Chinese Center for Disease Control and Prevention, Beijing,China.
School of Public Health, Peking University, Beijing, China.
PLoS One. 2019 Apr 23;14(4):e0215580. doi: 10.1371/journal.pone.0215580. eCollection 2019.
Hepatitis B infection is a major public health challenge in China. Clinicians report hepatitis B cases to the National Notifiable Disease Reporting System. A 2007 study found that only 35% of hepatitis B cases that had been reported as acute infections met a rigorous case definition of acute hepatitis B, implying overreporting of new-onset infections. To increase the accuracy of reported acute hepatitis B infections, in 2013, we initiated enhanced hepatitis B surveillance in 200 sentinel counties. We compared incidences and proportions of different stages of hepatitis B infection before and after implementation of enhanced surveillance. We checked the accuracy of reported data and re-diagnosed hepatitis B cases reported as acute infection according to the enhanced diagnostic criteria and calculated positive predictive value(PPV) of acute hepatitis B reports. Compared to previous surveillance, with enhanced surveillance, the incidence of reported acute hepatitis B infection decreased by 53.7% and the proportion of unclassified hepatitis B infection was reduced by 79.4%. From 2013 to 2016, the PPV of acute hepatitis B increased (55.8% to 71.0%); PPV rates in western and rural areas were lower than in other areas. We recommend enhancing hepatitis B surveillance nationwide using these new standards, and raising western and rural areas clinicians' diagnostic and reporting capacity, and ensuring sufficient resources for IgM anti-HBc testing.
乙型肝炎感染是中国面临的重大公共卫生挑战之一。临床医生将乙型肝炎病例报告给国家法定传染病报告系统。2007 年的一项研究发现，仅有 35%被报告为急性感染的乙型肝炎病例符合严格的急性乙型肝炎病例定义，这意味着新发病例的报告存在过度报告。为了提高报告的急性乙型肝炎感染的准确性，我们于 2013 年在 200 个监测县启动了强化乙型肝炎监测。我们比较了强化监测实施前后不同阶段乙型肝炎感染的发病率和比例。我们检查了报告数据的准确性，并根据强化诊断标准重新诊断报告为急性感染的乙型肝炎病例，并计算了急性乙型肝炎报告的阳性预测值（PPV）。与之前的监测相比，强化监测后，报告的急性乙型肝炎感染发病率下降了 53.7%，未分类的乙型肝炎感染比例下降了 79.4%。2013 年至 2016 年期间，急性乙型肝炎的 PPV 增加（55.8%至 71.0%）；西部地区和农村地区的 PPV 率低于其他地区。我们建议在全国范围内使用这些新标准加强乙型肝炎监测，并提高西部地区和农村地区临床医生的诊断和报告能力，确保有足够的资源进行 IgM 抗-HBc 检测。
