Study Of The Risk Of HBV Infection In The Public Service Place

BackgroundChina is the high prevalent region for HBV infection.To control and prevent HBV infection,Chinese government had taken many effective measures,including HepBV introduced into the national immunization programme(NIP) in 1992,integrated into the NIP in 2002,implemented free vaccination on all newborn children in 2004,and schemed vaccinating in the teenagers in 2008.The coverage rate of HepB₃ and the birthdose had gradually increased.In 2006,the national serological epidemiological survey on hepatitis B in China(the Hepatitis B survey) showed that:the prevalence rate of HBsAg is 7.18%in the population aged with 1～59 years-old,the rate is 2.08%for the children aged less than 15 years-Old(the rate is 0.96%for the children aged with 1～4 years old),the rate is 8.12%for the population aged above 15 years-old.Compared with the result of the hepatitis B survey in 1992,the rate of HBsAg among the children aged less than 15 years-old have obviously decreased(especially in the children aged with 1～4 years-old),and the rate of the population aged above 15 years-old have not significantly changed.These showed that the effect of the comprehensive prevention and control measures for Hepatitis B,which make the HepB V vaccinization as the center step among all measures,had been achieved great success in China,and it also implied that the epidemic character of the transmission way from mother to child would be gradually replaced by horizontal transmission for HBV in the future.Therefore,the strategies for hepatitis B control and prevention should be adjusted to adapt to the change of HBV prevalence characteristics in China. There are many beauty salons,pedicuring,hairdressing,tattoo and massage in the public service places(PSP),where the crowds flow frequently and need special service which these special services could cause the spread of HBV between the practitioners and the customer.The practitioners worked in the PSP are both high-risk group of HBV infection and infection source which could horizontally spread HBV.In China,there hasn't launched the investigation of HBV infection in the PSP,and also lack of the relative data which could evaluate the risk of HBV infection in the PSP.Therefore,we have carried out the study on the probability of HBV infection in the PSP of Qinghai, Hunan,Hainan and Shenzhen,which purpose will provide the scientific information to formulate the strategies for the control and prevention of HBV infection in the future.Objective1.To master the situation of apparatus disinfection in public services place and detect the HBsAg rate of bath the apparatus and the employees in those places,explore the probability of HBV infection in the PSP;2.To know main risk factors and risk scores about HBV infection in public service place by carrying out the case-control study;3.To evaluate the risk of HBV infection in the public service places,and provide theoretical basis to adjust the hepatitis B control and prevention tactics and relevant law about HBsAg carriers in China.Methods1.In Hunan province,Hainan province,Qinghai province and Shenzhen city,where the PSP has been divided into the large-,mid- and small-sized levels on the basis of management areas.Some beauty parlors,haircuting parlors,footbathing inns and bathing centers were chosen from the large-,mid- and small scales respectively.684 staffs and partial customers were investigated in questionnaire in these PSP.The HBsAg on the appliances used in the PSP and the staff's blood serum worked in those places were detected by RIA.2.In infectious disease hospitals and the hepatitis hospital of Hunan province, Hainan province,Qinghai province and Shenzhen city,there were 200 new hepatitis B cases(the case group) were chosen by random sampling among the patients infected by HBV in 2005～2006,and the 'control group' including 289 person was chosen from the population with the negative HBsAg and anti-HBc by the similar age,inhabited area, and the no-PSP relative risk factors with the 'control group',and the questionnaires have been carried out and HBsAg would been confirmed with RIA in both 'the case group' and 'the control group'.3.To calculate the major risk factors of HBV infection by Logistic regression,and the odds ratio of risk factors.Different risks in PSP were converted into the risk scores by using the statistical models.4.The data were analyzed by SPSS 13.0 software.Results1.The main disinfection methods of the appliances used in PSP are cleaned by alcohol,disinfected by ultraviolet ray,disinfected with steam,disinfected by chloric and disinfected by cleanout facilities;the