Global elimination of viral hepatitis as a public health threat: Promoting diagnosis and treatment is the key to reducing mortality / 临床肝胆病杂志

According to Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 - Accountability for the global health sector strategies 2016–2021: Actions for impact, released by WHO on May 20, 2021, there is still an estimated number of 296 million people with hepatitis B virus (HBV) infection and 58 million people with hepatitis C virus (HCV) infection in 2019. Among the individuals with chronic infections, only 30.4 million (10%) of those with chronic HBV infection were diagnosed, among whom 6.6 million (22%) received antiviral therapy. Globally, 15.2 million (21%) of those with HCV infection have been diagnosed, among whom 9.4 million (62%) received antiviral therapy. Although significant progress has been made in eliminating viral hepatitis globally by 2020, there is still a large gap from the 2030 goal, and global attention should be paid to eliminating viral hepatitis and promoting the diagnosis and treatment of viral hepatitis. WHO and all regions should continue to support the elimination of viral hepatitis, and meanwhile each member state should also actively implement the elimination of viral hepatitis, promote national strategies for diagnosis and treatment as soon as possible, and improve the coverage of diagnosis and treatment.

Sero-epidemiological characteristics of hepatitis E in population aged 1-29 years in China, 2014 / 中华流行病学杂志

Objective@#To analyze the epidemiological characteristics of hepatitis E Virus antibody (anti-HEV) in people aged 1-29 years in China in 2014.@*Methods@#Based on database of the national serologic survey of hepatitis B in people aged 1-29 years in China, in 2014, the sample size was estimated. The serum samples of the people surveyed were randomly selected to detect anti-HEV IgG by using enzyme- linked immunosorbent assay (ELISA). Statistical software SAS 9.1.3 was used to calculate the positive rate of anti-HEV and 95% confidence interval (CI) in different age, gender groups, urban and rural areas and geographic areas by using the Taylor series linear method with sampling weight. The difference was determined by comparing 95%CI.@*Results@#A total of 14 106 serum samples were detected from people aged 1-29 years, including 6 996 males (49.60%), 7 013 urban residents (49.72%). The positive rate of anti-HEV was 8.12%(95%CI: 7.19-9.15) in people aged 1-29 years. There was no statistical difference between the men and women, between urban area and rural area. The positive rates of anti-HEV in western area(11.36%, 95%CI: 9.45-13.62) was higher than those in eastern and central areas. The positive rates of anti-HEV were 2.46%, 2.24%, 4.50%, 7.58%, 11.89% and 17.27% in people aged 1-, 5-, 10-, 15-, 20- and 25-29 years, respectively. As the age increased, the positive rate of anti-HEV gradually increased. In different ethnic groups, the positive rate of anti-HEV was higher in Tibetan (18.32%, 95%CI: 12.02-26.90), Zhuang (9.54%, 95%CI: 4.33-19.73) ethnic groups.@*Conclusion@#The positive rate of anti-HEV declined slightly in China in 2014. It is still necessary to pay close attention to the HEV infection, morbidity of hepatitis E and risk factors in people aged 1-29 years.

The risk of hepatitis B virus infection in people with diabetes mellitus: a meta-analysis / 中华预防医学杂志

Objective@#To evaluate the relevance of diabetes mellitus and hepatitis B virus(HBV) infection in people by Meta-analysis.@*Methods@#Databases we searched included CNKI, VIP China Science and Technology Journal Database, Wanfang Data Knowledge Service Platform, PubMed, Cochrane Library and Web of Science Core Collection database. Publication time was from January 1997 to May 2017. The Languages were limited to Chinese and English. English search terms include: diabetes, diabetes mellitus, hepatitis B and risk. Chinese search terms include: diabetes mellitus, hepatitis B and risk. We included all observational studies on diabetes and HBV infection. Firstly, the Newcastle-Ottawa Scale and the evaluation criteria of Cross-sectional study recommended by Agency for Healthcare Research and Quality were used to evaluate the quality of articles. Secondly, RevMan 5.3 software was used for heterogeneity testing. Subgroup analysis, random effects model and Mantel-Haenszel method were used to calculate the combined OR value. Finally, Stata 14.0 software was used to conduct the sensitivity analysis, and Begg rank correlation method was used to detect the publication bias.@*Results@#A total of 12 studies were included, comprising 6 cross-sectional studies and 6 case-control studies. But the 12 articles were heterogeneous (χ2=42.10, P<0.001). After subgroup analysis, cross-sectional studies of diabetes and HBV infection were still heterogeneous (χ2=28.21, P<0.001), whose combined odds ratio (OR) was 1.36 (95%CI: 1.03-1.80). But the heterogeneity of case-control studies was not statistically significant (χ2=10.32, P=0.070), whose combined odds ratio (OR) was 1.55 (95%CI: 1.10-2.17). After the sensitivity analysis, the 95%CI of the combined OR of the 7 studies did not fluctuate, and the lower limit was above 1.07. No publication bias was detected in the cross-sectional study subgroup (Z=1.35, P=0.176) and the case-control study subgroup (Z=1.69, P=0.091).@*Conclusion@#Patients with diabetes are more likely to be infected with HBV than those without diabetes. Diabetes mellitus is likely to be a risk factor for HBV infection.

