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Introduction: This study analyzed long-term trends in the incidence of acute hepatitis B (AHB) in China, focusing on age, period, and cohort effects on incidence. Methods: Data on AHB from 2005 to 2021 were extracted from the National Notifiable Disease Reporting System (NNDRS) of China for analysis. Incidences of AHB were calculated by gender and age group using population denominators from the 2000, 2010, and 2020 censuses. Joinpoint regression was employed to evaluate trends, and an age-period-cohort model was used to assess the age, period, and cohort effects. Results: The annual average incidence of reported AHB in children aged 14 years and below in low, intermediate, and high endemic areas decreased from 1.65, 2.33, and 2.56 per 100,000 in 2005-2010 to 0.56, 0.58, and 0.48 per 100,000 in the 2016-2021 period. The 15-39-year age group in high endemic areas exhibited the most significant decline in incidence, dropping from 23.14 per 100,000 in 2005 to 4.59 per 100,000 in 2021 among males and from 10.62 per 100,000 to 3.21 per 100,000 among females. Age-period-cohort analysis indicated decreasing age, period, and cohort effects for reported AHB incidence in each endemic area, except for a slight upward trend in the 15-19-year age group and in the cohort born between 1951 and 1955. Conclusions: This study demonstrated a rapid decline in AHB incidence across various endemic areas since 2005. Children aged 14 years and below exhibited very low AHB incidences, while the incidence among individuals over 15 years was higher. To further reduce AHB incidence, hepatitis B vaccine (HepB) coverage should be enhanced among adolescents and adults.
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OBJECTIVES: To investigate whether high concentration iodinated contrast media (CM), compared with low concentration CM, could reduce pain and discomfort levels in patients who had level II and III venous conditions. METHODS: This prospective, single-center study enrolled patients who had level II and III venous conditions and underwent abdominal contrast-enhanced CT scan between July 2021 and February 2022. The venous condition to establish peripheral venous access for CM injection was graded using the Intravenous Access Scoring system, of which level II and III indicated poor venous condition and difficult venous access. Patients received iomeprol 400 in high concentration group and ioversol 320 in low group at an identical iodine delivery rate of 1.12 gI/s. The primary outcomes were pain and comfort levels. The secondary outcomes included adverse events and image quality. Patients rated pain intensity via Numerical Rating Scale and comfort level via Visual Analogue Scale with higher scores indicating higher levels of pain and discomfort. Quantitative and qualitative image assessment were compared between two groups. Continuous variables were compared using Student's t test or Mann-Whitney U test. Categorical variables were compared using χ2 test, χ2 test for trend or Fisher's exact test. RESULTS: A total of 206 patients (mean age, 60.13 ± 12.14 years; 81 males) were included with 99 in the high concentration group and 107 in the low concentration group. The high group had significantly lower pain scores (median 1 [IQR: 0-2] vs 2 (IQR 2-4), p < 0.001) and comfort scores (1 [IQR: 0-3] vs 3 [IQR: 2-5], p < 0.001) than the low group. Incidence of CM extravasation did not significantly differ (1.0 % vs 4.5 %, p = 0.214). No hypersensitivity reaction was observed. Qualitative assessment showed higher clarity scores of intrahepatic hepatic artery and portal vein in the high group. Quantitative assessment results were comparable between two groups. CONCLUSION: High concentration iodinated CM could lower pain intensity and improve comfort levels without comprising image quality of CT scan. High concentration CM is a preferable choice in patients with poor venous conditions during contrast-enhanced CT scan.
