Solarsh G C, McKerrow N, Mlisana K P, Loening W E, Gouws E
Department of Paediatrics, University of Natal, Durban.
S Afr Med J. 1996 Apr;86(4):345-9.
A study was undertaken to assess the prevalence of hepatitis B infection in selected residential child care facilities in Natal.
All residents at three facilities in the Durban and Pietermaritzburg areas of KwaZulu-Natal were tested for markers of hepatitis B infection as part of a broader health status assessment.
One hundred and ninety-five children between the ages of 3 and 194 months (78 +/- 47) were studied. Overall 66.2% of children had evidence of past exposure to hepatitis B virus. Of these 14.9% were positive for hepatitis B surface antigen, 13.3% for hepatitis B e antigen, 47.7% for hepatitis B surface antibody and 59.5% for hepatitis B core antibody. Relative rates of infection increased with age from 18.2%, 20% and 27.8% in the 1st, 2nd and 3rd years of life respectively to 72.2% and 88.2% in the 4th and 5th years of life. Relative rates of infection increased with duration of stay from 40% by the end of the 1st year to 100% by the end of the 5th year.
This study has demonstrated a very high rate of infection with hepatitis B virus and a high prevalence of hepatitis B surface antigenaemia in residential care facilities. It has also shown that the infection is horizontally transmitted within these facilities, that infection increases with duration of stay, that there is a dramatic increase in infection rates after the 3rd year of life, that the highest carrier rates are occurring in children between the ages of 2 and 4 years, and that the vast majority of carriers are highly infectious. These children are not only at risk themselves for the long-term complications of this disease but also constitute an important reservoir of hepatitis B infection within the larger community. There is an urgent need for uniform national guidelines for the screening and management of children in residential care facilities and children being prepared for adoption or foster care. There is also a need for a wider investigation into conditions at residential care facilities previously designated for black children in this country.
开展一项研究以评估纳塔尔选定的儿童保育机构中乙型肝炎感染的流行情况。
作为更广泛健康状况评估的一部分，对夸祖鲁 - 纳塔尔省德班和彼得马里茨堡地区三个机构的所有居民进行了乙型肝炎感染标志物检测。
研究了195名年龄在3至194个月（平均78±47个月）的儿童。总体而言，66.2%的儿童有既往接触乙型肝炎病毒的证据。其中，14.9%的儿童乙型肝炎表面抗原呈阳性，13.3%的儿童乙型肝炎e抗原呈阳性，47.7%的儿童乙型肝炎表面抗体呈阳性，59.5%的儿童乙型肝炎核心抗体呈阳性。感染相对率随年龄增长而增加，分别从1岁、2岁和3岁时的18.2%、20%和27.8%增至4岁和5岁时的72.2%和88.2%。感染相对率随居住时间延长而增加，从第1年末的40%增至第5年末的100%。
本研究表明，儿童保育机构中乙型肝炎病毒感染率非常高，乙型肝炎表面抗原血症患病率也很高。研究还表明，感染在这些机构内呈水平传播，感染率随居住时间延长而增加，3岁后感染率急剧上升，2至4岁儿童的携带率最高，且绝大多数携带者具有高度传染性。这些儿童不仅自身面临该疾病长期并发症的风险，而且在更大的社区中构成了乙型肝炎感染的重要传染源。迫切需要针对儿童保育机构以及准备收养或寄养儿童的筛查和管理制定统一的国家指南。还需要对该国以前指定为黑人儿童的儿童保育机构的情况进行更广泛的调查。
