摘要：
Objective To analyze the sero-epidemiological characteristics of hepatitis E virus (HEV) in Shandong province, and thereby to provide evidence for the policy-making of hepatitis E prevention and control. Methods The inhabitants aged between 1-59 years old were randomly selected to participate in the study by two-stage stratified random sampling method from 12 counties in Shandong province in October, 2014. Firstly two townships were selected from each county by probability proportional to size sampling (PPS) method. A total of 5229 participants aged 1-59 years old were selected by stratified random sampling method. All the participants finished a questionnaire survey and a venous blood sample (3-5 ml) was collected from each to test anti-HEV IgG by enzyme-linked assay (ELISA). The weighted prevalence of anti-HEV IgG with different demographic characteristics was estimated. The variance of the positive rate of anti-HEV IgG was calculated by Taylor series linearization method, as well as its 95%CI. A statistical test was conducted to compare the rate of its 95%CI, and the results in the present study were compared with those in sero-survey in 2006. Results A total of 5229 subjects entered the final analysis in 2014. The overall weighed prevalence of anti-HEV IgG was 9.19% (95%CI: 6.18%-12.20%) among natural population in Shandong province, decreased by 19.88% in comparison with that in 2006 sero-survey (11.47%,95%CI: 8.92%-14.02%). The prevalence increased with age increasing(χ2trend=288.11,P<0.001)in 2014, which was similar to the result in 2006 sero-survey. Except for 1-4 years old group, the prevalence of anti-HEV IgG in the other age groups were lower than it in the corresponding groups in 2006. The prevalence of anti-HEV IgG in urban (8.19%, 95%CI:0.00-22.23%), rural areas (9.69%, 95%CI:4.99%-14.38%), eastern areas (12.70%, 95%CI: 0.00-27.72%), central areas (4.74%, 95%CI: 0.00-9.91%) and western areas (9.32%, 95%CI:0.69%-17.94%) in 2014 were all lower than the corresponding prevalences (11.39%, 95%CI: 8.17%-14.62%; 11.92%, 95%CI: 8.75%-15.08%; 22.77%, 95%CI: 14.99%-30.55%; 7.97%, 95%CI: 4.75%-11.20%;10.59%, 95%CI:6.37%-14.82%) in 2006 survey. The prevalence of anti-HEV IgG in coastal areas (16.56%, 95%CI:12.94%-20.18%) and inland areas (7.63%,95%CI:5.16%-10.10%)in 2014 were lower than it in the corresponding areas (28.04%, 95%CI:20.45%-35.64%;9.50%, 95%CI:7.31%-11.70%)in 2006 survey. The prevalence among peasant (11.98%, 95%CI: 8.20%-15.76%), worker (9.68%, 95%CI:4.48%-14.88%), cadre (13.90%, 95%CI: 7.47%-20.33%), service provider (12.26%, 95%CI: 1.80%-22.73%) in 2014 survey were lower than it among the corresponding populations (13.76%, 95%CI:10.15%-17.38%;21.11%, 95%CI:12.67%-29.55%;17.81%, 95%CI:7.63%-28.00%;21.08%, 95%CI:0.03%-42.12%) in 2006 survey. Conclusion The prevalence of anti-HEV IgG has decreased in Shandong province in the recent years, but the epidemiological characteristics found no obvious changes. HEV susceptibility in natural population was generally high. Hepatitis E vaccines were recommended to be used in HEV high-risk population in the province.%目的 分析山东省人群戊型肝炎流行现状,为戊型肝炎防控提供参考.方法 于2014年10月,在山东省12个县(市、区)采用两阶段分层随机抽样方法,选取1~59岁常住人口作为调查对象.首先采用概率比例规模抽样法在调查县(市、区)抽取2个行政村/社区居委会,按照最适分配分层随机抽样方法抽取1~59岁人群,开展问卷调查并采集静脉血标本3~5 ml,共5229名.采用ELISA法检测戊型肝炎病毒(HEV)IgG抗体(抗-HEV IgG);采用抽样权重进行复杂抽样的抗-HEV IgG阳性率点值估计,采用泰勒级数线性法估计抗-HEV IgG阳性率的方差,然后构建估计值的95%CI.通过比较率点值的95%CI进行率的统计学检验.并与2006年山东省戊型肝炎血清流行病学调查结果相比较.结果 5229名调查对象的抗-HEV IgG阳性率为9.19%(95%CI:6.18%~12.20%),较2006年调查结果(11.47%,95%CI:8.92%~14.02%)下降19.88%;抗-HEV IgG阳性率随年龄增加而增高(χ2趋势=288.11,P<0.001),与2006年趋势相同.除1~4岁年龄组抗-HEV IgG与2006年基本持平外,其余各年龄组阳性率均低于2006年相应年龄组.2014年山东省城市人群抗-HEV IgG阳性率(8.19%,95%CI:0.00~22.23%)低于农村(9.69%,95%CI:4.99%~14.38%),东部(12.70%,95%CI:0.00~27.72%)高于中部(4.74%,95%CI:0.00~9.91%)和西部(9.32%,95%CI:0.69%~17.94%),且以上地区抗-HEV IgG阳性率均低于2006年相应地区(11.39%,95%CI:8.17%~14.62%;11.92%,95%CI:8.75%~15.08%;22.77%,95%CI:14.99%~30.55%;7.97%,95%CI:4.75%~11.20%;10.59%,95%CI:6.37%~14.82%).2014年沿海(16.56%,95%CI:12.94%~20.18%)、内陆(7.63%,95%CI:5.16%~10.10%)人群抗-HEV IgG阳性率均低于2006年(28.04%,95%CI:20.45%~35.64%;9.50%,95%CI:7.31%~11.70%).2014年,农民(11.98%,95%CI:8.20%~15.76%)、工人(9.68%,95%CI:4.48%~14.88%)、干部(13.90%,95%CI:7.47%~20.33%)、公共场所服务人员(12.26%,95%CI:1.80%~22.73%),抗-HEV IgG阳性率亦均低于2006年调查相应人群(13.76%,95%CI:10.15%~17.38%;21.11%,95%CI:12.67%~29.55%;17.81%,95%CI:7.63%~28.00%;21.08%,95%CI:0.03%~42.12%).结论 近年来山东省自然人群戊型肝炎阳性率有所下降,但流行特征未发生明显变化;人群易感性较高,应在高危人群中推广使用戊型肝炎疫苗.