Evaluation of training course of hepatic disease in grass roots clinical hepatic physicians in some poverty-stricken counties in Shanxi and Shaanxi provinces / 中华流行病学杂志

Objective To understand the awareness of hepatic disease related knowledge among hepatic physicians in poverty-stricken counties in China,assess the effectiveness of training and provide a reference for the training in the future.Methods The training was conducted in 90 clinical hepatic physicians selected from county hospitals in poverty-stricken counties (or cities) in Shanxi and Shaanxi provinces.An examination was conducted before the training,immediately after the training and at 5th month after the training,respectively.One-way analysis of variance and x2 test were conducted to evaluate the score and the correct rate.Results The knowledge score was (42.96± 14.02) before the training,(62.86 ± 13.28) immediately after the training and (59.03 ± 17.92) at 5thmonth after the training,and the differences were significant.After the training,the awareness of all aspects of related knowledge was improved,the difference was significant compared to knowledge score before training,and at 5th month after the training,the difference was still significant.Conclusion After the training,the awareness of liver disease related knowledge of clinical hepatic physicians in poverty-stricken counties (cities) in Shanxi and Shaanxi provinces was improved,and the improvement could be maintained for nearly halfa year.

Evaluation of training course of hepatic disease in grass roots clinical hepatic physicians in some poverty-stricken counties in Shanxi and Shaanxi provinces / 中华流行病学杂志

Objective To understand the awareness of hepatic disease related knowledge among hepatic physicians in poverty-stricken counties in China,assess the effectiveness of training and provide a reference for the training in the future.Methods The training was conducted in 90 clinical hepatic physicians selected from county hospitals in poverty-stricken counties (or cities) in Shanxi and Shaanxi provinces.An examination was conducted before the training,immediately after the training and at 5th month after the training,respectively.One-way analysis of variance and x2 test were conducted to evaluate the score and the correct rate.Results The knowledge score was (42.96± 14.02) before the training,(62.86 ± 13.28) immediately after the training and (59.03 ± 17.92) at 5thmonth after the training,and the differences were significant.After the training,the awareness of all aspects of related knowledge was improved,the difference was significant compared to knowledge score before training,and at 5th month after the training,the difference was still significant.Conclusion After the training,the awareness of liver disease related knowledge of clinical hepatic physicians in poverty-stricken counties (cities) in Shanxi and Shaanxi provinces was improved,and the improvement could be maintained for nearly halfa year.

The epidemiological characteristics of HBV susceptibility in 1-29 years old young people in China in 2006 and 2014: based on the national sero-survey data analysis / 中华预防医学杂志

