New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Zheng Hui , Wang Yu , Wang Fuzhen , Shen Liping , Zhang Guomin , Liu Jianhua , Wang Feng , Miao Ning , Li Jian , Ding Guowei , Meng Tongtong , Tang Lin , Zhang Shuang , Li Mingshuang , Li Yuan , Wang Xiaoqi , Liu Qianqian , Zhang Qian , Wu Dan , Yan Tingting , Wang Yu
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引用次数: 0

Abstract

Background

Since 1992, when recombinant hepatitis B vaccine was introduced in China, government health officials have used nationally representative serological surveys to monitor progress in prevention and control of hepatitis B. In 2020, we conducted the fourth seroepidemiological survey, which for the first time included medical evaluation of the clinical status of HBsAg positive subjects over the age of 15 and their medical management. We report survey results in comparison with the three previous surveys.

Methods

Consistent with previous national surveys, the 2020 survey used a stratified, three-stage cluster random sampling method to select for evaluation 1-69-year-olds in 120 national disease surveillance points. Blood samples were tested for HBsAg, anti-HBV surface antigen (anti-HBs), and anti-HBV core antigen (anti-HBc) in the National Hepatitis Laboratory of the Institute for Viral Disease Control and Prevention of China CDC. HBsAg positive subjects aged ≥15-year were evaluated for evidence of liver disease, and through face-to-face questionnaire-based survey, we determined the healthcare management cascade of HBV-infected individuals.

Findings

HBsAg prevalence in 1–69-year-olds was 5.86%; in children 1–4 years of age, seroprevalence was 0.30%; 75 million people were living with HBV nationwide. Among HBsAg-positive individuals 15 years and older, expert medical examination found that 78.03% were HBsAg carriers with no evidence of liver damage, 19.63% had chronic HBV with liver enzyme abnormalities, 0.84% had evidence of cirrhosis, and 0.15% had evidence of liver cancer. 59.78% of HBsAg + individuals were aware that they were positive before the survey, 30 million were unaware; 38.25% of those who knew they were positive (17 million) had medical indications for antiviral treatment, and 17.33% of these individuals (3 million) were being treated with antivirals.

Interpretation

The decline in HBsAg prevalence in the general population, from 9.72% in 1992 to 5.86% in 2020, and in 1–4-year-olds from 9.67% in 1992 to 0.30% in 2020, shows progress that continues on track toward WHO targets for prevention of new infections. Implementation of acceptable strategies to identify infected individuals and offer long-term medical monitoring and management will be important to prevent complications from hepatitis B infection and for meeting WHO cascade-of-care targets.

Funding

The study was funded by the Major Science and Technology Special Project of China’s 13th 5-Year Plan (grant no. 2017ZX10105015); Central finance-operation of public health emergency response mechanism of Chinese Center for Disease Control and Prevention (131031001000200001, 102393220020010000017).

中国乙型肝炎病毒(HBV)控制的新进展和乙型肝炎病毒感染者的逐级医疗保健:来自 2020 年第四次全国血清学调查的证据
背景自1992年中国引进重组乙型肝炎疫苗以来,政府卫生官员一直使用具有全国代表性的血清学调查来监测乙型肝炎防控工作的进展。2020年,我们开展了第四次血清流行病学调查,其中首次纳入了对15岁以上HBsAg阳性受试者的临床状态及其医疗管理的医学评估。与前三次调查相比,我们报告了调查结果。方法与前几次全国调查一样,2020 年的调查采用了分层三阶段整群随机抽样方法,在 120 个全国疾病监测点抽取 1-69 岁的人群进行评估。血样在中国疾病预防控制中心病毒病预防控制所肝炎国家实验室进行HBsAg、抗-HBV表面抗原(抗-HBs)和抗-HBV核心抗原(抗-HBc)检测。研究结果1-69岁人群HBsAg感染率为5.86%,1-4岁儿童血清阳性率为0.30%,全国HBV感染者达7500万人。在 15 岁及以上的 HBsAg 阳性者中,专家体检发现,78.03% 的 HBsAg 携带者无肝脏损伤迹象,19.63% 的 HBsAg 携带者为慢性 HBV 并伴有肝酶异常,0.84% 的 HBsAg 携带者有肝硬化迹象,0.15% 的 HBsAg 携带者有肝癌迹象。59.78% 的 HBsAg + 患者在调查前知道自己呈阳性,3000 万人不知道;在知道自己呈阳性的患者中,38.25% 的患者(1700 万人)有抗病毒治疗的医学指征,其中 17.33% 的患者(300 万人)正在接受抗病毒治疗。解读普通人群中的 HBsAg 感染率从 1992 年的 9.72% 下降到 2020 年的 5.86%,1-4 岁儿童中的 HBsAg 感染率从 1992 年的 9.67% 下降到 2020 年的 0.30%,这表明在实现世界卫生组织预防新感染的目标方面继续取得进展。实施可接受的策略来识别感染者并提供长期的医疗监测和管理,对于预防乙型肝炎感染并发症和实现世卫组织的级联护理目标非常重要。 基金项目 本研究得到了中国 "十三五 "科技重大专项(批准号:2017ZX10105015)、中国疾病预防控制中心公共卫生应急机制中央财政业务费(131031001000200001、102393220020010000017)的资助。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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