Martinson F E, Weigle K A, Royce R A, Weber D J, Suchindran C M, Lemon S M
Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill 27599-7400, USA.
Am J Epidemiol. 1998 Mar 1;147(5):478-87. doi: 10.1093/oxfordjournals.aje.a009474.
Most hepatitis B virus (HBV) infections in sub-Saharan African infants and children are acquired through horizontal transmission, but the exact mechanisms of spread have not been documented. The authors conducted a study in rural Ghana which determined seroprevalence in a probability sample of 1,385 individuals of all ages, and evaluated risk factors for horizontal transmission of HBV in a subsample of 547 children aged 1-16 years who were not hepatitis B surface antigen (HBsAg) carriers. Most residents in this district live in compounds which typically contain 2-4 households each. Overall prevalence of HBV seropositives (any HBV marker) was 74.7% (95% confidence interval (CI) 72.5%-76.9%). Prevalence of HBsAg was 20.9% (95% CI 18.8%-23.1%). The data suggest a continuous nonuniform acquisition of HBV infection with advancing age predominantly through horizontal transmission in childhood, with the household, rather than the domestic compound, being the primary place for transmission. The behaviors most strongly associated with prevalence of HBV were sharing of bath towels (OR = 3.1, 95% CI 2.1-4.5), sharing of chewing gum or partially eaten candies (OR = 3.4, 95% CI 2.3-5.0), sharing of dental cleaning materials (OR = 2.5, 95% CI 1.3-4.6), and biting of fingernails in conjunction with scratching the backs of carriers (OR = 2.5, 95% CI 1.6-4.3).
撒哈拉以南非洲地区的婴儿和儿童中，大多数乙肝病毒（HBV）感染是通过水平传播获得的，但确切的传播机制尚未有文献记载。作者在加纳农村地区开展了一项研究，确定了1385名各年龄段个体概率样本中的血清流行率，并在547名1至16岁非乙肝表面抗原（HBsAg）携带者的儿童子样本中评估了HBV水平传播的风险因素。该地区的大多数居民居住在每个通常包含2至4户家庭的大院里。HBV血清阳性（任何HBV标志物）的总体患病率为74.7%（95%置信区间[CI] 72.5% - 76.9%）。HBsAg的患病率为20.9%（95% CI 18.8% - 23.1%）。数据表明，随着年龄增长，HBV感染呈持续且不均匀的获得，主要通过儿童期的水平传播，家庭而非家庭大院是主要传播场所。与HBV患病率最密切相关的行为是共用浴巾（比值比[OR] = 3.1，95% CI 2.1 - 4.5）、共用口香糖或部分食用的糖果（OR = 3.4，95% CI 2.3 - 5.0）、共用口腔清洁用品（OR = 2.5，95% CI 1.3 - 4.6）以及在抓挠携带者背部时咬指甲（OR = 2.5，95% CI 1.6 - 4.3）。