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When a flowering plant species changes its life history from self-supply to parasite, its chloroplast genomes may have experienced functional physical reduction, and gene loss. Most species of Santalales are hemiparasitic and few studies focus on comparing the chloroplast genomes of the species from this order. In this study, we collected and compared chloroplast genomes of 12 species of Santalales and sequenced the chloroplast genomes of Taxillus nigrans and Scurrula parasitica for the first time. The chloroplast genomes for these species showed typical quadripartite structural organization. Phylogenetic analysis suggested that these 12 species of Santalales clustered into three clades: Viscum (4 spp.) and Osyris (1 sp.) in the Santalaceae and Champereia (1 sp.) in the Opiliaceae formed one clade, while Taxillus (3 spp.) and Scurrula (1 sp.) in the Loranthaceae and Schoepfia (1 sp.) in the Schoepfiaceae formed another clade. Erythropalum (1 sp.), in the Erythropalaceae, appeared as a third, most distant, clade within the Santalales. In addition, both Viscum and Taxillus are monophyletic, and Scurrula is sister to Taxillus. A comparative analysis of the chloroplast genome showed differences in genome size and the loss of genes, such as the ndh genes, infA genes, partial ribosomal genes, and tRNA genes. The 12 species were classified into six categories by the loss, order, and structure of genes in the chloroplast genome. Each of the five genera (Viscum, Osyris, Champereia, Schoepfia, and Erythropalum) represented an independent category, while the three Taxillus species and Scurrula were classified into a sixth category. Although we found that different genes were lost in various categories, most genes related to photosynthesis were retained in the 12 species. Hence, the genetic information accorded with observations that they are hemiparasitic species. Our comparative genomic analyses can provide a new case for the chloroplast genome evolution of parasitic species.
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Genoma del Cloroplasto , Loranthaceae , Parásitos , Animales , Loranthaceae/genética , Filogenia , Secuencia de BasesRESUMEN
Comparing gene expressions among parasitic plants infecting different host species can have significant implications for understanding host-parasite interactions. Taxillus nigrans is a common hemiparasitic species in Southwest China that parasitizes a variety of host species. However, a lack of nucleotide sequence data to date has hindered transcriptome-level research on T. nigrans. In this study, the transcriptomes of T. nigrans individuals parasitizing four typical host species (Broussonetia papyrifera (Bpap), a broad-leaved tree species; Cryptomeria fortunei (Cfor), a coniferous tree species; Cinnamomum septentrionale (Csep), an evergreen tree species; and Ginkgo biloba (Gbil), a deciduous-coniferous tree species) were sequenced, and the expression profiles and metabolic pathways were compared among hosts. A total of greater than 400 million reads were generated in nine cDNA libraries. These were de novo assembled into 293823 transcripts with an N50 value of 1790 bp. A large number of differentially expressed genes (DEGs) were identified when comparing T. nigrans individuals on different host species: Bpap vs. Cfor (1253 DEGs), Bpap vs. Csep (864), Bpap vs. Gbil (517), Cfor vs. Csep (259), Cfor vs. Gbil (95), and Csep vs. Gbil (40). Four hundred and fifteen unigenes were common to all six pairwise comparisons; these were primarily associated with Cytochrome P450 and environmental adaptation, as determined in a KEGG enrichment analysis. Unique unigenes were also identified, specific to Bpap vs. Cfor (808 unigenes), Bpap vs. Csep (329 unigenes), Bpap vs. Gbil (87 unigenes), Cfor vs. Csep (108 unigenes), Cfor vs. Gbil (32 unigenes), and Csep vs. Gbil comparisons (23 unigenes); partial unigenes were associated with the metabolism of terpenoids and polyketides regarding plant hormone signal transduction. Weighted gene co-expression network analysis (WGCNA) revealed four modules that were associated with the hosts. These results provide a foundation for further exploration of the detailed molecular mechanisms involved in plant parasitism.
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Muérdago , Perfilación de la Expresión Génica , Biblioteca de Genes , Humanos , Redes y Vías Metabólicas/genética , Transcriptoma/genéticaRESUMEN
Transmission rate and role in hosts contribute to the prevalence of an endosymbiont. However, factors affecting transmission and role of facultative endosymbionts are still not well understood. Here, we illustrated that host plants and environmental temperatures affected the transmission, relative abundance and role of Arsenophonus in the cotton aphid Aphis gossypii. The transmission rate of this endosymbiont from mother aphids to offspring was relatively lower. High temperatures impeded the transmission, and infection rates declined as aphids were exposed to 30°C. Contents of amino acids and secondary metabolites were remarkably different among host plants. Aphids feeding on zucchini leaves containing a higher titre of amino acids and lower secondary metabolites harboured a relatively lower abundance of Arsenophonus. Concentrations of an amino acid and a plant secondary metabolite, cucurbitacin B, in aphid diet were not associated with Arsenophonus abundance. However, gossypol, another plant secondary metabolite, was strongly related with the abundance. Arsenophonus imparted a fitness benefit to aphids, and the benefit was dependent on host plants and gossypol concentration. In sum, plant secondary metabolite and environmental temperature affect transmission, relative abundance and role of Arsenophonus, which determine the endosymbiont prevalence in aphid populations.