Objective@#To analyze the epidemiological characteristics of HBV susceptible people in 1-29 years old people in 2006 and 2014 in China.@*Method@#Data is from the 2006 and 2014 national sero-survey, and both of them were conducted in 160 disease surveillance points of 31 provinces (excluding Hong Kong, Macao Special Administrative Region and Taiwan province) in China. We used the centralized face-to face investigation method to collect basic information including birth date, gender, ethnicity, resident place, hepatitis B vaccination (HepB) history and so on, and 5 ml venous blood was collected for all subjects to test the sero-markers of HBsAg, anti-HBs and anti-HBc. We definite the HBV susceptible people as the HBsAg, anti-HBs and anti-HBc all negative together. And we use chi-square to analyze the epidemiological characteristics of HBV susceptibility in 1-29 years old young people in 2006 and 2014, and use multiple factors logistic regression to analyze the affect factors on HBV susceptible appearing in people with HepB vaccination.@*Result@#In 2006 and 2014 sero-surveys, the investigated 1-29 year-old people were 49 849 and 31 713, respectively. And compared with 2006, the proportion of HBV susceptible people with HepB among 1-29 in 2014 increased from 20.87% (10 401) to 28.55% (9 055) (χ2=630.69, P<0.001); and the proportion of susceptible people without HepB decreasing from 15.02% (7 485) to 7.66% (2 460) (χ2=953.73, P<0.001). Compared with Han nationality, the high risk of susceptible appearing in minority people after HepB vaccination (OR=1.38). And compared with less than 3 doses HepB vaccination, the more than 3 doses vaccination could reduce the anti-HBs disappearing rate (OR=0.68); Compared with one year after last dose vaccination, the 2-4 years interval (OR=3.33) and more than 5 years interval (OR=6.53) would have high risk for anti-HBs disappearing. All above were P<0.001. In western area, the proportion of susceptible people without HepB (9.58%, 1 047/2 460) was higher than the proportion in eastern (6.30%, 657/2 460) and middle area (7.30%, 756/2 460) (P<0.001).@*Conclusion@#The HepB coverage maintained in high level in 1-4 years old children. The HBV susceptible proportion mainly concentrated in 15-29 years old people, and the immunization gap was in western, rural areas and minority peoples.

Anti-HBs persistence after revaccination with three doses of hepatitis B vaccine among low-responder infants following primary vaccination: 4-year of follow-up / 中华预防医学杂志

Objective@#Assess the 4-year antibody against hepatitis B surface antigen (anti-HBs) persistence after revaccination with 3-dose of hepatitis B vaccine (HepB) among low-responder infants following primary vaccination.@*Methods@#According to stratified cluster sampling, a total of 4 147 infants were enrolled and primarily vaccinated with 5 μg HepB derived in Saccharomyces Cerevisiae (HepB-SC) at 0-1-6 months schedule from 75 towns of Jinan, Weifang, Yantai, Weihai prefectures, Shandong Province, China in Aug and Sep 2009. Blood samples were collected one to six months after the third dose of primary immunization and tested for anti-HBs using chemiluminescence microparticle immunoassay (CMIA). 717 infants who appeared low response (10 mU/ml ≤ anti-HBs<100 mU/ml) were revaccinated with 3-dose of HepB. Blood samples were collected from a total of 315 infants one month (T0), four years (T1) after revaccination and anti-HBs, antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected by CMIA. Information about their birth, primary vaccination were collected. The risk factors associated with positive rate of anti-HBs and GMC of anti-HBs were identified by multiple non-conditional logistic regression analysis and multifactor linear regression model analysis, respectively.@*Results@#Among 315 children, 165 (52.38%) were male and 150 (47.62%) were female. The positive rate was 83.81% (264/315) at T0 and it decreased to 16.51% (149/529) at T1. The corresponding GMC decreased from 473.15 mU/ml to 17.37 mU/ml. The average annual decreasing rate of positive rate and GMC was 33.38% and 56.23% from T0 to T1. Multivariable analysis showed the positive rate and GMC among those whose anti-HBs titer higher at T0 were significantly higher at T1. The positive rate at T1 among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000, ≥1 000 mU/ml at T0 were significantly higher than those whose anti-HBs titer less than 200 mU/ml. The OR (95%CI) of the positive rate was 4.29 (1.03-17.84), 4.53 (1.25-16.47), 4.19 (1.10-15.97) and 9.13 (2.91-28.63), respectively. The GMC at T1 among those whose anti-HBs titer 400-<600, 600-<800, 800-<1 000 mU/ml and those whose anti-HBs titer ≥1 000 mU/ml at T0 were higher than those whose anti-HBs titer<200 mU/ml. The b value (95% CI) of GMC was 0.84 (0.06-1.62), 1.13 (0.46-1.79), 1.33 (0.65-2.01) and 1.88 (1.33-2.44), respectively. GMC among full-term infants were significantly higher than premature infants at T1. The b value (95% CI) of GMC was 0.86 (0.04-1.68).@*Conclusion@#Anti-HBs GMC decreased rapidly 4 years after revaccination among low-responder infants, but still kept good protection. The anti-HBs persistence after revaccination was associated with anti-HBs level of titer one month after revaccination.

