美国在消除医护人员中乙肝病毒传播方面取得的进展。

Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States.

作者信息

Mahoney F J, Stewart K, Hu H, Coleman P, Alter M J

机构信息

Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

出版信息

Arch Intern Med. 1997;157(22):2601-5.

PMID:9531229

Abstract

BACKGROUND

Hepatitis B virus (HBV) infection is a well-recognized occupational risk for health care workers (HCWs). Vaccination coverage, disease trends, and the need for booster doses after hepatitis B vaccination of adults have been the subject of intense study during the 15 years of the vaccine's availability.

METHODS

Vaccination coverage of HCWs was determined from a review of medical records on a sample of employees from 113 randomly selected hospitals. The number of HBV infections among HCWs and the general US population for 1983 through 1995 was estimated from national surveillance data. Studies on long-term protection after hepatitis B vaccination of adults were reviewed.

RESULTS

A total of 2837 employee medical records were reviewed; 2532 employees (90%) were eligible to receive hepatitis B vaccine, and 66.5% of them (95% confidence interval, 61.9%-70.9%) had received 3 doses of hepatitis B vaccine. Vaccination coverage was highest (75%) for personnel with frequent exposure to infectious body fluids (phlebotomists, laboratory personnel, and nursing staff) and lowest (45%) for employees at low risk for exposure (dietary and clerical staff). The number of HBV infections among HCWs declined from 17,000 in 1983 to 400 in 1995. The 95% decline in incidence observed among HCWs is 1.5-fold greater than the reduction in incidence in the general US population. Studies on long-term protection demonstrate that vaccine-induced protection persists at least 11 years even when titers of antibody to hepatitis B surface antigen decline below detectable levels.

CONCLUSIONS

Although a high percentage of HCWs have been fully vaccinated with hepatitis B vaccine, efforts need to be made to improve this coverage. There has been a dramatic decrease in the number of HBV infections among HCWs who are now at lower risk of HBV infection than the general US population. Vaccine-induced protection persists at least 11 years and booster doses are not needed at this time for adults who have responded to vaccination.

摘要

背景

乙型肝炎病毒（HBV）感染是医护人员（HCWs）公认的职业风险。在疫苗上市的15年里，疫苗接种覆盖率、疾病趋势以及成人接种乙肝疫苗后是否需要加强剂量一直是深入研究的课题。

方法

通过查阅113家随机抽取医院的部分员工病历确定医护人员的疫苗接种覆盖率。根据国家监测数据估算1983年至1995年医护人员和美国普通人群中HBV感染的人数。对成人接种乙肝疫苗后的长期保护研究进行了综述。

结果

共查阅了2837份员工病历；2532名员工（90%）有资格接种乙肝疫苗，其中66.5%（95%置信区间，61.9%-70.9%）接种了3剂乙肝疫苗。经常接触传染性体液的人员（采血技师、实验室人员和护理人员）疫苗接种覆盖率最高（75%），接触风险低的员工（饮食和文书工作人员）疫苗接种覆盖率最低（45%）。医护人员中HBV感染人数从1983年的17000例降至1995年的400例。医护人员中观察到的发病率下降95%，比美国普通人群发病率的下降幅度大1.5倍。长期保护研究表明，即使乙肝表面抗原抗体滴度降至检测水平以下，疫苗诱导的保护至少持续11年。