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Áfidos , Gammaproteobacteria , Gosipol , Aminoácidos , Animales , Plantas , Prevalencia , Simbiosis , TemperaturaRESUMEN
Dianthus chinensis is a medicinal plant. Its complete chloroplast genome sequence is 149,570 bp in length, containing 126 complete genes, including 84 protein-coding genes (84 PCGs), 8 ribosomal RNA genes (8 rRNAs), and 34 tRNA genes (34 tRNAs). The overall GC content of cp DNA is 34.1%, the corresponding values of the LSC, SSC, and IR regions are 34.0%, 29.8%, and 42.5%, respectively. Phylogenetic tree shows that D. chinensis is a sister to D. longicalyx.
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Scutellaria scordifolia Fisch. ex Schrank Li is a traditional Chinese medicinal plant of genus Scutellaria from the Labiatae family. The complete chloroplast genome of was 152,336 bp in length, which contained 133 complete genes including 87 protein-coding genes (87 PCGs), 8 ribosomal RNA genes (8 rRNAs), and 37 transfer RNA genes (37 tRNAs). The GC content of chloroplast DNA was 38.3%. The corresponding values of the LSC, SSC, and IR regions were 36.3%, 32.5%, and 43.6%, respectively. Phylogenetic tree showed that the species from genus Scutellaria were divided into two monophyletic clades, and the divergence time of S. scordifolia was earlier than that of the other species.
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BACKGROUND AND AIMS: China has conducted surveillance for hepatitis A since 1990, and hepatitis A was highly-to-intermediately endemic in 1992 when a Chinese hepatitis A vaccine (HepA) was licensed and introduced as a family-pay vaccine. In 2008, HepA was introduced into the Expanded Program on Immunization as a free childhood vaccine. APPROACH AND RESULTS: Three nationally representative surveys conducted in 1992, 2006, and 2014 assessed hepatitis B serology. The 1992 survey included hepatitis A virus (HAV) serology, and we tested sera from the 2006 and 2014 surveys for HAV antibodies. We used surveillance, seroprevalence, and vaccination status data to describe the changing epidemiology of hepatitis A in China from 1990 through 2014. Before HepA licensure, anti-HAV seroprevalence was 60% at 4 years of age, 70% at 10 years, and 90% at 59 years; incidence was 52/100,000 and peaked at 4 years. In 2006, after >10 years of private sector vaccination, HepA coverage was <30% among children <5 years, and incidence was 5.4/100,000 with a peak at 10 years. In 2014, coverage was >90% among children under 5 years; incidence was 1.9/100,000. Individuals born before the national introduction of HepA (1988-2004) had lower anti-HAV seroprevalence than earlier and later birth cohorts. CONCLUSIONS: The incidence of hepatitis A declined markedly following HepA introduction and improvement of sanitation and hygiene. The emerging epidemiology is consistent with disease-induced immunity having been replaced by vaccine-induced immunity, resulting in a low incidence of hepatitis A. Catch-up HepA campaigns to close the immunity gap among the 1998-2004 birth cohorts should be considered.