Analysis on sero-epidemiological characteristics of hepatitis B virus among people born during 1994-2001 before and after hepatitis B vaccine catch-up vaccination, China / 中华预防医学杂志

Objective@#To analyze the sero-epidemiological characteristics of hepatitis B virus among people born during 1994-2001, conducted by the national hepatitis B sero-epidemiological surveys in 2006 and 2014.@*Methods@#Based on the data of the two national hepatitis B sero-epidemiological surveys in 2006 and 2014, people born during 1994-2001 were included into our analysis as this study subjects. The two surveys were conducted in 160 disease surveillance points of 31 provinces (not including Hong Kong, Macao and Taiwan) in China. Face-to-face interviews with the subject by door to door or on the investigation site were conducted by trained staff using standard questionnaires to obtain basic information including birth date, sex, ethnicity, resident place and so on. And then 5 ml venous blood was collected. Enzyme-linked immunosorbent assay (ELISA) reagents were used for HBsAg, anti-HBs and anti-HBc measurements and Abbott micro-particle enzyme immunoassay (MEIA) reagents was used to confirm test. We analyzed HBsAg, anti-HBs and anti-HBc positive rate by gender, ethnicity, urban/rural, eastern/central/western region, birth years and compared the distribution of serum epidemiological characteristics in 2006 and 2014.@*Results@#19 821 and 4 712 people born during 1994-2001 were involved in 2006 and 2014 national serosurveys of China, respectively. For the people born during 1994-2001, HBsAg positive rate were 2.02% (95% CI: 1.82%-2.21%) in 2014 and 1.95% (95% CI: 1.56%-2.35%) in 2006. Anti-HBc positive rate were 7.94% (95%CI: 7.17%-8.71%) in 2014 and higher than that in 2006 (6.49%, 95%CI: 6.15%-6.83%), especially for the female (8.31%, 95% CI: 7.20%-9.43%), urban (7.45%, 95% CI: 6.38%-8.52%), western region (11.25%, 95%CI: 9.79%-12.71%), minority people (16.02%, 95%CI: 13.47%-18.57%) in 2014 were higher than that of the female (6.29%, 95% CI: 5.81%-6.78%), urban (4.82%, 95% CI: 4.40%-5.24%), western region (7.97%, 95% CI: 7.31%-8.63%), minority people (11.88%, 95% CI: 10.66%-13.00%) in 2006 respectively. Anti-HBs positive rate were 57.80% (95%CI: 57.11%-58.48%) in 2014 and 59.13% (95%CI: 57.72%-60.53%) in 2006. Anti-HBs positive rate of rural (58.80%, 95% CI: 56.83%-60.78%),western region (58.50%, 95% CI: 56.23%-60.78%), minority people (57.20%, 95% CI: 53.76%-60.63%) in 2014 was higher than of rural (52.62%, 95% CI: 51.64%-53.61%),western region (51.73%, 95% CI: 50.54%-52.96%),minority people (41.14%, 95%CI: 39.28%-43.00%) in 2006.@*Conclusion@#Anti-HBc positive rate among people born during 1994-2001 in 2014 survey showed a rising tendency than in 2006. The risk of HBV infection was existed. Hepatitis B vaccine catch-up in childhood was necessary.

Comparison of antibody persistence after primary immunization with 5 μg and 10 μg recombinant hepatitis B vaccine among newborns with normal and high response: a five-year following-up / 中华流行病学杂志

Objective To compare the antibody persistence 5 years after primary immunization with 5 μg and 10 μg recombinant hepatitis B vaccine (HepB) among newborns with normal and high response.Methods Newborns who completed three doses of 5 μ g HepB made by recombinant dexyribonucleic acid technique in Saccharomyces (HepB-SC) or 10 μg HepB made by recombinant dexyribonucleic acid technique in Hansenula polymorpha (HepB-HP) were recruited.Standardized questionnaire was used and blood samples were collected 1-6 months (T0) and five years (T1) after the third dose respectively.The titer of anti-HBs was detected by chemiluminescence microparticle imunoassay (CMIA).Those who achieved normal or high antibody response (anti-HBs titer ≥100 mIU/ml) were included in the study and the positive rate (≥ 10 mIU/ml) and titer of anti-HBs at T1 were compared between 5 μg HepB group and 10 μg HepB group.Multivariable analysis was conducted to identify the independent factors associated with the antibody persistence.Results The positive rate of anti-HBs at T1 was 49.92％ (943/1 883) and 75.92％ (1 135/1 495) respectively in 5 μg HepB group and 10 μg HepB group,the difference was significant (x2=237.75,P＜0.001).The anti-IBs geometric mean concentrations at T1 were 10.23 mIU/ml (95％CI:9.38-11.16) and 28.91 mIU/ml (95％CI:26.65-31.35) in the two groups respectively,the difference was also significant (F=280.36,P＜0.001).Among those whose anti-HBs titer was ＜ 10 mIU/ml at T1,the distributions of anti-HBs titer were significantly different between 5 μg HepB group and 10 μg HepB group (x2=39.75,P＜ 0.001).The multivariable analysis showed that dosage of HepB was independently associated with both positive rate and titer of anti-HBs at T1 after excluding the other factors [P＜0.001,OR=1.44(95％ CI:1.20-1.73);P＜0.001,β =0.27 (95％ CI:0.14-0.40)].Conclusion Five year anti-HBs persistence after primary immunization with 10 μg HepB might be better than that after primary immunization with 5 μg HepB among infants who achieved normal or high anti-HBs response after primary HepB immunization.

