The Evaluation Of Epidemic Reporting Equality And Analysis Of Epidemic Characteristics On Hepatitis B In Jiyang County

BackgroundHepatitis B is a common infectious disease caused by hepatitis B virus (HBV), which seriously endangers people’s physical and mental health. Additionally, the illness may repeat over with long course and no special drug treatment, leading to heavy finanical burden. The carriers with HBV are restricted in many ways, such as enrollment, employment and other discrimination[1]. Consequently, it brings a series of social problems.The infection of HBV is an important cause of morbidity and mortality in China. About60%of the population has a history of HBV infection, and9.8%of the population carry HBV [2]. Approximately263000people died from liver cancer or cirrhosis associated with HBV infection each year, accounting for37%-50%death of hepatitis B around the world[3]. The results from two epidemiological investigations on national hepatitis serum demonstrate that our country is an epidemic area with hepatitis B[4-5]. China statistical yearbook showed that the morbidity of viral hepatitis in2005China was91.42per100,000, which was the second in the reporting of notifiable diseases only lower to tuberculosis. The mortality rate was0.09/100,000, next only to HIV/AIDS, rabies and tuberculosis, which was the fourth in the notifiable diseases reporting[6]. In January2006, the ministry of health issued the "the national hepatitis B prevention and control planning from2006to2010". Its goal is to protect susceptible population, contain the epidemic effectively and decrease the morbidity and mortality of hepatitis B through the comprehensive measures to take the immune prevention first, then prevention and control[7]The hepatitis B vaccine was involved into the immunization management in1992in our country [8]. Especially from hepatitis B vaccine into children immunization in2002[9], the hepatitis B vaccine inoculation of newborn and young children has gradually improved and the degree of hepatitis b virus (HB V) infection has fallen sharply [10]. Moreover, the hepatitis b vaccine immunization should be expanded to teenagers and adults in order to decrease the incidence and infection rate of hepatitis B fast.[11,l2].According to the statutory epidemic reporting system, the report cases of hepatitis B viral have risen slowly in recent years in China, but the reason is unclear, remained to be further research.Jiyang Country was established to be the national hepatitis B monitoring station in2006, then the provincial monitoring station in Shandong Province in2009. Considering for the situation of the hepatitis B incidence, more strict requirement should be taken into the prevention of hepatitis B in Jiyang. Thus, we evaluated the equality of the epidemic reporting system and the epidemic characteristics of hepatitis B, to understand the capacity of hepatitis B diagnosis, treatment, and reporting in Jiyang.Objective1. understand the capacity of hepatitis B diagnosis, treatment and reporting2. evaluate the quality of epidemic reporting system in Jiyang Country3. analyze the epidemic characteristics of hepatitis B during1991-2012in Jiyang CountryResults:1. The capacity of hepatitis B diagnosis, treatment and reporting in medical institutions in Jiyang Country.(1) The capacity of hepatitis B detection in Medical institutionsThe prevention and control of hepatitis B was based on the teams with reasonable structure and business skilled, which was a systematic project needing reasonable allocation of staff. Compared with the results of a survey in2005, this survey found JiYang attracted young highly educated talents in medical institutions in recent years, but the structure of job title was worse due to unreasonable distribution of the talents and personnel qualifications. Young staffs in the medical institutions in the country were short of work experience; For improving the capacity of prevention and control of hepatitis B in Jiyang, a team should be build which is stable and professional. Moreover, more talents with high level of specialty and high efficiency should be introduced in order to improve the structure of personnel.Inspectors are the key of inspection work, whose number significantly influence the prevention and control of hepatitis B. The survey found that the number of inspectors in the hospitals in the county and township increased than that in2005, which was14people (28/2) and2.33people (21/9), respectively. It indicated that the clinical laboratories in medical institutions enhanced the construction of human resource.The capacity of hepatitis B detection was the support and guarantee for the level of hepatitis B reporting, which was the important component of the prevention system of hepatitis B. The survey found that100%hospitals in the country and33.33%hospitals in the township equipped with enzyme standard instrument ELISA test and other apparatus required for a variety of test, which was higher than the average level of the nation in2006, but just for the quick check of hepatitis in the township. Compared with2005, the instruments increased in all levels of medical institution clinical laboratories, there was a big gap among them.All levels of clinical laboratory can do second liver two half-and-half detect, but anti-HBc IgM, HBV-DNA and anti-HAV IgM test were not carried out; The survey found that only JiYangXian hospital carried out new liver meritorious service from2005, and other projects were still not carried out.(2) The hepatitis B detection capacity of clinicians in all levels medical institutions in Jiyang CountryClassification and diagnosis of hepatitis B cases, such as the identification of acute and chronic hepatitis B, can’t only rely on history of hepatitis B epidemiology, but laboratory testing. In this survey,54clinical doctors were investigated, and there were42respondents thinking in most cases they can accurately distinguish the acute hepatitis B and chronic hepatitis B. And less than50%of doctors considered that "anti-HBc IgM" was the key to diagnose acute hepatitis B and distinguish acute and chronic hepatitis B. In practical work, anti-HBc IgM test was important for monitoring, diagnosis and treatment of the acute hepatitis B cases. Only one-third (17/54) of clinical doctors knew clearly the new "hepatitis B diagnostic criteria"(WS299-2008) issued by the ministry of health in December2008. Medical institutions were the main part of the reporting hepatitis B cases, and the ability of diagnosing the hepatitis B in medical institutions was poor, influencing the accuracy of the