肝炎流行病学-中国CDC.ppt

* 1 1 1 耿贯一,主编.流行病学,乙型肝炎,第2版.人民卫生出版社.1996年.北京. * Hepatitis B by year, United States, 1966 – 2000 Since hepatitis B vaccine was licensed for use in the United States in 1981, the incidence of acute hepatitis B has changed dramatically. During the 1980s, use of hepatitis B vaccine had little impact on disease incidence, which actually increased during the early 1980s. The incidence declined between 1985 and 1988, and between 1988 and 1991, when fewer cases were reported among men who have sex with men and among injecting drug users, respectively. In both of these groups the decline in incidence was likely related to behavioral changes in response to the epidemic of acquired immunodeficiency syndrome (AIDS) rather than to vaccine use. The incidence has continued to decline during the first half of the 1990s; a likely contributing factor for this most recent decline is the widespread use of hepatitis B vaccine in response to regulations issued by the Occupational Safety and Health Administration. Future declines in incidence are expected to occur as a result of the implementation of routine infant and routine adolescent vaccination, which have been recommended in the 1990s. * 2010年全国乙肝报告发病率地区分布 2005～2010年全国和北京市急性乙肝报告发病率比较 北京地区乙肝流行情况 人群乙肝表面抗原携带率3.36% 人群乙肝感染率接近45% 孕妇乙肝表面抗原携带率平均3% 12岁以下儿童乙肝表面抗原携带率0.5% 急性乙肝发病率20/10万左右 10岁以下儿童乙肝发病率2/10万左右 慢性乙肝患病率114/10万 传染源 所有携带乙肝病毒的人都是传染源 急性乙肝患者； 长期携带乙肝病毒的慢性感染者 各种肝功能正常的病毒携带者； 慢性乙肝病人； 乙肝肝硬化病人； 乙肝肝癌病人。 * 乙肝的传播途径—多样、复杂 新生儿 HBV 免疫规划，母婴传播比例下降 医源性传播、性及肠道外传播 (静脉毒品)明显上升 传染源 急性病人 慢性病人 携带者 含病毒的血、渗出液、精液、阴道分泌液等 母婴传播 接触传播 性传播 血源性传播 宫内传播、产道传播和围产期哺乳或护理传播 高 中 低或 不能检出 血 精液 尿液 血清 阴道液 粪便 伤口渗出液 唾液 汗液 泪液 乳汁 不同体液中乙肝病毒的浓度 易感人群 普遍易感 高危人群： 医务人员； 经常接触血液的人员； 器官移植患者； 经常接受输血或血液制品者； 免疫功能低下者； 易发生外伤者； HBsAg阳性者的家庭成员； 男性同性恋或有多个性伴侣者； 静脉内注射毒品者。 我国HBV感染者的转归 据此推断，我国有2000万－3000万慢性乙肝患者， 每年约有30万人死于乙肝病毒感染相关的疾病。 死亡人数比艾滋病、结核、血吸虫加起来还多。 乙肝的报告 如已知该病例曾经作出诊断并被报告过，则本年度不再进行报告 如对该病例的报告情况不清楚，或在同年内多次接诊该病例(包括复发病例)，则仅对首次就诊进行一次报告。再次就诊且诊断结果未发生变更时则不再进行报告 发现乙肝病原携带者，可不进行网络直报，但