Survey of economic burden of hepatitis B-related diseases in 12 areas in China / 中华流行病学杂志

Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.

Sero-epidemiological analysis on hepatitis B among children aged 1-14 years old born to HBsAg positive mother in China, 2014 / 中华流行病学杂志

Objective To analyze the sero-epidemiological features of hepatitis B among children aged 1-14 years old who were born to HBsAg positive mothers.Methods Based on the results from the hepatitis B national sero-survey in 2014,children aged 1-14 years old born to HBsAg positive mother were involved in this study.Positive rates on HBsAg,anti-HBs,anti-HBc by gender,age,nationality,birth place,residency (urban/rural),region (eastern/central/western) and related factors of HBsAg and anti-HBs for children under research,were analyzed by SPSS 18.0 statistical software.Results A total of 645 children aged 1-14 years old that born to HBsAg positive mothers were analyzed in the study.Positive rates on HBsAg,anti-HBs,anti-HBc among these children were 3.41％ (22/645),71.94％ (464/645) and 7.60％ (49/645),respectively.HBsAg positive rates for children aged 1-2 years,3-4 years,5-9 years,10-14 years appeared 1.27％ (3/236),3.23％ (6/186),5.71％ (8/140) and 6.02％ (5/83),respectively.The anti-HBs positive rates were 85.17％ (201/236),69.35％ (129/186),56.43％ (79/140),66.27％ (55/83) while the anti-HBc positive rates were 4.66％ (11/236),5.38％ (10/186),11.43％ (16/140) and 14.46％ (12/83),respectively.Results from the multifactor logistic analysis showed that birth place,time of the first dose of HepB inoculation were major influencing factors on the positive rates among children with HBsAg.HBsAg positive rate for the children born outside the hospital was higher than those born in the hospital (OR=7.47,95％ CI:1.50-37.25).HBsAg positive rate for children with the first dose of HepB inoculation＞24 h after birth,was higher than that inoculation within 24 h after birth (OR=6.21,95％ CI:2.15-17.99).Conclusions Some achievements in preventing mother-to-child transmission of hepatitis B had been seen in China.Hospital delivery for pregnant women and timely HepB vaccination with birth-dose for the neonates,remained the key strategy on prevention of HBV vertical transmission.

Consistency analysis on acute hepatitis B inpatients reported by hepatitis B surveillance pilot spots in six provinces of China / 中华流行病学杂志

Objective To understand the characteristics of acute hepatitis B inpatients reported by the hepatitis B surveillance pilot points and to estimate the consistency between the diagnosed and reported types of hepatitis B by the clinicians involved.Methods Data related to acute hepatitis B was from the NNDRS and the characteristics of acute hepatitis B were classified by querying Hospital Information System.We recorded the results based on clinical diagnosis and analyzed the consistency between the reported and diagnosed types that the clinicians made,on hepatitis B.Resulis A total of 179 patients were included in this study with all of them as acute hepatitis B reported through NNDRS in 2015-2016.In terms of the durations of disease,among the 179 cases who were HBsAg positive,32.40％ (58/179) of them exceeding 6 months,2.79％ (5/179) within 6 months and 64.80％ (116/179) tested the first time or never.Among the 179 cases who claimed having the history of hepatitis,33.52％ (60/179) of them identified as having hepatitis B,1.12％ (2/179) were hepatitis A,C or E,41.34％ (74/179) did not have the signs on hepatitis,while the rest 24.02％ (43/179) did not know the situation.Only 79.89％(143/179) of the patients showed the symptoms or signs of hepatitis,but the rest 20.11％(36/179) did not.Among the 179 reported acute hepatitis patients,67 of them were diagnosed as acute hepatitis B while 112 cases were as non-acute hepatitis B.The consistent rate of acute hepatitis B was 37.43％ (67/179).Among the 112 cases that were diagnosed as non-acute hepatitis B,proportions of chronic hepatitis B and cirrhosis were 49.11％(55/112) and 16.07％(18/112) respectively.Conclusion Consistency between the reported type of acute hepatitis B inpatients and the types diagnosed by clinicians was poor.Our results suggested that clinicians should make the accurate diagnosis at first place and then report to the Network in accordance with the clinical diagnosis classification criterfia,set by the government.

