| BackgroundHepatitis B is a contagious disease caused by Hepatitis B virus (HBV) infection, which will lead to inflammatory illness in liver as well as multiple organ damage. It is estimated that about2billion people were infected HBV. More than350million people suffered from chronic infectious liver disease. Each year about600thousand people died from acute or chronic Hepatitis B. Hepatitis B is endemic in China and other Asian area, where most people were infected with HBV in childhood. And8%-10%adult population suffered from chronic infection. It is estimated that93million people suffered from chronic Hepatitis B in our country. Acute HBV infection can induce Acute Hepatitis B, whichis usually self-limited. But in some cases, acute hepatitis B can deteriorate into chronic hepatitis B or fulminant hepatitis. Meanwhile, acute hepatitis B can result in acute liver failure, which poses great threat to life. Therefore, the potential threat of acute hepatitis B to public health can not be ignored. Because of the high infection rate of HBV, Hepatitis B has become the major disease that affect public health in China negatively. What’s more, due to its long course and difficulty to cure, Hepatitis B has become one kind of disease that will result in poverty because of its high medical expense. Therefore, Hepatitis B has become a kind of disease that has harmful effect on the national economy and development of society. And the Sate Council and Ministry of Health has put it into the disease list that effective measures, such as strengthening the vaccination of Hepatitis B in children and setting up a monitor system of Hepatitis B,should be taken to control it. However, several problems, such as high complete lost rate, underreporting, repeated reporting and mistaken reporting, hamper the control of Hepatitis B.Therefore, along with the goal about the control of Hepatitis Bput forward by the Shandong Provincial Department of Public Health and the recent reporting incidence of Hepatitis B in Zoucheng City, there is an increasing need for more effective measurements to control Hepatitis B in Zoucheng City. Moreover, according to the notice about setting up the provincial sentinel for Hepatitis B launched by Shandong Provincial Government, Zoucheng City has been set as one of the sentinel and carriesout the monitor of the incidence of Hepatitis B. Therefore, it is necessary to further explore the risk factors and transmission medium of acute hepatitis B in Zoucheng City combined with the current incidence of Hepatitis B. And we would like to know the makeup of acute hepatitis B and chronic hepatitis B as well as the accuracy about the Hepatitis B incidence report in the reporting system of notifiable disease. Finally, the monitor of Hepatitis B will provide scientific evidence for the control of Hepatitis B and the improvement of the reporting system.Objective1To know the makeup of Acute Hepatitis B cases and Chronic Hepatitis B cases in the reporting system of notifiable disease2To investigate the accuracy about the Hepatitis B incidence report in the reporting system of notifiable disease3To explore the risk factors of Acute Hepatitis B4To provide scientific evidence for the improvement of the Hepatitis B reporting system according to the monitoring of Hepatitis B casesMethodsFirstly, collect venous blood specimen from all the objectives. Secondly, detect Hepatitis B related indicators in Municipal laboratory. Thirdly, in order to get to know the risk factor of acute hepatitis B, trained health worker will carry out an epidemiological investigation using a questionnaire for each acute hepatitis B case. Fourthly, for the cases that are confirmed by laboratory detection, a follow-up visit will be carried out6-8months later.Period:Jan1st2009-Dec31st2010Statistical analysis:Use Epidata3.1for setting up a database and data entry. Use SPSS16.0to analyze all the data.Quality control:1Quality control of experiment:Set up a standard for the laboratory detection of Hepatitis B and ensure that each step is done according to the standard. 2Quality control of investigation:For the questionnaire completed by county-level investigator, we will choose some of the questionnaires randomly according to the certain ratio. And we will also contact the patients with the recorded phone number in the questionnaire to check some items. All the unqualified questionnaires should be completed once again.3Quality of data entry:when we set up the database, we design the program to check the error committed during data entry. And each questionnaire will be typed in by two data entry clerk simultaneously.Results:1The basic information of Hepatitis B monitoring report in ZouCheng City(1)841patients were primarily diagnosed as Hepatitis B, When all the cases were double-checked by Center for Disease Control and Prevention of Shandong Province,485patients were identified as Hepatitis B. Among them,18cases were Acute Hepatitis B and467patients were identified as chronic Hepatitis B. The ratio of acute hepatitis B and chronic hepatitis is0.04:1.