the 1976 study. Serum samples were tested using commercial solid phase radioimmunoassays. The prevalences of anti-HBs and antibody to hepatitis B core antigen (anti-HBc) were 7.2% (95% confidence interval (CI) = 5.7-9.0) and 5.2% (95% CI = 3.8-6.6), respectively. Twenty-one dentists (31%) only had anti-HBs (without prior vaccination). Age-standardization of the two data sets (1976 and 1985) indicated no substantial change in seroprevalence. Private practitioners, especially those working in Copenhagen, had an increased odds ratio (OR) of being seropositive compared with that of pedodontists (OR = 3.0 (95% CI = 1.3-6.8) adjusted for age and sex and OR = 2.4 (95% CI = 1.1-5.2) adjusted for age and site of practice). The proportion attributable to occupational exposure was approximately 50%. In a logistic regression model, site of practice and type of specialty were associated with hepatitis B virus seropositivity (p = 0.01 and 0.05, respectively), whereas age, sex, hours of oral surgery per week, and use of gloves were not. Four persons had become seropositive in the follow-up study, for a seroconversion rate of 0.2% per year. Seven out of 18 dentists who were anti-HBs positive in 1976 were found to be anti-HBs negative in 1985. Most of these dentists had values below 10.0 units by S/N ratio (ratio of counts per minute of sample compared with the mean number of counts per minute of negative controls). The findings do not justify institution of a large-scale vaccination program for dentists, but there are certain subgroups of dentists which constitute candidates for vaccination.
1985年，作者测定了丹麦牙医中乙肝病毒标志物的血清流行率，以评估职业风险因素。采用病例对照研究方法，将儿童牙医作为零暴露对照组。该研究还对参加1976年类似研究的牙医进行了血清学和流行病学随访。作者试图确定该人群中接触乙肝病毒是否有时会导致免疫而无感染（仅乙肝表面抗原抗体（抗-HBs）阳性）。共有922名牙医（占丹麦所有牙医的22%）献血；其中，254人（28%）参加了1976年的研究。血清样本采用商业固相放射免疫分析法检测。抗-HBs和乙肝核心抗原抗体（抗-HBc）的流行率分别为7.2%（95%置信区间（CI）=5.7-9.0）和5.2%（95%CI=3.8-6.6）。21名牙医（31%）仅抗-HBs阳性（未事先接种疫苗）。对两个数据集（1976年和1985年）进行年龄标准化后，血清流行率无显著变化。与儿童牙医相比，私人执业者，尤其是在哥本哈根工作的私人执业者，血清阳性的比值比（OR）增加（调整年龄和性别后OR=3.0（95%CI=1.3-6.8），调整年龄和执业地点后OR=2.4（95%CI=1.1-5.2））。职业暴露所致比例约为50%。在逻辑回归模型中，执业地点和专业类型与乙肝病毒血清阳性相关（p分别为0.01和0.05），而年龄、性别、每周口腔外科手术时间和手套使用情况则无关。在随访研究中有4人血清阳转，血清转化率为每年0.2%。在1976年抗-HBs阳性的18名牙医中，有7人在1985年被发现抗-HBs阴性。这些牙医中的大多数S/N比值（样本每分钟计数与阴性对照平均每分钟计数之比）低于10.0单位。这些发现并不支持为牙医实施大规模疫苗接种计划，但有某些亚组的牙医可作为疫苗接种的对象。