Comparison of antibody persistence after primary immunization with 5 μg and 10 μg recombinant hepatitis B vaccine among newborns with normal and high response: a five-year following-up / 中华流行病学杂志

Objective To compare the antibody persistence 5 years after primary immunization with 5 μg and 10 μg recombinant hepatitis B vaccine (HepB) among newborns with normal and high response.Methods Newborns who completed three doses of 5 μ g HepB made by recombinant dexyribonucleic acid technique in Saccharomyces (HepB-SC) or 10 μg HepB made by recombinant dexyribonucleic acid technique in Hansenula polymorpha (HepB-HP) were recruited.Standardized questionnaire was used and blood samples were collected 1-6 months (T0) and five years (T1) after the third dose respectively.The titer of anti-HBs was detected by chemiluminescence microparticle imunoassay (CMIA).Those who achieved normal or high antibody response (anti-HBs titer ≥100 mIU/ml) were included in the study and the positive rate (≥ 10 mIU/ml) and titer of anti-HBs at T1 were compared between 5 μg HepB group and 10 μg HepB group.Multivariable analysis was conducted to identify the independent factors associated with the antibody persistence.Results The positive rate of anti-HBs at T1 was 49.92％ (943/1 883) and 75.92％ (1 135/1 495) respectively in 5 μg HepB group and 10 μg HepB group,the difference was significant (x2=237.75,P＜0.001).The anti-IBs geometric mean concentrations at T1 were 10.23 mIU/ml (95％CI:9.38-11.16) and 28.91 mIU/ml (95％CI:26.65-31.35) in the two groups respectively,the difference was also significant (F=280.36,P＜0.001).Among those whose anti-HBs titer was ＜ 10 mIU/ml at T1,the distributions of anti-HBs titer were significantly different between 5 μg HepB group and 10 μg HepB group (x2=39.75,P＜ 0.001).The multivariable analysis showed that dosage of HepB was independently associated with both positive rate and titer of anti-HBs at T1 after excluding the other factors [P＜0.001,OR=1.44(95％ CI:1.20-1.73);P＜0.001,β =0.27 (95％ CI:0.14-0.40)].Conclusion Five year anti-HBs persistence after primary immunization with 10 μg HepB might be better than that after primary immunization with 5 μg HepB among infants who achieved normal or high anti-HBs response after primary HepB immunization.

Survey of economic burden of hepatitis B-related diseases in 12 areas in China / 中华流行病学杂志

Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.

Sero-epidemiological analysis on hepatitis B among children aged 1-14 years old born to HBsAg positive mother in China, 2014 / 中华流行病学杂志

Objective To analyze the sero-epidemiological features of hepatitis B among children aged 1-14 years old who were born to HBsAg positive mothers.Methods Based on the results from the hepatitis B national sero-survey in 2014,children aged 1-14 years old born to HBsAg positive mother were involved in this study.Positive rates on HBsAg,anti-HBs,anti-HBc by gender,age,nationality,birth place,residency (urban/rural),region (eastern/central/western) and related factors of HBsAg and anti-HBs for children under research,were analyzed by SPSS 18.0 statistical software.Results A total of 645 children aged 1-14 years old that born to HBsAg positive mothers were analyzed in the study.Positive rates on HBsAg,anti-HBs,anti-HBc among these children were 3.41％ (22/645),71.94％ (464/645) and 7.60％ (49/645),respectively.HBsAg positive rates for children aged 1-2 years,3-4 years,5-9 years,10-14 years appeared 1.27％ (3/236),3.23％ (6/186),5.71％ (8/140) and 6.02％ (5/83),respectively.The anti-HBs positive rates were 85.17％ (201/236),69.35％ (129/186),56.43％ (79/140),66.27％ (55/83) while the anti-HBc positive rates were 4.66％ (11/236),5.38％ (10/186),11.43％ (16/140) and 14.46％ (12/83),respectively.Results from the multifactor logistic analysis showed that birth place,time of the first dose of HepB inoculation were major influencing factors on the positive rates among children with HBsAg.HBsAg positive rate for the children born outside the hospital was higher than those born in the hospital (OR=7.47,95％ CI:1.50-37.25).HBsAg positive rate for children with the first dose of HepB inoculation＞24 h after birth,was higher than that inoculation within 24 h after birth (OR=6.21,95％ CI:2.15-17.99).Conclusions Some achievements in preventing mother-to-child transmission of hepatitis B had been seen in China.Hospital delivery for pregnant women and timely HepB vaccination with birth-dose for the neonates,remained the key strategy on prevention of HBV vertical transmission.

