Epidemiological Characteristics And Molecular Epidemiology Of Hepatitis B In Ethnic Minorities In Yunnan Province

Objective:Based on the study of the epidemic characteristics and molecular epidemiology of hepatitis B in ethnic minorities in Yunnan Province,this paper grasps the epidemic trend and three distributions of hepatitis B,discusses the molecular epidemiological characteristics of hepatitis B in Yunnan ethnic minorities,provides scientific basis for the formulation of prevention and control strategies and measures of hepatitis B,and lays a certain foundation for the effective control of hepatitis B in ethnic minorities in Yunnan Province.Methods:1.From 2009 to 2018,the incidence data of hepatitis B reported cases from the national statutory infectious disease information reporting system were analyzed by descriptive epidemiological method;Using SOM,tidyverse and RM function packages of R software,the similarity time trace clustering of self-organization characteristics of hepatitis B incidence data of major ethnic groups in Yunnan Province was carried out by SOM clustering method,so as to find out the ethnic groups with similar characteristics.2.Excel software(version 2007)was used to sort out the data and draw charts;SPSS software(version 17.0)was used for statistical analysis,and chi square test was used to compare the rates.3.Adopt laboratory detection technology,including ELISA,nucleic acid extraction,HBV DNA S-region nested PCR amplification,electrophoresis and gene sequencing were used to study the molecular biological characteristics of HBV samples from ethnic minorities in Yunnan Province in 2018-2019.The obtained sequences were sorted out by sequencer software;the reference plant sequences were downloaded from GenBank;the phylogenetic tree was constructed by mega software to determine the HBV genotype and gene subtype of each sample.Results:1 epidemiological characteristics of hepatitis B cases in Yunnan ethnic minorities in 2009-20181.1 General situationDuring the 2009-2018 years,95132 cases of hepatitis B cases among 18 ethnic minorities,such as Bai,Dai and Wa,were reported.The average incidence rate was 41.27/10 million,lower than the average incidence level of the whole country and the whole province.All ethnic groups have hepatitis B cases,the highest incidence rate in the top three ethnic groups are:wa(95.26/10 million),Hui(59.04/10 million),Dulong and Nu(54.17/10 million),the lowest incidence rate is Jingpo(22.51/10 million),Yao(28.59/10 million),Lahu(30.32/10 million)1.2 Cluster analysis resultsAccording to the time track of incidence rate data,the time trajectories of hepatitis B incidence rate in minority groups are clustered into 4 categories.The first category includes:Yunnan,Hani,ethnic minorities,Yi,Lahu,Yao and Tibetan;the second types of center sequences are obviously higher than the other three categories,including China,WA,Zhuang and Miao;the third categories include Lisu,Dai,Brown.Pu Mei,Jingpo and Bai.The fourth categories include Hui,Nu,Dulong and Naxi ethnic groups,and the incidence rate trajectory is similar in the same category1.3 Epidemiological characteristics1.3.1 Time distributionDuring the 2009-2018 years,18 main ethnic minorities in Yunnan province reported hepatitis B cases every year.Incidence rate began to increase in 2009,and the highest in 2012(51.21/10 million),then decreased year by year,and lowest in 2016(30.44/10 million),and then there was an upward trend in recent years.The overall incidence rate of ethnic minorities has a similar trend with the overall situation of Yunnan Province,which is quite different from that of the whole country.1.3.2 Regional distributionThe distribution of hepatitis B cases is basically the same as that of the ethnic groups.The incidence rate of Wa nationality is the highest(95.26/10 million),mainly distributed in Ximeng and Cangyuan counties,followed by Hui(59.04/10 million),mainly distributed in Xundian and Weishan counties.The third are Dulong and Nu(54.17/10 million),mainly gathered in Gong Shan county.The three lowest incidence rate groups are Jingpo nationality(22.51/10 million),mainly distributed in Dehong Prefecture;Yao(28.59/10 million)is mainly distributed in Hekou County,Jinping County;Lahu(30.32/10 million),mainly distributed in Zhenyuan County,Shuang Jiang county and Lancang county.1.3.3 Population distributionThe incidence rate of hepatitis B among men in minority nationality of Yunnan province was higher than that of women in 2009-2018 years.There were 63404 male cases,with an incidence rate of 51.77/10 million;31728 cases of female,the incidence rate was 29.00/10 million.The gender ratio of incidence rate was 1.78:1(P<0.001).Cases were reported in all age groups,the highest proportion of cases was 40-49 years group(23%),followed by 30-39 years group(20%);the lowest was 0-9 years group and 80 years and above group(1%).2.A study on the molecular epidemiology of hepatitis B virus in ethnic minorities in Yunnan Province2.1 Basic informationDuring 2017-2018,of the 765 HBV positive samples from ethnic minorities in Yunnan Province,672 were successfully amplified by HBV DNA.with