乙肝流行现状.ppt

北京大学医学部,Peking University,Health Science Center,我国乙型肝炎流行现状,微生物学系,庄辉,我国乙型肝炎发病率是否逐,年上升,?,2006,年全国乙型肝炎血清流,行病学调查的初步结果,1,我国乙型肝炎发病率是否逐年上升,?,2,0,10,20,30,40,50,60,70,80,我国乙型肝炎报告发病率,发病率,(/10,万,),1990,1992,1994,1996,1998,2000,2002,2004,1991,1993,1995,1997,1999,2003,2001,2005,中国,CDC,报告,3,年份,0,10,20,30,40,50,60,70,80,90,100,构成比,(%),我国,19902005,年各型病毒性肝炎的构成变化,(,中国,CDC,报告,),非甲非乙,未分型,乙肝,甲肝,丙肝,戊肝,1990,1992,1994,1996,1998,2000,2002,2004,1991,1993,1995,1997,1999,2003,2001,2005,2003,年,21 145,例,2004,年,37 748,例,2004,年,52 057,例,丙肝,4,年份,0,5,10,15,20,25,30,35,40,45,50,1990,1991,1992,1993,1994,1995,1996,1997,1998,19992000,2001,2002,2003,2004,2005,发病率,(1/10,万,),北京市全人群乙型肝炎发病率,北京市,CDC,报告,年份,5,年份,0,5,10,15,20,19902005,年上海市一般人群乙型肝炎发病率,上海市,CDC,报告,1990,1991,1992,1993,1994,1995,1996,1997,1998,1999,2000,2001,2002,2003,2004,2005,6,发病率,(1/10,万,),0,10,20,30,40,50,60,70,80,90,1990,1991,1992,1993,1994,1995,1996,1997,1998,1999,2000,2001,2002,2003,2004,2005,发病率,(/10,万,),山东省,19902005,年乙型肝炎发病率,山东省,CDC,报告,年份,7,12,岁以下,美国,19902004,年报告的各年龄组急性乙型肝炎发病率,10,8,6,4,2,0,发病率,(/10,万,),1990,1992,1994,1996,1998,2000,2002,2004,MMWR,2005,54(RR-16):1-32,年份,8,1219,岁,12,岁以下,美国,19902004,年报告的各年龄组急性乙型肝炎发病率,10,8,6,4,2,0,发病率,(/10,万,),1990,1992,19941996,1998,2000,2002,2004,MMWR,2005,54(RR-16):1-32,年份,9,20,岁以上,1219,岁,12,岁以下,美国,19902004,年报告的各年龄组急性乙型肝炎发病率,10,8,6,4,2,0,发病率,(/10,万,),1990,1992,1994,1996,1998,2000,2002,2004,MMWR,2005,54(RR-16):1-32,年份,10,1990,1992,1994,1996,1998,2000,2002,2004,7,6,3,2,1,0,4,5,发病率,(/10,万,),亚太人,MMWR,2005,54(RR-16):1-32,美国,19902004,年报告的,19,岁以下不同民族急性乙型肝炎发病率,年份,11,1990,1992,1994,1996,1998,2000,2002,2004,7,6,3,2,1,0,4,5,发病率,(/10,万,),亚太人,黑人,MMWR,2005,54(RR-16):1-32,美国,19902004,年报告的,19,岁以下不同民族急性乙型肝炎发病率,年份,12,1990,1992,1994,1996,1998,2000,2002,2004,7,6,3,2,1,0,4,5,发病率,(/10,万,),亚太人,黑人,美国印第安,/,阿拉斯