(2) Among all the primary cases,783cases were identified by laboratory detection.49patients were confirmed by clinical diagnosis. The ratio of laboratory identified case and clinical diagnosis case was0.06:1.(3) The average age of patients suffered from acute hepatitis B is35.9±14.3years old. The occupation of most of investigated cases was farmer. The major clinical symptom is fatigue, nausea and anorexia. It was found by laboratory detection that the negative rate of anti-HAV IgM and anti HBs is100%. The positive rate of HBs Ag and anti-HBc IgM is100%.2The risk factors and follow-up of acute hepatitis B in Zoucheng City.(1) The response rate of the section about the risk factors of Hepatitis B was relatively low. Only9patients answered these questions. All the patients deny sharing teethbrush, razor and syringe with other people. No patients have experienced hemodialysis.4patients have been exposed to stomatological operation.3patients have been operated with invasive therapy in a beauty salon.(2)6-8months after the initiation of acute hepatitis B, all the patients completed a follow-up visit. No obvious change was found in clinical symptom among all the acute hepatitis patients. It was found by laboratory detection that there were11 patients with abnormal ALT level, making up61.1%. The seroconversion rate of HBsAg is27.9%. In terms of anti-HBs, it is28.6%. The seroconversion of anti-HBc IgM occurred only in one patient.3The quality evaluation of Hepatitis B monitoring report in Zoucheng City(1) Compared with confirmed diagnosis by Center for Disease Control and Prevention of Shandong Province, a relatively high misdiagnosis rate was found in initial diagnosis. The misdiagnosis rate of acute hepatitis B is57.6%, and that of chronic hepatitis B is39.5%. Furthermore, it was found that80%of misdiagnostic acute hepatitis B cases were identified by laboratory detection. And94.8%of misdiagnostic chronic hepatitis B cases were confirmed by laboratory detection.(2) After the analysis of the repeated reports in this survey, it was found that, in2009, there were13repeated cases, and the repeating rate is2.4%. In2010, there were4repeated cases, and the repeating rate is1.2%. But when the data of2009and2010was analyzed together, it was found that there were28repeated cases. The repeating rate is3.4%, which indicated that some cases have been reported both in2009and2010.(3) In terms of acute hepatitis B, there is no repeated case in2009or2010or both in2009and2010, which indicated that repeated cases occurred only in chronic hepatitis B case report.Conclusion and suggestion1From2009to2010, the majority of Hepatitis B reporting cases in Zoucheng City was chronic Hepatitis B. However, the potiential threats of acute hepatitis B to the public health in Zoucheng City can not be ignored, especially when quite a few studies have showed that sexual contact become the major transmission medium of acute infection with HBV. Meanwhile, along with the improvement of life level, it can not be ignored that the invasive therapy of stomatology and beauty salon has become the potential risk factors for Acute Hepatitis B.2The misdiagnosis rate of Hepatitis B case in the notifiable disease reporting system of Zoucheng City was quite high from2009to2010. The misdiagnosis rate of Acute Hepatitis B was57.7%and that of Chronic Hepatitis B was39.5%, which indicating that the standard of reporting Hepatitis B case was inconsistent when the doctor reported them. And it was further demonstrated that most of doctors did not master the reporting standard of Hepatitis B accurately. Therefore, it is necessary to strengthen the training of clinical doctors, especially those in basic medical facilities and increase their awareness of reporting infectious disease as well as mastering the clinical principal of Hepatitis B so that it can enhance the accuracy of diagnosis on Hepatitis B and let medical staff report cases according to the diagnosis standard, which can reduce the phenomenon of misreport and misstatement.3There were repeated reports in Hepatitis B reporting cases of Zoucheng City from2009to2010. All of them were chronic hepatitis B, maybe because the course of chronic hepatitis B was much longer than acute hepatitis B and patients go to see doctor repeatedly. Therefore, in order to reduce repeated reports, it is necessary to strengthen the checkup after the primary report. What’s more, it is proper to add the unique identification number of patient, for example Number of Identification Card, into the questionnaire. |
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