Hepatitis B Virus in the United States: Infection, Exposure, and Immunity Rates in a Nationally Representative Survey
Hepatitis B Virus in the United States: Infection, Exposure, and Immunity Rates in a Nationally Representative Survey
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DOI：
10.7326/0003-4819-154-5-201103010-00006
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发表时间：
2011-03-01
影响因子：
39.2
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
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作者：
Ioannou, George N.
背景：对乙型肝炎病毒（HBV）感染、暴露和免疫的流行率进行最新估计对于评估正在进行的旨在预防HBV传播的计划的有效性是必要的。目的：确定1999年至2008年美国慢性HBV感染、既往暴露和免疫的患病率及其相关性。设计：具有全国代表性的横断面家庭调查。设定：美国平民，非机构人口。对象：1999 - 2008年全国健康与营养调查39787名2岁及以上的参与者。测量：慢性HBV感染的定义是血清HBV表面抗原的存在和6岁或以上人群中乙型肝炎核心抗原血清抗体的既往暴露。婴儿免疫的定义是2岁儿童血清乙型肝炎表面抗原抗体的存在。结果：在6岁及以上人群中，0.27% （95% CI, 0.20% ~ 0.34%）患有慢性HBV感染（相当于全国约704000人），4.6% （CI, 4.1% ~ 5.0%）暴露于HBV（约1199.3万人）。这些估计值（P < 0.001）低于美国1988年至1994年报告的HBV感染（0.42%）和暴露（5.1%）估计值。感染和过去的接触在6至19岁的人群中非常罕见。2岁儿童的免疫率较高（68.6% [CI, 64.1% ~ 73.2%]）。成年人，包括那些感染风险高的人，免疫力要低得多。局限性：未对被监禁者和无家可归者进行抽样调查。种族或民族分类没有确定高危人群，如亚洲人和太平洋岛民后裔。结论：在美国，一群儿童和青少年对乙肝病毒的免疫力很高，感染率很低。应继续强调高危成人的疫苗接种。
Background: Up-to-date estimates of the prevalence of hepatitis B virus (HBV) infection, exposure, and immunity are necessary to assess the effectiveness of ongoing programs aimed at preventing HBV transmission.Objective: To determine the prevalence and associations of chronic HBV infection, past exposure, and immunity in the United States from 1999 to 2008.Design: Nationally representative, cross-sectional household survey.Setting: U.S. civilian, noninstitutionalized population. Participants: 39 787 participants in the National Health and Nutrition Examination Survey (1999 to 2008) aged 2 years or older.Measurements: Chronic HBV infection was defined by presence of serum HBV surface antigen and past exposure by serum antibody to hepatitis B core antigen among persons aged 6 years or older. Infant immunity was defined by presence of serum antibody to hepatitis B surface antigen among children aged 2 years.Results: Among persons aged 6 years or older, 0.27% (95% CI, 0.20% to 0.34%) had chronic HBV infection (corresponding to approximately 704 000 persons nationwide), and 4.6% (CI, 4.1% to 5.0%) had been exposed to HBV (approximately 11 993 000 persons). These estimates are lower (P < 0.001) than estimates of HBV infection (0.42%) and exposure (5.1%) in the United States reported from 1988 to 1994. Infection and past exposure were very uncommon among persons aged 6 to 19 years. Children aged 2 years have high rates of immunity (68.6% [CI, 64.1% to 73.2%]). Adults, including those at high risk for infection, have much lower rates of immunity.Limitations: Incarcerated and homeless persons were not sampled. Categorization of race or ethnicity did not identify high-risk groups, such as persons of Asian and Pacific Islander descent.Conclusion: A cohort of children and adolescents is growing up in the United States with high rates of immunity against HBV and very low rates of infection. Vaccination of high-risk adults should continue to be emphasized.