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Vacunas contra la Hepatitis A/uso terapéutico , Virus de la Hepatitis A Humana/inmunología , Hepatitis A/epidemiología , Adolescente , Adulto , Niño , Preescolar , China/epidemiología , Notificación de Enfermedades/estadística & datos numéricos , Femenino , Hepatitis A/inmunología , Hepatitis A/prevención & control , Anticuerpos de Hepatitis A/inmunología , Humanos , Incidencia , Lactante , Masculino , Vacunación Masiva/estadística & datos numéricos , Persona de Mediana Edad , Vigilancia en Salud Pública , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
The complete chloroplast genome sequence of Salix maizhokunggarensis, a native shrub willow species in the south of China, has been characterized using Illumina pair-end sequencing. The plastome is 155,093 bp in length, with one large single copy region of 83,956 bp, one small single copy region of 16,221 bp, and two inverted repeat (IR) regions of 27,458 bp. It contains 116 genes, including 79 protein-coding genes, 8 ribosomal RNA, and 36 transfer RNA. Phylogenetic tree shows that this species is a sister species to S. suchowensis. The plastome of Salix can provide significant insight for elucidating the phylogenetic relationship of taxa within Salicaceae.
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In 2002, China integrated hepatitis B vaccine (HepB) into its Expanded Program on Immunization (EPI) using HepB vaccine containing 5 µg of antigen. Although not recommended nationally, there was a common clinical practice in China of screening children for anti-HBs antibody level and giving a booster dose to HBV surface antigen (HBsAg)-negative children with non-protective anti-HBs antibody levels. We report an evaluation of the protective effectiveness of the 5 µg HepB vaccine and the serological response to the booster dose. We used data from a 2014 hepatitis B serological survey to determine HBsAg positivity and anti-HBs antibody levels among children who received and did not receive a booster dose. We determined HepB coverage from the Children Immunization Information Management System (CIIMS). We obtained and analyzed reports of acute Hepatitis B (AHB) during 2008-2014 obtained from the National Notifiable Disease Reporting System (NNDRS). The HBsAg-positive rate among children who had not received a booster dose was 0.41%, and did not increase with age (i.e., time since infant immunization). The anti-HBs positivity rate among the 6% of children who received a booster dose (88.41%) was higher than among those who had not received a booster (60.85%); anti-HBs antibody levels declined with age regardless of booster dose status. There was no statistically significant difference in HBsAg positivity between children who received a booster dose and those who did not. The AHB incidence among children born between 2002 and 2007 did not increase with age. Use of routine 5 µg HepB vaccine was not associated with an increase in AHB or of HBsAg positivity by time since vaccination, providing supportive evidence that individuals vaccinated with the 5 µg HepB vaccine do not need a booster dose. Although a booster dose was associated with increases in anti-HBs antibody levels, our study provided no evidence to support the need for this clinical practice. We should continue to strengthen serological monitoring of children, especially for those born to HBsAg positive mothers.
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Vacunas contra Hepatitis B/inmunología , Hepatitis B/epidemiología , Inmunización Secundaria/estadística & datos numéricos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Niño , China/epidemiología , Femenino , Hepatitis B/sangre , Hepatitis B/prevención & control , Hepatitis B/transmisión , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Vacunas contra Hepatitis B/administración & dosificación , Virus de la Hepatitis B/inmunología , Humanos , Programas de Inmunización/estadística & datos numéricos , Esquemas de Inmunización , Inmunogenicidad Vacunal , Incidencia , Lactante , Masculino , Estudios Seroepidemiológicos , Cobertura de Vacunación/estadística & datos numéricos , Vacunas de ADN/administración & dosificación , Vacunas de ADN/inmunologíaRESUMEN
We selected four Populus euphratica Oliv. forest plots (100 m × 100 m) in the upper reaches of the Tarim River in the Xinjiang Uygur Autonomous Region of China. Each of the four forest plots was chosen to represent a different growth and death stage of P. euphratica forest: juvenile forest, mature forest, dying forest, and dead forest. In each plot, we measured the coordinates, DBH, height, and status of all P. euphratica individuals. We used (1) spatial pattern analysis to explore spatial distribution patterns and associations of live trees and dead trees, (2) a random mortality model to test whether the tree death was random or non-random, and (3) a generalized linear mixed-effect model (GLMM) to analyse factors related to tree survival (or death). In the juvenile plot, live trees were significantly aggregated at all scales (p < 0.05); while in the mature and dying plots, live trees were more aggregated at small scales and randomly distributed at larger scales. Live trees and dead trees showed a significantly positive association at all scales in the juvenile plot (p < 0.05). While in the mature and dying plots, live trees and dead trees only showed a significantly positive association at scales of 0-3 m (p < 0.05). There was significant density-dependent mortality in the juvenile plot; while mortality was spatially random at all scales in the mature and dying plots. The distance from the river showed significantly negative correlations with tree survival (p < 0.01). DBH and height had significantly positive associations with tree survival in the juvenile, mature, and dying plots (p < 0.05). In extreme drought, dying trees appeared to be shape-shifting into more shrub-like forms with clumps of root sprouts replacing the high canopies. The shift under extreme drought stress to more shrub-like forms of P. euphratica may extend their time to wait for a favourable change.