加土著人,MMWR,2005,54(RR-16)1-32,美国,19902004,年报告的,19,岁以下不同民族急性乙型肝炎发病率,年份,13,1990,1992,1994,1996,1998,2000,2002,2004,7,6,3,2,1,0,4,5,发病率,(/10,万,),亚太人,黑人,美国印第安,/,阿拉斯加土著人,西班牙人,MMWR,2005,54(RR-16):1-32,美国,19902004,年报告的,19,岁以下不同民族急性乙型肝炎发病率,年份,14,1990,1992,1994,1996,1998,2000,2002,2004,7,6,3,2,1,0,4,5,美国,19902004,年报告的,19,岁以下不同民族急性乙型肝炎发病率,发病率,(/10,万,),亚太人,黑人,美国印第安,/,阿拉斯加土著人,西班牙人,白人,MMWR,2005,54(RR-16):1-32,年份,15,Harpaz et al.JInfect Dis 2000;181:413-8;CDC,美国新生儿乙肝免疫成效,乙肝携带率,(%),免疫前,免疫,后,阿拉斯加本土儿童,05,岁,610,岁,3,0,8,0,夏威夷,68,岁,1.6,0.4,亚裔母亲生的婴儿,6.6,0.6,110,岁,16,欧洲部分国家一般人群,HBsAg,流行率,(%),挪威,丹麦,英国,比利时,德国,法国,希腊,意大利,CDC 1991,WHO 2002,国家,2,2,2,2,2,2,2.8,2.8,0.5,0.1-0.2,1,0.7,0.62,0.2,2.1,0.9,CDC 1991;WHO World Health Report 2002;BMS Colloqua 2003-4,17,欧洲及其他地区国家一般人群,HBsAg,流行率,(%),葡萄牙,土耳其,捷克,波兰,斯洛伐克,西班牙,阿尔及利亚,以色列,CDC 1991,WHO 2002,国家,2.8,7.8,28,28,28,28,28,2,12,6.6,1,12,1,1.2,0.78,0.65,CDC 1991;WHO World Health Report 2002;BMS Colloqua 2003-4,18,National Immunization Survey,CDC,19922003,年美国,1935,月龄幼儿乙肝疫苗覆盖率,1992,年实施新生儿计划免疫,1991,1992,1993,1994,1995,1996,1997,1998,1999,2000,2001,2002,2003,覆盖率,(%),0,20,40,60,80,100,年份,19,1992,年实施新生儿计划免疫,National Immunization Survey,CDC,19922003,年美国,1935,月龄幼儿乙肝疫苗覆盖率,1991,1992,1993,1994,1995,1996,1997,1998,1999,2000,2001,2002,2003,覆盖率,(%),0,20,40,60,80,100,HBV,发病率,(/10,万,),年份,20,50%,7580%,90,%,全国乙型肝炎疫苗覆盖率调查,(1999),西藏,8%,云南,44%,贵州,25%,江西,41%,重庆,41%,湖北,47%,陕西,39%,新疆,40%,甘肃,46%,青海,31%,(10,省,),507%,(8,省,),(9,省,),(4,省,),我国各省市自治区婴儿接种乙型肝炎疫苗的覆盖率,城市：,88.5%,农村：,62.7%,平均：,70.7%,21,0,10,20,30,40,50,60,70,80,90,100,覆盖率,(%),西藏,贵州,新疆,云南,甘肃,四川,江西,重庆,湖北,陕西,青海,广西,湖南,浙江,宁夏,广东,山西,上海,江苏,安徽,福建,天津,内蒙古,河南,北京,山东,辽宁,吉林,河北,海南,黑龙江,覆盖率,:28.6%99.8%(,平均,89.4%),全国,HepB,3,覆盖率调查,2004,(,调查,2003,年,19,月出生的,41 