| Background and objectiveHepatitis e(HE)has caused 44,000 people dead worldwide.In China,the reported incidence of hepatitis E has surpassed Hepatitis A as the leading cause of acute viral Hepatitis since 2012,resulting in a higher disease burden.This study conducts a meta-analysis on the prevalence of HE in China’s mainland,conducts a preliminary study on the ecological epidemiology of HE,and conducts a health economics evaluation on the intervention strategies for patients with chronic hepatitis B,in order to providing a reference for the prevention and control of HE in China and other developing countries.Methods(1)In recent ten years,relevant literatures are searched nationwide and meta-analysis is conducted based on the literatures to conduct an ecological epidemiological study on the status of hepatitis e in China.HEV seroprevalences in humans and pigs are analyzed,and subgroup analysis is performed for porcine related occupational groups and swine products.(2)Laboratory tests are conducted on the serum and water samples of swine bile collected from a monitoring site in Jiangsu province.Anti-hev Ig G,anti-hev Ig M and HEV RNA is analyzed by fluorescence quantitative and sequencing analysis,and the homology of HEV in ecological swine,swine products and patients is analyzed from the genetic level.(3)Based on the Tree decision-Markov model,the health economics effect of the vaccination of hepatitis B patients with overlapping hepatitis e infection is evaluated from the social perspective,the dominant strategy is determined by incremental cost-effectiveness ratio and incremental cost-utility ratio,and the sensitivity of model parameters is determined by unitary sensitivity analysis and probabilistic sensitivity analysis.Results(1)The seroprevalence of anti-HEV Ig G among the general population,occupational population,and swine are 27.30%,47.40% and 66.40%,respectively.The overall prevalence of Ig M among the general population is 1.80%.The prevalence is higher in people over 40 years of age,and higher in rural than urban populations.The highest anti-HEV Ig G prevalence(59%)is observed in East China,whereas the odds ratio is2.18 compared to North China.In the occupational population,the highest prevalence(77.0)is observed among swine vendors.The correlation coefficient for the prevalence of anti-HEV Ig G between the professional population and adult pigs is0.88.(2)The prevalence of HEV RNA positive rate about swine in Jiangsu province’s monitoring stations is 2.90%,the prevalence of swine occupational contact people is36.50%.People over 40 years old has higher prevalence than people below 40 years old.The highest anti-HEV Ig G prevalence is observed in breeding work.The d4 h genotype accounted for 68.57% of the patients diagnosed with hepatitis E with suspected acute viral hepatitis.The overlap infection rate between hepatitis B and hepatitis E is 22.22%.(3)The ICER of inoculation after screening of all inoculation is 5.35 ten thousand/ case,3.00 ten thousand/ case and ICUR in the population with chronic hepatitis B overlapping infection with hepatitis E,as opposed to ICUR is27,362.52/QALY,15,300.10/QALY.The ICER of elderly patients of inoculation after screening of all inoculation is 4.43 ten thousand/ case,2.08 then thousand/ case,as opposed to ICUR is 22,380.11/QALY,10,413.61/QALY.Conclusions(1)The incidence of hepatitis E virus infection in swine occupational contacts is higher than that in general population,and there is a correlation between occupational infection rate and adult swine(>3 months).(2)HEV prevalences in swine and humans at a monitoring site in Jiangsu province are homologous.(3)From the social point of view,it is considered that vaccination is an advantageous strategy for the immunization of chronic hepatitis B patients in the sporadic area of hepatitis E. |
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