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Bosques , Populus/fisiología , Análisis Espacial , China , Simulación por Computador , Sequías , Ecología , Geografía , Modelos Lineales , Raíces de Plantas , Ríos , ÁrbolesRESUMEN
BACKGROUND: Hepatitis A (HepA) vaccination and economic transitions can change the epidemiology of HepA. China's Gross Domestic Product (GDP) per capita was known to be inversely associated with the incidence of HepA, but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking. We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China. METHODS: We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season. We categorized the country into three regions, the sequential years into five era, compared the incidence, quartile age, seasonal intensity and coverage of HepA of the three regions. Linear regression was performed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence. RESULTS: The annual mean incidences of HepA in the eastern, central, and western regions decreased from 63.52/100 000, 50.57/100 000 and 46.39/100 000 in 1990-1992 to 1.18/100 000, 1.05/100 000 and 3.14/100 000 in 2012-2017, respectively. Decreases in incidence were seen in all age groups in the three regions; the incidence was highest (9.3/100 000) in the youngest age group (0-4 years) of the western region, while in the central region, the age group with the highest incidence changed from 0 to 9 years to adults ≥60 years old. In 2017, the median age of HepA cases was 43 years (Q1-Q3: 33-55), 47 years (Q1-Q3: 32-60) and 33 years (Q1-Q3: 9-52) in the eastern, central, and western provinces, respectively. Seasonal peaks became smaller or were nearly elimination nationwide, but seasonality persisted in some provinces. After the Expanded Program on Immunization (EPI) included HepA vaccine into the routine schedule in 2007, HepA coverage increased to > 80% in the three regions and was negatively association with the HepA incidence. CONCLUSION: The incidence of HepA decreased markedly between 1990 and 2017. A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China's EPI system, but inequity in incidence still existed in lower socio-economic developed region.
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Vacunas contra la Hepatitis A/administración & dosificación , Hepatitis A/epidemiología , Programas de Inmunización/estadística & datos numéricos , Factores Socioeconómicos , Vacunación/estadística & datos numéricos , China/epidemiología , Geografía , Hepatitis A/virología , Incidencia , Estudios Longitudinales , Estaciones del Año , Factores de TiempoRESUMEN
Genetic polymorphism and endosymbiont infection are ubiquitous in aphid populations. It has been known that the obligate symbiont Buchnera provides aphids with essential amino acids which cannot be ingested from plant sap. Buchnera often coexists with facultative endosymbionts in aphids. However, it is unclear whether the facultative endosymbionts affect the aphid's amino acid requirements from diet. In this study, we found that the facultative endosymbiont status in populations of the cotton-melon aphid Aphis gossypii was associated with aphid genotype or host plant. The infection frequency of Arsenophonus in aphids living on cotton was significantly higher than that in aphids on cucumber, and cucumber leaves contained higher titers of free amino acids than cotton leaves, especially amino acids Leu, Arg, Ile, Val, and Phe. The net reproductive rates of five aphid genotypes infected with Arsenophonus were not different on the complete-amino-acid diet, but the values were significantly different among seven Arsenophonus-free aphid genotypes. Moreover, the net reproductive rates of aphids on the amino-acid-deficient diet were significantly affected by Arsenophonus infection and aphid genotype. Arsenophonus infection decreased aphid performance on the Phe-free diet but improved performance on the Leu-free diet and did not affect the performance on the Ile-free or Val-free diet. Arsenophonus infections altered aphid requirements for amino acids that were significantly different in cotton and cucumber leaves, suggesting this endosymbiont would modulate the host specialization of this aphid.IMPORTANCE The facultative endosymbiont Arsenophonus plays an important role in regulating reproduction through son killing, enemy resistance, and the dietary breadth of its insect hosts. In this study, we found Arsenophonus could alter aphid performance on the amino-acid-deficient diets. Arsenophonus infection increased aphid requirements for the amino acid Phe, but decreased requirements for the Leu. Cotton and cucumber leaves contained drastically different titers of free amino acids Phe and Leu, and aphids living on these two plants were infected with different incidences of Arsenophonus We hypothesize that host specialization or the host plant range of aphids may be mediated by Arsenophonus.
