INTERNATIONAL TRAINING GRANT IN EPIDEMIOLOGY RELATED TO

尽管中国在1997年发现献血者中人类免疫缺陷病毒的高感染率后，通过了全面的献血法，但献血者的感染仍在继续。HIV感染率高达6%，丙型肝炎病毒(HCV)感染率高达23%，尤其是在农村地区的医院。因此，很明显，艾滋病毒和丙型肝炎病毒正在向受污染血液单位的接受者传播。大多数县医院既没有资金也没有技术技能来检测收集的每一单位血液中最有可能的血液病原体。因此，这是一项建议，以衡量在两个已报告艾滋病毒传播给血液接受者的省份的两个县医院的献血者中艾滋病毒、乙肝和丙型肝炎的流行率，并评估保护血液供应的替代战略。800名捐赠者以及从800名受感染的接受者中追踪到的80名捐赠者将同时接受检测，并分析受感染捐赠者的流行率和感染的相关因素。此外，还将在县医院的医生中进行一项常见血液做法的调查，以估计不必要使用血液的流行率。调查结束后，将与医院代表、美国红十字会南加州地区负责人、地方和省级防疫站以及卫生部和卫生部的代表一起举办讲习班，讨论利用前一次调查结果减少不必要的血液使用的战略。研讨会的成果将是制定县医院使用血液的指导方针。将在县级医院中进行第二次调查，以确定当前和潜在的血液来源，以及保护县医院一级血液供应的替代战略的潜在制约因素。调查结束后，将在地方、省和国家各级为30名关心血液供应安全的卫生专业人员举办第二次讲习班，以确定最可接受和最可行的保护血液的替代战略。这一战略随后将在采用和不采用替代战略的县医院的试点研究中进行评估。调查和讲习班以及试点研究的结果将分发给县医院、地方和省级卫生行政人员以及卫生部。

Although China passed a comprehensive Blood Donation Law in 1997 following the discovery of high rates of human immunodeficiency virus (HIV) in blood and plasma donors, infection of donors continues. Rates of HIV as high as 6% and of hepatitis C virus (HCV) as high as 23% still occur, especially in the rural area hospitals. Thus, it is clear that HIV and HCV are being transmitted to recipients of contaminated blood units. Most county hospitals have neither the funds nor the technical skills to test every unit of blood that is collected for the most likely blood pathogens. This, therefore, is a proposal to measure the prevalence of HIV, HBV and HCV among blood donors in two county hospitals in each of two provinces in which transmission of HIV to blood recipients has been reported and to evaluate alternative strategies to protect the blood supply. Eight hundred donors, as well as 80 donors who were traced from 800 infected recipients, will be tested concurrently and analyzed for both the prevalence of infected donors and for correlates of infection. In addition, a survey of usual blood practices will be conducted among physicians at the county hospitals to estimate the prevalence of unnecessary use of blood. Following the survey a workshop will be conducted with representatives of the hospitals, the director of the Southern California Region of the American Red Cross Services, and representatives of the local and provincial anti-epidemic stations and departments of health and the Ministry of Health to discuss strategies to reduce the unnecessary use of blood using the results of the prior survey. The outcome of the workshop will be development of guidelines for the use of blood in county hospitals. A second survey will be conducted among the county level hospitals to identify the current and potential sources of blood and potential constraints to alternative strategies for protecting the blood supply at the county hospital level. Following the survey a second workshop will be held for 30 health professionals concerned with the safety of the blood supply at the local, provincial, and national levels to identify the most acceptable and feasible alternative strategy to protect the blood. This strategy will then be evaluated in a pilot study in county hospitals adopting and not adopting the alternative strategy. Results of the surveys and workshops and the pilot study will be disseminated to the county hospitals, local and provincial health administrators, and the Ministry of Health.