826,名儿童,),22,0.0,20.0,40.0,60.0,80.0,100.0,1989,合计,城市,农村,19892005,年北京市新生儿乙型肝炎疫苗全程接种率,1991,1993,1995,1997,1999,2001,2003,2005,北京市,CDC,报告,覆盖率,(%),23,0.0,20.0,40.0,60.0,80.0,100.0,1989,合计,城市,农村,19892005,年北京市新生儿乙型肝炎报告发病率及疫苗全程接种率,1991,1993,1995,1997,1999,2001,2003,2005,乙肝报告发病率,北京市,CDC,报告,覆盖率,(%),24,年份,年份,95.0,96.0,97.0,98.0,9.09,100.0,1992,1994,1996,1998,2000,2002,2004,2006,上海市,19922006,年乙型肝炎疫苗全程接种率,上海市,CDC,报告,25,乙肝疫苗接种率,(%),年份,95.0,96.0,97.0,98.0,99.0,100.0,1992,1994,1996,1998,2000,2002,2004,2006,上海市,19922006,年乙型肝炎报告发病率及疫苗全程接种率,乙肝报告发病率,乙肝疫苗全程接种率,上海市,CDC,报告,26,乙肝疫苗接种率,(%),为什么全球接种乙型肝炎疫苗后，乙型肝炎发病率均下降，惟独我国乙型肝炎发病率却逐年上升,?,乙型肝炎疫苗覆盖率调查结果是假的,乙型肝炎疫苗覆盖率调查结果是真的，但乙型肝炎疫苗是假的,乙型肝炎疫苗覆盖率调查结果和乙型肝炎疫苗是真的，但发病报告有问题,27,1,2,3,4,5,6,10,152030,0,2,4,6,8,10,12,HBsAg,流行率,(%),年龄,(,岁,),2002,年,19921995,年,2.2,3.6,4.5,8.5,10.2,10.5,2.2,2.4,4.8,7.1,9.2,9.7,12.0,11.7,11.2,12.7,11.5,10.5,13,1992,、,2002,年全国,30,岁以下人群,HBsAg,流行率年龄分布,戴志澄,祁国明,.,中国病毒性肝炎血清流行病学调查,.,科学技术文献出版社,1997:39-59,;,梁晓峰,等,.,中华流行病学杂志,2005,26:655-658,28,1,5,10,15,20,25,30,35,40,0,24,6,8,10,12,HBsAg,流行率,(%),2006,年,1992,年,1992,与,2006,年北京一般人群,HBsAg,流行率年龄分布,年龄,(,岁,),戴志澄,祁国明,.,中国病毒性肝炎血清流行病学调查,.,科学技术文献出版社,1997:39-59,;,梁晓峰,等,.,中华流行病学杂志,2005,26:655-658,50,60,0.6,2.4,5.2,8.5,10.9,3.8,6.7,6.4,6.9,6.4,0.0,0.0,0.9,0.4,1.1,4.6,4.0,5.7,5.5,4.4,3.2,2006,年总人群,3.7%,1992,年总人群,5.8%,2006,年,5,岁以下,0.44%,1992,年,5,岁以下,2.54%,29,上海市对,1045,名儿童乙型肝炎疫苗免疫后,10,年的效果观察,HBsAg,阳性率为,0.47%,抗,-HBc,阳性率为,1.69%,乙肝疫苗接种前同年龄组,HBsAg,携带率为,7.42%,30,8,省监测试点工作乙型肝炎病例报告水平调查,8,省共抽取,95,家医疗机构，其中省级,8,家，地市级,15,家，,县区级,36,家，乡镇级,36,家。其中省、地、县级抽取,2004,年报告乙型肝炎病例最多的医疗机构，乡镇级为随机抽取,从抽取的每家医疗机构中，选取,2004,年报告乙型肝炎病,例最多的科室，该科室的所有医务人员作为调查对象，共,调查,594,名医务人员,31,我国病毒性肝炎监测试点省及县区,四川,甘肃,河南,山东,吉林,广东,浙江,北京,32,7%,急性,62%,慢性,31%,未分型,2005,年,13,月报告的乙型肝炎病例构成,中国,CDC,报告,33,30.1%,临床诊断,0.1%,疑似病例,66.8%,实验室诊断,3.1%,携带者,报告的乙型肝炎病例构成,中国,CDC,报告,34,调查了宁波市,55,所医疗机构发现,对宁波市医务人员掌握乙型肝炎报告和诊断标准的调查,对乙肝报告对象了解正确率,35.0%,；,对各类