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Áfidos/microbiología , Cadena Alimentaria , Gammaproteobacteria/fisiología , Simbiosis , Aminoácidos/deficiencia , Animales , Áfidos/crecimiento & desarrollo , Cucumis sativus , Gossypium , Ninfa/crecimiento & desarrollo , Ninfa/microbiologíaRESUMEN
BACKGROUND: To determine the treatment behaviors among a community-based cohort of chronic hepatitis B virus (HBV)-infected persons and to examine the disease progression among non-antiviral-treated HBV-infected cases after 5 years of follow-up. METHODS: We conducted a community-based prospective study on people with chronic HBV infection in mainland China from 2009 to 2014. In 2009, we recruited participants who were identified as HBV infected in 2006 in a national sero-survey. A face-to-face follow-up investigation was completed in 2014, and the personal information, the clinical diagnosis provided at the last hospital visit, the HBV antiviral treatment history, and the insurance type was collected for each patient for analysis. Multivariable logistic regression was used to identify factors that are associated with active medical care- seeking and antiviral treatments. RESULTS: Among the 2422 chronic HBV-infected patients recruited in 2009, 1784 (73.7%) were followed-up to 2014, and 638 (35.8%) had sought medical care in hospitals; among them, 140 (21.9%) received antiviral treatments. The lowest medical care-seeking rate (26%) was in participants over 50-year old. We determined that the frequency of medical care-seeking was higher among those participants living in urban areas (aRR = 1.3, 95% CI:1.0-1.6), those in 0-19-year old (aRR = 1.5, 95% CI:1.1-2.1), 20-39-year old (aRR = 2.2, 95% CI:1.7-3.0) and 40-49-year old (aRR = 1.5, 95% CI:1.1-2.0), and persons with insurance of the type Urban residents' basic medical insurance (URBMI) or Commercial health insurance (CHI) (aRR = 2.5, 95% CI:1.7-3.6) and New Rural Cooperative Medical System (NRCMS) (aRR = 1.9, 95% CI:1.4-2.6). Patients were more likely to receive antiviral treatment if they were 20-39-year old (aRR = 0.4, 95% CI:0.3-0.7), had insurance of the type URBMI or CHI (aRR = 2.6, 95% CI:1.1-6.3) or NRCMS (aRR = 3.0, 95% CI:1.3-6.9) and were treated at prefecture and above-level hospitals (aRR = 2.0, 95% CI:1.4-3.0). Among non-antiviral-treated HBV-infected cases, we found the annual rates for HBsAg sero-clearance, progress to cirrhosis and HCC were 1.0, 0.6 and 0.2%, respectively. CONCLUSION: The rates of medical care-seeking and antiviral treatment were low among community-based chronic HBV-infected persons, thus we recommend improving the insurance policies for HBV-infected persons to increase the antiviral treatment rate, and conducting extensive education to promote HBV-infected patients actively seeking medical care from hospitals.
