中国北京新型甲型肝炎监测系统的探索：基于分子流行病学。

Exploration of a new hepatitis a surveillance system in Beijing, China: based on molecular epidemiology.

机构信息

Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16, He Ping Li Middle Street, Dongcheng District, 100013, Beijing, China.

NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 102206, Beijing, China.

出版信息

BMC Infect Dis. 2022 Jan 4;22(1):22. doi: 10.1186/s12879-021-06872-4.

DOI:10.1186/s12879-021-06872-4

PMID:34983383

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8725380/

Abstract

BACKGROUND

The incidence of hepatitis A virus (HAV) infection is low in Beijing, China, but the risk of outbreaks still exists. It is difficult to identify possible sources of infection among sporadic cases based on a routine surveillance system. Therefore, a more effective surveillance system needs to be established.

METHODS

The epidemiological data of hepatitis A were obtained from a routine surveillance system. Patients with HAV confirmed at the local hospitals were asked to complete a questionnaire that included additional case information and possible sources of infection. Serum and fecal specimens were also collected for testing HAV RNA by polymerase chain reaction. In addition, the 321-nucleotide segment of the VP1/2A junction region was sequenced to determine the HAV genotype.

RESULTS

In 2019, 110 HAV cases were reported in Beijing, with an incidence rate of 0.51/100,000. 61(55.5%) of these patients were male. The greatest proportion of these patients were aged from 30 to 60 years. The rate was lower in suburban and rural areas compared to urban areas. Contaminated food consumption, particularly seafood consumption, was the primary potential source of infection. Among the 16 specimens of confirmed HAV cases that could be sequenced, 93.8% were HAV IA, and 6.3% were HAV IB. In addition, the samples collected from all HAV sequences in this investigation showed 89.4-100% nucleotide homology. Two groups (each with three sporadic cases) showed 100% nucleotide homology. The three sporadic cases in one group had the same possible source of infection: contaminated salad with raw vegetables and seafood. In the other group, the three sporadic cases did not have an epidemiological connection.

CONCLUSIONS

In a low HAV prevalent area, such as in Beijing, incorporating molecular epidemiology into the routine surveillance system could help inform possible clusters of outbreaks and provide support for earlier control of HAV transmission. Nevertheless, increased sampling from detected cases and improved specimen quality are needed to implement such a system.

摘要

背景

在中国北京，甲型肝炎病毒（HAV）感染的发病率较低，但仍存在暴发的风险。根据常规监测系统，很难确定散发病例的可能感染源。因此，需要建立更有效的监测系统。

方法

从常规监测系统中获取甲型肝炎的流行病学数据。当地医院确诊的 HAV 患者被要求完成一份问卷，其中包括额外的病例信息和可能的感染源。还采集血清和粪便标本，通过聚合酶链反应检测 HAV RNA。此外，对 VP1/2A 连接区的 321 个核苷酸片段进行测序，以确定 HAV 基因型。

结果

2019 年，北京报告了 110 例 HAV 病例，发病率为 0.51/10 万。其中 61 例（55.5%）为男性。这些患者中最大的比例年龄在 30 至 60 岁之间。郊区和农村的发病率低于城市地区。受污染食物的摄入，特别是海鲜的摄入，是主要的潜在感染源。在可测序的 16 份确诊 HAV 病例标本中，93.8%为 HAV IA，6.3%为 HAV IB。此外，本次调查中所有 HAV 序列样本的核苷酸同源性为 89.4-100%。两组（每组 3 例散发病例）的核苷酸同源性为 100%。一组中的 3 例散发病例具有相同的可能感染源：受污染的生蔬菜和海鲜沙拉。在另一组中，3 例散发病例没有流行病学联系。