乙型肝炎临床诊断标准了解正确率,11.0,；,对乙型肝炎急性、慢性和未分型标准了解正确率,9.8调查医院诊断为乙型肝炎的,800,患者,原医院诊断与本次调查的一致率为,53.5%,不一致率为,46.5%,诊断为乙型肝炎患者中，,26.90%,无乙型肝炎病史或感染史、无,实验室检测结果,中国,CDC,报告,35,2006,年全国乙肝血清流行病学调查初步结果,36,1979,、,1992,、,2002,和,2006,年,4,次全国血清流行病学调查,1979,1992,2002,2006,HBV,携带率,5,岁以下儿童携带率,8.8%,目标人群,277,186,调查的省份数,29,调查的县数目,209,检测方法,RPHA,8.9%,*Disease surveillance sites,National Surveys for HBV Prevalence,1979,1992,2002,and 2006,37,1979,、,1992,、,2002,和,2006,年,4,次全国血清流行病学调查,1979,1992,2002,2006,HBV,携带率,5,岁以下儿童携带率,8.8%,目标人群,277,186,调查的省份数,29,调查的县数目,209,检测方法,RPHA,8.9%,*,疾病检测点,9.7%,67,124,30,145*,RIA,9.8%,1979,、,1992,年全国乙型肝炎流行病学调查,38,1979,、,1992,、,2002,和,2006,年,4,次全国血清流行病学调查,1979,1992,2002,2006,HBV,携带率,5,岁以下儿童携带率,8.8%,目标人群,277,186,调查的省份数,29,调查的县数目,209,检测方法,RPHA,8.9%,9.7%,67,124,30,145*,RIA,9.8%,8.2%,62,159,31,132,EIA,3.1%,*,疾病检测点,1979,、,1992,、,2002,年全国乙型肝炎流行病学调查,39,1979,、,1992,、,2002,和,2006,年,4,次全国血清流行病学调查,1979,1992,2002,2006,HBV,携带率,5,岁以下儿童携带率,8.8%,目标人群,277,186,调查的省份数,29,调查的县数目,209,检测方法,RPHA,8.9%,9.7%,67,124,30,145*,RIA,9.8%,8.2%,62,159,31,132,EIA,3.1%,6.97,81,950,31,160*,EIA,1.1,*,疾病检测点,1979,、,1992,、,2002,、,2006,年全国乙型肝炎流行病学调查,40,1,5,10,15,20,30,40,50,0,2,4,6,8,10,12,9.7,10.2,11.3,10.5,11.5,9.9,9.3,7.6,年龄,(,岁,),1979,、,1992,、,2002,年全国乙型肝炎流行病学调查一般人群,HBsAg,流行率,HBsAg,流行率,(%),*,预计流行率,1979,、,1992,、,2002,年全国乙型肝炎流行病学调查,1992,2006*,1.1,1.4,41,HBsAg,流行率,(%),2006,19,岁儿童,HBsAg,流行率比较,年龄,(,岁,),1992,1,2,3,4,5,6,7,8,9,0.69,1.01,1.11,1.46,1.17,0.94,1.00,1.75,2.33,9.02,7.48,9.05,8.49,9.44,7.84,42,1992,年与,2006,年乙型肝炎流行病学调查结果比较,1992,年,2006,年,HBsAg,流行率,(%),9.75,6.97,HBsAg,携带者人数,1.2,亿,9,000,万,流行强度,高,中,2020,年,3,4,000,万,低,携带者人数减少,3,000,万,8,000,万,经济损失减少,(,元,),9143,亿,24,382,亿,陈兴宝,等,.,肝脏，,2002,7(2):79-81,共调查,1 395,例慢性乙肝，来自,1,所市级、,1,所区级,传染病院、,2,所市级综合医院，每年每例慢性乙型肝炎直接和间接经济损失平均为,30477,元,43,Hepatitis B is dead!,20XX?,谢谢！,