rate of the cleaned by alcohol and disinfected by ultraviolet ray accounts for 34.60%and 30.79%respectively.2.The HBsAg detection rate of the appliances used in the PSP is 2.13%,the detected rate of the appliances used in the large-,med- and small-sized PSP is 0.63%, 2.67%and 3.70%respectively,the detected rate of the appliances used in large- and small- scale PSP is remarkable different(x2=6.68,P＜0.05 ).The rate of the appliances used in the beauty parlors,barbering shop and footbath inns respectively is 2.97%, 0.61%and 3.42%respectively;The detection rate of the different appliances are different,the rate is higher on the acne needles(5.13%) and the forceps(4.17%).The detection rate with the knives used in footbath inns is 8.33%;and that in beauty parlors is 4.17%.3.The adjusted positive rate of HBsAg among the employees worked in the PSP is 9.17%,the positive rate of HBsAg among the employees worked in large-,Med- and small-scale PSP is 7.34%,8.33%and 2.94%respectively;the positive rate of HBsAg among the staffs worked in beauty parlors,barbering shops,footbath inns and bathing centers is 9.01%,6.37%,4.35%and 7.29%respectively;for different service,the rate of HBsAg are different,the highest rate is 13.33%in the tattoo workers(13.33%),the pedicures workers(12.68%),the Massagists(8.03%).The rate of HBsAg among the employees worked in the beauty parlors is positive correlative with the working years (R=0.83).The rate of HBsAg among the employees with pedicuring,massaging and tattooing is positive correlative with the working years(R=0.89). 4.The positive rate of HBsAg among the staffs with the skin scathing history is 12.99%(23/177),and the rate is 4.25%for the staff without the skin scathing history. The HBsAg rate among staff with the skin scathing history and without the skin scathing history has statistical difference(x2=16.07,P＜0.01).Among the staff with the skin scathing history,the positive rate of HBsAg among the employees worked in the beauty parlor is 15.15%,the rate is 12.50%for the pedicuring workers and 18.75%for the bathing workers,and the rate of HBsAg is obviously higher than those without the skin scathing history(5.13%,1.89%and4.00%respectively).The HBsAg rate among the pedicuring worker with the skin scathing history is 56.25%.The HBsAg rate of the tatooing worker with the skin scathing history is obviously higher than those without the skin scathing history.Among 177 people with the skin scathing history,the rate of HBsAg is 15.00%among the 120 people who are still working without enswathing,the rate is 8.77%among the 57 people who are continued to serve for customers by easily enswathement,and the rates of both people are higher than the natural population.5.The Multi-factors analysis of the case control study shows that:besides the occupation and education levels of the study objects,the risk factors about HBV infection in the PSP mainly have the following factors,such as shaving,hairdressing, pedicuring,and tattooing;the HepB vaccinating and KAP scores about Hepatitis B are protection factors.6.The KAP investigation show that the staffs and customers of the PSP are lack of self-protection awareness of hepatitis B,which are mainly embodied in:(1) Knows a little about HBV dissemination methods;(2) After the HBV infection,people have little attention to severity,lacks knowledge about the hepatitis B clinical manifestation,it is difficult to discover,diagnose and treat early;(3) The employees worked in the PSP know that HepB vaccinating will prevent the HBV infection effectively,but the people with HepB vaccinating account for only 22%;(4) Some employees with the skin scathing history are continued to serve for customers by easily enswathement or without enswathement.7.Different risk factors of HBV infection in PSP were converted into risk scores. The related risk scores were added to obtain a combined risk scores to predict the individual's risk of HBV infection in PSP. ConclusionThis investigation is the first national system study about the appliances disinfection and HBsAg contamination situation,the rate of HBsAg among the employees and the customers in the PSP.We have analyzed the risk factors about HBV infection and achieved good data in PSP.The results show that in the public service place has the possibility of HBV infection(dissemination),and indicate that the appliances disinfection management should be strengthened,the disinfection methods should be regulated,HepB should be vaccinated among the staff worked in the PSP.The findings also suggest that we should carry out the public health education about Hepatitis B and strengthen people's legal supervision consciousness.