Consistency analysis on acute hepatitis B inpatients reported by hepatitis B surveillance pilot spots in six provinces of China / 中华流行病学杂志

Objective To understand the characteristics of acute hepatitis B inpatients reported by the hepatitis B surveillance pilot points and to estimate the consistency between the diagnosed and reported types of hepatitis B by the clinicians involved.Methods Data related to acute hepatitis B was from the NNDRS and the characteristics of acute hepatitis B were classified by querying Hospital Information System.We recorded the results based on clinical diagnosis and analyzed the consistency between the reported and diagnosed types that the clinicians made,on hepatitis B.Resulis A total of 179 patients were included in this study with all of them as acute hepatitis B reported through NNDRS in 2015-2016.In terms of the durations of disease,among the 179 cases who were HBsAg positive,32.40％ (58/179) of them exceeding 6 months,2.79％ (5/179) within 6 months and 64.80％ (116/179) tested the first time or never.Among the 179 cases who claimed having the history of hepatitis,33.52％ (60/179) of them identified as having hepatitis B,1.12％ (2/179) were hepatitis A,C or E,41.34％ (74/179) did not have the signs on hepatitis,while the rest 24.02％ (43/179) did not know the situation.Only 79.89％(143/179) of the patients showed the symptoms or signs of hepatitis,but the rest 20.11％(36/179) did not.Among the 179 reported acute hepatitis patients,67 of them were diagnosed as acute hepatitis B while 112 cases were as non-acute hepatitis B.The consistent rate of acute hepatitis B was 37.43％ (67/179).Among the 112 cases that were diagnosed as non-acute hepatitis B,proportions of chronic hepatitis B and cirrhosis were 49.11％(55/112) and 16.07％(18/112) respectively.Conclusion Consistency between the reported type of acute hepatitis B inpatients and the types diagnosed by clinicians was poor.Our results suggested that clinicians should make the accurate diagnosis at first place and then report to the Network in accordance with the clinical diagnosis classification criterfia,set by the government.

Analysis on duplicate reporting of hepatitis B in national notifiable communicable disease report system in China, 2011-2013 / 中华流行病学杂志

Objective To analyze the duplicated reporting of hepatitis B in the national notifiable communicable disease report system (NNDRS) in China during 2011-2013.Methods The data of hepatitis B reported from January 1,2011 to December 31,2013 were collected from NNDRS,the duplicated reporting were searched with software SAS 9.1.3 according to the cases' ID number,name,gender,birth data and current address code.Results During 2011-2013,a total of 3 389 374 hepatitis B cases were reported through NNDRS,but the duplicated reporting rate was 7.35％ (249 047).According to 6 protocols,the duplicated reporting rate ranged from 0.88％ to 6.38％.If using the data in 2011 as the baseline,the duplicated reporting rate in the three years was 2.91％,8.11％ and 11.72％,respectively.In the duplicated repeating,33.04％ (71 709) occurred in the same year,and 66.96％ (145 329) occurred in other year.Without the duplicated repeating,the hepatitis B incidence in Xinjiang and Qinghai provinces in 2013 could decreased by 30.80/100 000 and 26.26/ 100 000,respectively.Conclusions The analysis indicated that the duplicated repeating rate of hepatitis B was 7.36％ in NNDRS during 2011-2013,and the duplicated reporting mainly occurred in other years.The duplicated reporting of hepatitis B in NNDRS had greatly affected the accuracy of surveillance data in some provinces,such as Xinjiang and Qinghai.