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Hepatitis B Crónica/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Antivirales/uso terapéutico , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/virología , Niño , Preescolar , China/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Antígenos de Superficie de la Hepatitis B/análisis , Virus de la Hepatitis B , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/virología , Humanos , Lactante , Recién Nacido , Seguro de Salud/estadística & datos numéricos , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Motivación , Estudios Prospectivos , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Mother to child transmission of hepatitis B virus (HBV) remains the most common form of HBV infection in China. Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine (HepB) series and hepatitis B immunoglobulin. Post-vaccination serological testing (PVST) is utilized to determine an infant's outcome after HBV exposure and completion of HepB series. We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up (LTFU). METHODS: We conducted a retrospective cohort review of previously collected data in Fujian, Jiangxi, Zhejiang and Chongqing provinces in China from 1 June 2016-31 December 2017. The study population included all HBV-exposed infants and their mothers. SAS software was used for statistical analyses. Bivariate and multivariate regression analyses (presented in odds ratio [OR] with 95% confidence intervals [CI]) were used to compare the proportional differences of factors associated with PVST not being completed. RESULTS: Among enrolled 8474 target infants, 40% of them transferred out of the study provinces without further information and 4988 were eligible for PVST. We found 20% (994) of infants were not compliant with the testing cascade: 55% of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field, 16% transferred out after 6 months of age, and 10% of families chose to have independent, confidential PVST completed without reporting results. High PVST noncompliance rates were more likely to be from Fujian (aOR = 17.0, 95% CI: 9.7-29.9), Zhejiang (aOR = 5.7, 95% CI: 3.2-10.1) and Jiangxi (aOR = 1.9, 95% CI: 1.0-3.4), and from HBV e antigen positive mother (aOR = 1.2, 95% CI: 1.1-1.4). CONCLUSIONS: This study found that the LTFU rate reached 20% in PVST program, which was a significant problem. We recommend implementing a national electronic information system for tracking HBV at risk mother-infant pairs; encourage further research in developing a less invasive means of completing PVST, and take effective measures nationally to reduce HBV stigma. Without reducing the loss to follow up rate among infants eligible for PVST, elimination of vertical HBV transmission will be impossible.
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Virus de la Hepatitis B/fisiología , Hepatitis B/tratamiento farmacológico , Cooperación del Paciente/estadística & datos numéricos , Pruebas Serológicas/estadística & datos numéricos , Vacunación/estadística & datos numéricos , China , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Perdida de Seguimiento , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVES: Nation-wide hepatitis B vaccination coverage among healthcare workers (HCWs) is not well researched in China. This study aims to investigate the self-reported hepatitis B vaccination status among HCWs in China. METHODS: We conducted a cross-sectional survey of health_care workers' vaccination statuses in 120 hospitals in China by collecting demographic and vaccination data. Univariate and multivariate logistic regression analysis were used to assess factors associated with hepatitis B vaccination coverage. RESULTS: Eighty-six percent (2,666/3,104) of respondents reported having received at least one dose of the hepatitis B vaccination and 60% (1,853/3,104) reported having completed ≥3 doses of the hepatitis B vaccination. Factors associated with completing ≥3 doses of the hepatitis B vaccination included workplaces offering free hepatitis B vaccination with vaccination management, age, medical occupation, hospital level, acceptable hepatitis B knowledge and having received training on hepatitis B. HCWs in workplaces offering a free hepatitis B vaccine with vaccination management were 1.4 times more likely (OR = 1.4, 95% CI: 1.1-1.8) to complete their hepatitis B vaccination compared to HCWs in workplaces that did not offer a free hepatitis B vaccine. Either the possession of acceptable hepatitis B knowledge or an age of 30-39 years increased the odds of complete hepatitis B vaccination by 1.3-fold (95% CIs: 1.1-1.5 and 1.1-1.7, respectively) over their referent category. The receipt of training on hepatitis B was also associated with a higher percentage of completing the hepatitis B vaccination (OR = 1.5, 95% CI: 1.2-1.8). The main self-reported reason for incomplete hepatitis B vaccination was "forgot to complete follow-up doses" among 43% (234/547) of respondents. Among those who never received any hepatitis B vaccination, only 30% (131/438) intended to be vaccinated. Obtaining immunity from work (40%) and hospitals that did not provide hepatitis B vaccination activities (40%) were the top reasons mentioned for refusing hepatitis B vaccination. CONCLUSIONS: The complete hepatitis B vaccination rate among HCWs in China is low, and the desire of HCWs for vaccination is indifferent; therefore, education campaigns are needed. In addition, a free national hepatitis B vaccination policy for HCWs that includes vaccination management should be prioritized to improve hepatitis B coverage among HCWs who are at-risk for HBV infection.