1994—2023年云南省玉溪市甲型病毒性肝炎流行病学分析

Epidemiological characteristics of hepatitis A in Yuxi city, 1994–2023

  • 摘要:目的】 分析1994—2023年玉溪市甲型病毒性肝炎(以下简称“甲肝”)的流行特征和甲肝减毒活疫苗纳入扩大免疫规划(EPI)前(1994—2008年)后(2009—2023年)的发病率变化。方法:从云南省玉溪市疫情资料汇编和中国疾病预防控制信息系统,收集玉溪市1994—2023年甲肝报告发病相关资料,分析2008年甲肝疫苗纳入EPI前后甲肝的发病率变化,用集中度分析法分析甲肝发病的季节性。结果:1994—2023年玉溪市共报告甲肝6 028例,年均报告发病率为9.75/10万。报告发病率总体呈逐年下降趋(χ趋势2=3 566.82,P<0.001),年均报告发病率从EPI前的16.78/10万降至EPI后的2.72/10万。甲肝发病的季节性不明显(1994—2023年,M=0.184;EPI前,M=0.207;EPI后,M=0.059)。病例职业构成方面,EPI前,甲肝病例的职业以学生为主(37.20%),EPI后以农民为主(48.73%)。男性甲肝报告发病率(11.47/10万)高于女性(7.98/10万)。各年龄段均有发病,甲肝年均报告发病率随着年龄递增而下降。EPI后,30~岁年龄组的报告发病率最高(0.72/10万)。1994—2023年玉溪市累计报告发病率居前3位的县(市、区)是通海县(18.41/10万)、峨山县(15.42/10万)、江川区(10.34/10万)。EPI后,各地区甲肝报告发病率均大幅下降,平均报告发病率由17.50/10万降至2.31/10万。按照国内生产总值(GDP)水平将玉溪市9个县(市、区)分为3类地区,甲肝报告发病率随地区GDP水平上升而降低。结论:玉溪市将甲肝疫苗纳入EPI后,甲肝发病率下降。农民、30~岁人群是甲肝防治的重点人群,GDP水平较低地区是甲肝防治的重点地区。应在重点地区进一步扩大重点人群疫苗接种覆盖面,同时加强卫生健康教育与环境改善,以巩固防控效果,缩小发病差异。

     

    Abstract: Objective: To analyze the epidemiological characteristics of hepatitis A virus infection in Yuxi City from 1994 to 2023, and examine changes in its incidence rate before (1994-2008) and after (2009-2023) the inclusion of the attenuated hepatitis A vaccine in the Expanded Program on Immunization (EPI). Methods: Data on reported hepatitis A cases in Yuxi City, Yunnan Province from 1994 to 2023 were collected from the Yuxi City Epidemic Data Compilation and the China Disease Prevention and Control Information System. The analysis examined changes in hepatitis A incidence rates before and after the inclusion of the hepatitis A vaccine in the EPI in 2008. Seasonality in hepatitis A incidence was analyzed using the concentration method. Results: From 1994 to 2023, Yuxi City reported a total of 6 028 cases of hepatitis A, with an average annual incidence rate of 9.75/100 000. The reported incidence rate showed an overall downward trend over the years (χ2trend = 3 566.82, P<0.001). The annual incidence rate decreased from 16.78/100 000 before the EPI (1994-2008) to 2.72 /100 000 after EPI implementation (2009-2023). No seasonal variation was observed in incidence before or after EPI (1994-2023: M=0.184; pre-EPI: M=0.207; post-EPI: M=0.059). Regarding occupational distribution, pre-EPI cases predominantly involved students (37.20%), while post-EPI cases primarily involved farmers (48.73%). The reported incidence rate of hepatitis A was higher among males (11.47/100 000) than females (7.98/100 000). Cases occurred across all age groups, with the annual average reported incidence rate decreasing with increasing age. Post-EPI, the highest reported incidence rate was observed in the 30-39 age group (0.72/100 000). From 1994 to 2023, the top three counties (cities, districts) in cumulative reported incidence in Yuxi City were Tonghai County (18.41/100 000), Eshan County (15.42/100 000), and Jiangchuan District (10.34/100 000). Following the implementation of the EPI, reported incidence rates of hepatitis A declined significantly across all regions, with the average incidence rate decreasing from 17.50/100 000 to 2.31/100 000. When categorizing Yuxi City's nine counties (cities and districts) into three groups based on their gross domestic product (GDP) levels, the reported incidence of hepatitis A decreased as regional GDP levels increased. Conclusion: Following the inclusion of hepatitis A vaccines in Yuxi City's EPI, the incidence of hepatitis A has declined. Farmers and individuals aged 30-<45 constitute key target groups for hepatitis A prevention and control, while regions with lower GDP levels represent priority areas for intervention. Efforts should focus on expanding vaccination coverage among these priority populations in key regions, while simultaneously strengthening health education and environmental improvements to consolidate prevention outcomes and reduce disparities in disease incidence.

     

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