Li Miaolei, Zu Jian, Shen Mingwang, Zhuang Guihua, Chen Siyuan, Wang Fuzhen, Zheng Hui, Zhang Guomin
School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.
School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, P. R. China.
BMC Public Health. 2021 Feb 19;21(1):388. doi: 10.1186/s12889-021-10408-5.
The long-term impact of sexual transmission on the hepatitis B virus (HBV) infection in China remains unclear. This study aims to estimate the independent influence of sexual transmission on HBV infection.
Based on the natural history of HBV infection and three national serosurvey data of hepatitis B in China, we developed an age- and sex-specific discrete model to describe the transmission dynamics of HBV. The initial conditions of the model were determined according to the age- and sex-specific national serosurvey data in 1992. Based on the national survey data of hepatitis B in 1992 and 2006, by using the Markov Chain Monte Carlo (MCMC) method, we estimated the age- and sex-specific seroclearance rates of hepatitis B surface antigen (HBsAg) and the horizontal transmission rates as well as their 95% confidence intervals (CI). Then we used the age- and sex-specific national serosurvey data of hepatitis B in 2014 to test the accuracy of our model-based estimation. Finally, we evaluated the independent impact of sexual transmission on HBV infection and discussed the long-term effect of promotion of condom use in China.
We estimated that the annual rates of HBsAg seroclearance for males and females aged 1-59 years were respectively 1.04% (95% CI, 0.49-1.59%) and 1.92% (95% CI, 1.11-2.73%). Due to sexual transmission, in 2014, the total number of chronic HBV infections in people aged 0-100 years increased 292,581, of which males increased 189,200 and females increased 103,381. In 2006, the acute HBV infections due to sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) and in 2014, which accounted for 34.59% (male: 42.93%, female: 25.73%). However, if the condom usage rate was increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1-59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).
Sexual transmission has become the predominant route of acute HBV infection in China, especially for men. The promotion of condom use plays a significant role in reducing the cases of acute HBV infection.
性传播对中国乙型肝炎病毒（HBV）感染的长期影响尚不清楚。本研究旨在评估性传播对HBV感染的独立影响。
基于HBV感染的自然史以及中国三次全国性乙型肝炎血清学调查数据，我们建立了一个按年龄和性别划分的离散模型，以描述HBV的传播动态。该模型的初始条件根据1992年按年龄和性别划分的全国血清学调查数据确定。基于1992年和2006年的全国乙型肝炎调查数据，采用马尔可夫链蒙特卡罗（MCMC）方法，我们估计了按年龄和性别划分的乙型肝炎表面抗原（HBsAg）血清清除率和水平传播率及其95%置信区间（CI）。然后我们使用2014年按年龄和性别划分的全国乙型肝炎血清学调查数据来检验基于模型估计的准确性。最后，我们评估了性传播对HBV感染的独立影响，并讨论了在中国推广使用避孕套的长期效果。
我们估计，1至59岁男性和女性的HBsAg年血清清除率分别为1.04%（95%CI，0.49 - 1.59%）和1.92%（95%CI，1.11 - 2.73%）。由于性传播，2014年，0至100岁人群中慢性HBV感染总数增加了292,581例，其中男性增加了189,200例，女性增加了103,381例。2006年，性传播导致的急性HBV感染占24.76%（男性：31.33%，女性：17.94%），2014年占34.59%（男性：42.93%，女性：25.73%）。然而，如果从2019年开始每年将避孕套使用率提高10%，那么与当前情况相比，2019年至2035年急性HBV感染总数将减少16.68%（男性：21.49%，女性：11.93%）。2035年1至59岁人群中的HBsAg流行率将降至2.01%（男性：2.40%，女性：1.58%）。
性传播已成为中国急性HBV感染的主要途径，尤其是对男性而言。推广使用避孕套对减少急性HBV感染病例起着重要作用。
