Department of Epidemiology, School of Public Health, Air Force Medical University, Xi'an 710032, Shaanxi, China.
Wuwei municipal Center for Disease Control and Prevention, Wuwei 733000, Gansu, China.
Biomed Environ Sci. 2020 Oct 20;33(10):735-744. doi: 10.3967/bes2020.098.
Despite the remarkable progress in efforts to control disease spread, the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus (HBV) infection in Western China. This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement.
Susceptible population vaccination, health education, professional training of doctors, and other prevention and control measures have been implemented in Wuwei city since 2010. Data were obtained from three representative cross-sectional serosurveys conducted in 2010, 2013, and 2015. The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers: HBV surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). Estimates of variance were determined using Taylor series linearization methods.
The three serosurveys revealed decreases in the prevalence of HBsAg (7.19% in 2010 6.51% in 2013 5.87% in 2015) and anti-HBc positivity (43.89% 32.87% 28.46%) and an increase in the prevalence of anti-HBs positivity (49.07% 53.66% 53.72%) over time. From 2010 to 2015, the legally reported incidence of hepatitis B in Wuwei city decreased from 686.53/100,000 to 53.72/100,000. Notably, persistently high HBsAg-positive rates (above 5.40%) were observed among subjects aged 20-69 years old in the three serosurveys; the prevalence of HBsAg was above 1% among children younger than 10 years old. Furthermore, rural subjects had higher rates of HBsAg and anti-HBc positivity than their urban counterparts (6.04% 4.83% and 30.26% 20.35%, respectively) in 2015 but had a lower rate of anti-HBs positivity (49.68 55.18%). Multivariate regression analysis showed that age, urban and rural areas, and education level were the main factors affecting HBV infection.
Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time, the hepatitis B infection rate in children younger than 10 years was still higher than the national average level. Therefore, the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.
尽管在控制疾病传播方面取得了显著进展，但中国乙型肝炎（HBV）的全国性消除仍受到西部地区 HBV 感染率持续居高不下的阻碍。本研究旨在评估中国西部地区乙型肝炎预防和控制策略，并确定潜在的改进领域和策略。
自 2010 年以来，武威市已实施了针对易感人群的疫苗接种、健康教育、医生专业培训等预防控制措施。数据来自 2010 年、2013 年和 2015 年三次具有代表性的横断面血清学调查。对血清样本进行酶联免疫吸附试验，以检测乙型肝炎表面抗原（HBsAg）、乙型肝炎表面抗体（抗-HBs）和乙型肝炎核心抗体（抗-HBc）等血清标志物。使用泰勒级数线性化方法确定方差估计值。
三次血清学调查显示，HBsAg 流行率（2010 年为 7.19%，2013 年为 6.51%，2015 年为 5.87%）和抗-HBc 阳性率（43.89%、32.87%、28.46%）呈下降趋势，抗-HBs 阳性率呈上升趋势（49.07%、53.66%、53.72%）。2010 年至 2015 年，武威市法定报告乙型肝炎发病率从 686.53/10 万下降到 53.72/10 万。值得注意的是，三次血清学调查中，20-69 岁人群 HBsAg 阳性率持续高于 5.40%；10 岁以下儿童 HBsAg 阳性率高于 1%。此外，2015 年农村人群 HBsAg 和抗-HBc 阳性率高于城市人群（分别为 6.04%、4.83%和 30.26%、20.35%），而抗-HBs 阳性率较低（分别为 49.68%、55.18%）。多变量回归分析显示，年龄、城乡和教育水平是影响 HBV 感染的主要因素。
尽管基于疫苗的预防控制措施随着时间的推移降低了武威市的 HBV 感染率，但 10 岁以下儿童的乙型肝炎感染率仍高于全国平均水平。因此，母婴传播的预防和控制以及感染者的管理应成为未来预防和控制工作的重点。
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