Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.
U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010.
Mil Med. 2020 Sep 18;185(9-10):e1654-e1661. doi: 10.1093/milmed/usaa131.
Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies.
HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections.
The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession.
Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice.
了解现役军人乙型肝炎病毒（HBV）感染的当代流行病学情况，可为美国国防部（DoD）潜在的筛查政策以及感染和疾病控制策略提供信息。
通过评估 2007 年至 2010 年间最近部署到伊拉克和阿富汗作战行动的 10000 名军人的血清，确定入伍时和部署后的 HBV 感染状况。从美国国防部的角度出发，开发了一个成本模型，用于将对申请入伍者的 HBV 感染筛查纳入现有的疫苗可预防感染新兵筛查计划中。
入伍时慢性 HBV 感染的流行率为 2.3/1000（95%CI：1.4，3.2）；部署后发现的大多数病例（16/21，76%）在入伍时就存在。发现了 110 例与军事服务相关的 HBV 感染。对被鉴定为 HBV 易感者进行 HBV 表面抗原筛查，然后进行 HBV 表面抗原中和确认，其成本优势不及不筛查，且每年净增加成本 578 万美元。然而，每年通过入伍筛查可排除多达 514 例 HBV 病例。
在入伍时筛查 HBV 感染可能会减少部队中的慢性 HBV 感染，降低战场血液供应中输血传播 HBV 感染的威胁，并有助于早期诊断和提供治疗服务；但是，申请人筛查并不能节省成本。与服务相关的感染病例表明存在持久的威胁，需要改进基于实验室的监测工具，并需要重新审查免疫接种政策和实践。
