Gardner L I, Redfield R R, Lednar W M, Lemon S M, Miller R N
Am J Epidemiol. 1986 Mar;123(3):464-72. doi: 10.1093/oxfordjournals.aje.a114261.
Hepatitis B hospitalization rates for US Army enlisted personnel were determined by occupation and geographic area for 1980. The only group in the US Army currently recommended to receive hepatitis B vaccine is medical personnel regularly exposed to blood. Other groups of Army personnel, specifically those working in areas of high hepatitis B endemicity, have been thought to be at higher risk. Therefore, this work was undertaken to document hospitalization rates for all personnel using occupational blood exposure criteria as well as geographic area of assignment as risk factors for hepatitis B. The hospitalization rates underestimate true rates of hepatitis B incidence by a wide margin, and therefore were not used to calculate specific costs and specific benefits for a new vaccination strategy. In spite of this limitation, these data were useful for calculating relative risk, attributable risk, and amount of vaccine preventable disease. The risk of hospitalization for blood-exposed employees was consistently higher than that for non-blood-exposed personnel. The magnitude of the relative risk for blood exposure may be as high as 3.8 times or as low as 1.2 times, depending on which occupational comparison group is used. The relative risk of hospitalization in South Korea vs. the United States was 3.1 (p less than 0.0001), that for Europe vs. the United States, 2.1 (p less than 0.0001). Of all occupational and geographic risk comparisons, assignment to South Korea carried the highest attributable risk: 225 per 100,000. The amount of vaccine preventable disease in personnel assigned to South Korea was similar to that in occupationally blood-exposed employees (5.5 vs. 5.2 hospitalized cases per 1,000 vaccinees) after prorating exposure to risk based on average number of days of exposure to risk over three years. These data support the argument that geographic factors are as important as occupational blood exposure in defining risk of hepatitis B hospitalization among the US Army enlisted personnel.
1980年，美国陆军应征人员的乙型肝炎住院率按职业和地理区域进行了测定。目前美国陆军中唯一被建议接种乙型肝炎疫苗的群体是经常接触血液的医务人员。其他陆军人员群体，特别是那些在乙型肝炎高流行地区工作的人员，被认为风险更高。因此，开展这项工作是为了记录所有人员的住院率，将职业性血液接触标准以及工作地理区域作为乙型肝炎的风险因素。住院率大大低估了乙型肝炎的实际发病率，因此未用于计算新疫苗接种策略的具体成本和具体效益。尽管有这一局限性，但这些数据对于计算相对风险、归因风险和疫苗可预防疾病的数量很有用。接触血液的员工的住院风险一直高于未接触血液的人员。根据所使用的职业比较组不同，血液接触的相对风险幅度可能高达3.8倍，也可能低至1.2倍。韩国与美国相比，住院的相对风险为3.1（p小于0.0001），欧洲与美国相比为2.1（p小于0.0001）。在所有职业和地理风险比较中，派驻韩国的归因风险最高：每10万人中有225例。在根据三年平均接触风险天数对风险进行比例调整后，派驻韩国人员的疫苗可预防疾病数量与职业性接触血液的员工相似（每1000名接种者中有5.5例与5.2例住院病例）。这些数据支持了这样一种观点，即在确定美国陆军应征人员乙型肝炎住院风险方面，地理因素与职业性血液接触同样重要。