Analysis on duplicate reporting of hepatitis B in national notifiable communicable disease report system in China, 2011-2013 / 中华流行病学杂志

Objective To analyze the duplicated reporting of hepatitis B in the national notifiable communicable disease report system (NNDRS) in China during 2011-2013.Methods The data of hepatitis B reported from January 1,2011 to December 31,2013 were collected from NNDRS,the duplicated reporting were searched with software SAS 9.1.3 according to the cases' ID number,name,gender,birth data and current address code.Results During 2011-2013,a total of 3 389 374 hepatitis B cases were reported through NNDRS,but the duplicated reporting rate was 7.35％ (249 047).According to 6 protocols,the duplicated reporting rate ranged from 0.88％ to 6.38％.If using the data in 2011 as the baseline,the duplicated reporting rate in the three years was 2.91％,8.11％ and 11.72％,respectively.In the duplicated repeating,33.04％ (71 709) occurred in the same year,and 66.96％ (145 329) occurred in other year.Without the duplicated repeating,the hepatitis B incidence in Xinjiang and Qinghai provinces in 2013 could decreased by 30.80/100 000 and 26.26/ 100 000,respectively.Conclusions The analysis indicated that the duplicated repeating rate of hepatitis B was 7.36％ in NNDRS during 2011-2013,and the duplicated reporting mainly occurred in other years.The duplicated reporting of hepatitis B in NNDRS had greatly affected the accuracy of surveillance data in some provinces,such as Xinjiang and Qinghai.

Study on health-seeking behavior and influencing factors among Chinese hepatitis B surface antigen positive adults / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of health-seeking behaviors and related influencing factors of the community-based hepatitis B surface antigen (HBsAg) positive adults, in China.</p><p><b>METHODS</b>Based on the cohort formed by the HBsAg positive patients, in the national sero-survey project in 2006, we conducted a follow-up programs in 2010 and 2014. In the latest follow-up project, we carried out a cross-sectional study to collect information on health-seeking behaviors of the patients. Questionnaires would include information on clinic visits, diagnosis, regular physical examination and treatments,etc. We used the SPSS 18.0 software for data analysis.</p><p><b>RESULTS</b>Totally, 2 478 HBsAg positive adults (≥18 years old) were followed through, with 34.4% (853/2 478) of them had visited the doctors and diagnosed after they were informed the status of HBsAg positivity, in the 2006-sero-survey program. Among patients who ever visiting the clinic, 51.2% (372/727) of them underwent at least medical examination once a year, with 31.5% (229/727) of them received treatment. Furthermore, 34.5% (79/229) of the treated patients adopted the traditional Chinese medicine or medicine for ' liver protection'. 56.8% (130/229) of the treated patients received antiviral drugs. Data from the binary logistic regression showed that the major influencing factors on clinic visits would include: age, level of education received and residencial areas (rural/urban).</p><p><b>CONCLUSIONS</b>Consciousness on health was low in those community-based HBsAg positive people. Standerdized management and clinical treatment programs should be set up accordingly.</p>

Whole-sequence Analyses for 12 HBV C/D Recombinants from a Population in Tibet (China) / 病毒学报

We wished to undertake molecular genetic typing and evaluate recombinants of the hepatitis-B virus (HBV) in Tibet (China). Multistage random sampling was used to collect HBsAg-positive samples. Nested polymerase chain reactions were used to amplify the whole sequence of the HBV. DNAstar, MEGA6 and SimPlot were used to assemble sequences, create phylogenetic trees, and undertake recombination analyses. Twelve whole sequences of the HBV of a Tibetan population were collected using these methods. Results showed that all 12 strains were C/D recombinants. Nine of the recombinations were at nt750, and the other three at nt1526. Therefore, the 12 strains could be divided into two types of recombinants: C/Da and C/Db. Analyses of the sequence of the whole genome revealed that the 12 strains belonged to genotype C, and that the nucleotide distance was > 4% between the 12 strains and sub-genotypes C1 to C15 in Genbank. The most likely sub-genotype was C1. Individuals with C/Da were from central and northern Tibet (e.g., Lasa, Linzhi, Ali) and those with C/Db recombinants were from Shannan in southern Tibet. These data suggest that the two types of recombinants had a good distribution in Tibet. Also, they can provide important information for studies on HBV recombination, gene features, virus evolution, as well as the control and prevention of HBV infection in Tibet.