hepatitis B cases reporting.2. The evaluation of epidemic report system equality(1) The situation of notifiable diseases reporting system reporting hepatitis B in JiYang CountryThere were183cases hepatitis B reported in JiYang Country by NNDRS during2009-2011, with100%report rate;183blood samples were collected in this study and the specimen collection rate was100%(183/183); The filling out rate of "the first diagnosed with hepatitis b","for the first time detection HBsAg positive time","is the first time this year, the""whether to have hepatitis associated symptoms and signs" rate were97.81%(179/183),91.26%(167/183),97.27%(178/183) and96.17%(176/183), respectively. Specimen collection rate, case report rate and the filling out rate on the report cards reached more than90%. On review classification,21cases were confirmed to acute hepatitis B, including complete follow-up of6cases with follow-up rate28.57%(6/21), and follow-up1HBsAg negative case. The follow-up rate was low, and it indicated that the work of hepatitis B cases follow-up was difficult, and the main cause of lost to follow-up is the social discrimination against hepatitis B patients with false name, false address, refusing to follow up and concealing history to avoid discrimination when they see a doctor. So we should carry out the relevant health education and formulate relevant laws and regulations in order to reduce the social discrimination against hepatitis B patients, and let them using the real message to go to see a doctor, decreasing the rate of lost to follow-up, increasing the rate of follow-up and providing support for CDC follow-up work.(2) The characteristic of identified cases of hepatitis B reported through notifiable diseases system from2009to2011in JiYang CountryAmong the183hepatitis B cases,176cases were reported by the county hospitals, accounting for96.17%(176/183) and township-level hospitals reported7cases, accounted for3.83%(7/183). It indicated that the level of diagnosis in the country was higher than the level in township. The minimum age among these patients was2months and the maximum was90years old, and the main age ranged from16-45years old, accounting for53.01%(97/183). The reason was mainly due to this part of the crowd protection consciousness were poor, causing the low rate of hepatitis B vaccine. The results suggest that we should spread the knowledge of hepatitis B prevention in the susceptible population and improve their consciousness of protection to enhance the population hepatitis B vaccination to protect them. Children under the age of15accounted for1.09%(2/183), which showed that the hepatitis b vaccine inoculation of newborn has made great achievement in China.(3) The evaluation of NNDRS reporting systemAfter reviewing classification of all183cases from2009to2011, acute and chronic hepatitis B reviewing consistent rate was84.34%(140/166), followed by acute hepatitis B with reviewing consistent rate30%(3/10), and chronic hepatitis B consistent rate87.18%(136/156). Kappa test value was0.18, showing the poor classification consistency. It indicated that hepatitis B clinical classification error was common and the diagnosis level of hepatitis B from doctor remained to be further improved.3. The analysis of epidemic of hepatitis B cases during1991-2012in Jiyang CountryA total of4491hepatitis B cases were collected in this study, including3248males (72.32%),1243females (27.68%) and the rate between males and females was2.61. The morbidity of reported hepatitis B was38.91/100,000in Jiyang from1991to2012, which was lower than the level of the nation. From1991, the incidence of patients on0-14ages has tended to be decreased significantly. During1991-2012, the average age of hepatitis B patients was35.60, including35.84for males and34.97for females. Since1991, both men and women, the average age of all hepatitis B patients were significantly increased (P<0.0001) in Jiyang. The average age was41.54in2012, increasing to14.59years compared with26.59in1991. It may be due to this vaccine causing the incident of small age group down, which suggest that the level of population immunity should be strength to keep persist. At the same time, further research should be performed to analyze the fixed number of year of the hepatitis B vaccine immune and free problems.Conclusion and suggestion1. The ability of detecting hepatitis B in all levels of medical institutions should be improved in Jiyang.The capacity of foundation construction should be strengthened in medical institutions at all levels, which are equipped with the necessary health care equipment and introduce new technologies and methods to improve the detection ability. Moreover, we should strength the training and supervising of hepatitis B test in clinical laboratory and standardize its detection method in order to enhance the evaluation and guidance of hepatitis B detection in the reagent market.2. The clinicians in the medical institutions in Jiyang Country should improve their ability of hepatitis B detection.For the scientific and harmonious development of public health in Jiyang, we need to build an appropriate and reasonable medical team by allocating various health workers and enhance the comprehensive education to improve the quality of medical staff. What is important is that we should strength the education about the notifiable diseases report, to make sure the accuracy and promptness of hepatitis B report. Relevant workers on the health policy should provide an appropriate method to rual health workers, and effective incentive measures to generalize the technology in the primary health care institutions.3. All levels of medical institutions at all levels of hepatitis b cases report quality remains to be further improved. Firstly, we should strength the treatment of clinicians in medical institutions, to let them clearly knowing the diagnostic criteria of hepatitis B. Secondly, we should improve the ability of hepatitis B detection in laboratory in order to providing support for hepatitis B diagnosis. At last, we should improve the quality of hepatitis B case report card by enhancing the worker responsibility for checking on the case report to avoid the report loss and increase the response rate.4. The newborn hepatitis B immunization should be further improved in Jiyang Country to strength the primary inoculation rate and full coverage rate. Last but not least, we should improve the health education of hepatitis B prevention to improve the population prevention and control consciousness, especially for the adolescent immunity improvement to reduce the spread.