Thomas D L, Factor S H, Kelen G D, Washington A S, Taylor E, Quinn T C
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
Arch Intern Med. 1993 Jul 26;153(14):1705-12.
Health care personnel are at increased risk of occupational acquisition of hepatitis B virus (HBV) infection. While effective vaccination for HBV is widely available, the prevalence of HBV and vaccine acceptance in hospital personnel have not been recently assessed. In addition, hepatitis C virus (HCV) is a newly recognized cause of parenterally acquired hepatitis, and the risk of HCV transmission to health care personnel remains unclear.
From April to December 1991, health care personnel at The Johns Hopkins Hospital, Baltimore, Md, were offered anonymous testing for HBV and HCV and were asked to complete a confidential questionnaire. Serum samples were tested for HBV surface antigen and antibodies to HBV core antigen, HBV surface antigen, and HCV. Seroprevalence rates were compared with those detected in local blood donors during the same year.
Antibodies to HBV core antigen were found in 59 (6.2%) of 943 health care workers compared with 1879 (1.8%) of 104,239 local blood donors (P < .001). In contrast, antibodies to HCV were found in seven (0.7%) of 943 health care workers and 0.4% of local blood donors (P = .10). Infection with HBV was associated with age (> or = 33 years) (P < .001), black race (P < .001), type of health care worker (nurse) (P = .02), 10 ore more years of clinical employment (P = .003), and lack of HBV vaccination (P < .001). After logistic regression, only absence of HBV vaccination was independently associated with HBV infection (P < .001).
These data suggest that the prevalence of HCV infection in health care personnel at The Johns Hopkins Hospital is similar to that observed in local blood donors, and that HBV may be more efficiently transmitted than HCV in the health care setting. Efforts to vaccinate health care personnel against HBV should be vigorously pursued since 23% remain unvaccinated after 9 years of HBV vaccine availability.
医护人员职业感染乙型肝炎病毒（HBV）的风险增加。虽然已有广泛可用的HBV有效疫苗，但医院工作人员中HBV的流行情况和疫苗接种率尚未得到近期评估。此外，丙型肝炎病毒（HCV）是一种新发现的经肠道外途径传播的肝炎病因，HCV传播给医护人员的风险仍不明确。
1991年4月至12月，为马里兰州巴尔的摩市约翰霍普金斯医院的医护人员提供了HBV和HCV匿名检测，并要求他们填写一份保密问卷。检测血清样本中的HBV表面抗原、HBV核心抗原抗体、HBV表面抗原和HCV。将血清阳性率与同年当地献血者中检测到的阳性率进行比较。
943名医护人员中有59人（6.2%）检测出HBV核心抗原抗体，而104239名当地献血者中有1879人（1.8%）检测出该抗体（P <.001）。相比之下，943名医护人员中有7人（0.7%）检测出HCV抗体，当地献血者中有0.4%检测出该抗体（P =.10）。HBV感染与年龄（≥33岁）（P <.001）、黑人种族（P <.001）、医护人员类型（护士）（P =.02）、临床工作10年或更长时间（P =.003）以及未接种HBV疫苗（P <.001）有关。经过逻辑回归分析，只有未接种HBV疫苗与HBV感染独立相关（P <.001）。
这些数据表明，约翰霍普金斯医院医护人员中HCV感染的流行情况与当地献血者中观察到的情况相似，并且在医疗环境中HBV可能比HCV传播更有效。鉴于在有HBV疫苗可用9年后仍有23%的医护人员未接种疫苗，应大力推动医护人员接种HBV疫苗。