a success rate of 87.84%;649 completed S gene sequencing,with a success rate of 97%.649 HBV strains can be divided into four genotypes,among which 138(21.3%)belong to B genotype,497(76.6%)belong to C genotype,12(1.8%)belong to D genotype,and 2(0.3%)belong to 1 genotype.Genotype B can be divided into different subtypes,including B1 subtype in 1 case,B2 subtype in 118 cases,B3 subtype in 9 cases,B4 subtype in 7 cases,B7 subtype in 2 cases,and B8 subtype in 1 case;among the C genotype,C1 subtype in 394 cases,C2 subtype in 60 cases,C5 subtype in 17 cases,C8 subtype in 24 cases.C10 subtype in 1 case.C17 subtype in 1 case;there were 11 C/D recombinant genotypes and 1 D3 subtype in D genotype,and 2 cases in I genotype were all I1 subtypes.2.2 Molecular epidemiological characteristics of HBV in ethnic minorities in Yunnan ProvinceThere are national differences in the distribution of HBV genotypes and subtypes in Yunnan Province.The dominant genes of all ethnic groups are C type,except for the C2 subtype of Dulong ethnic group,the others are mainly C1 subtype,the second is B type,the main is B2 subtype,and the D type is mainly C/D recombinant genotype.There was no statistical difference in gender and age distribution among the four genotypes.The ratio of male to female was about 1:1,and C was the main genotype.The maximum age was 87 years old,and the minimum age was 1 year old.C genotype was the main genotype in all age groups.There are differences in regional distribution.C genotype is distributed in each state and city,B genotype is mainly distributed in Wenshan,two cases of 1 genotype are found in Wenshan,and D genotype is mainly distributed in Diqing.There was no statistical difference in the distribution of four genotypes between two years.2.3 Analysis of clinical characteristics of different genotypesIn 165 cases of acute hepatitis B,the symptoms of asthenia,anorexia,nausea,anorexia and jaundice of different genotypes had no statistical difference,and all cases had no signs such as hepatomegaly,splenomegaly,hepatopalmar and spider nevus;158 cases(95.8%)had abnormal ALT value,and the ALT value of different genotypes had no statistical difference.Conclusion:1 epidemiological characteristics of hepatitis B cases in Yunnan ethnic minorities in 2009-20181.1 The average incidence rate of hepatitis B among the ethnic minorities in Yunnan was 41.27/10 million in 2009-201 8 years,which was lower than the average incidence level of the whole country and the whole province.Cases occurred in all ethnic groups,Wa was the highest(95.26/100000),mainly distributed in Ximeng County and Cangyuan County;Jingpo was the lowest(22.51/100000),mainly distributed in Dehong Prefecture.The average incidence rate of different nationalities is statistically different.Young adults are the most important group of hepatitis B in ethnic minorities1.2 The incidence rate trajectories of the same class included by SOM clustering analysis were strongly similar.The second category includes:the whole country,Wa,Zhuang and Miao are significantly higher than the other three categories,so we should pay enough attention to the prevention and control of hepatitis B and the allocation of health resources2.A study on the molecular epidemiology of hepatitis B virus in ethnic minorities in Yunnan Province2.1 Four genotypes B,C,D and I were found in this study.Different genotypes can be divided into different subtypes.The 18 ethnic minorities,such as Achang,Bai and Bulang,are mainly C-type,mainly Cl subtype;the B genotype is mainly distributed in Yi;the D genotype is mainly distributed in Tibetan cases,and is C/D recombinant genotype,and the two I-type cases are Zhuang.There are ethnic differences in the distribution of HBV genotype and gene subtype,and the biological susceptibility of different ethnic groups may be in the differences of HBV prevalence work.There was no difference in gender and age distribution2.2 There was no significant difference in the main symptoms and signs of acute hepatitis B in ethnic minorities,such as asthenia,anorexia,nausea,poor appetite,jaundice and ALT value.3 Prevention and control advice3.1 Young and middle-aged men are the key population of hepatitis B in ethnic minorities.In the prevention and control work,according to the characteristics of young and middle-aged men,carry out health publicity and education,improve the awareness of the hazards of infectious diseases and self-protection,and reduce the risk of hepatitis B infection by reducing risk behaviors3.2 The ethnic groups of high incidence rate should be investigated and analyzed,such as WA,Hui,Dulong and Nu,and targeted preventive measures and strategies should be formulated.3.3 We should continue to consolidate and implement the basic immunization of hepatitis B vaccine,and improve the whole vaccination rate and timely vaccination rate of children's hepatitis B vaccine.3.4 HBV infection in ethnic minorities in Yunnan Province is mainly type C,which suggests that most of our cases are at high risk of progression to liver cirrhosis and liver cancer,so we should strengthen the publicity and policy promotion of three-level prevention.