| Objective:To analyze the epidemiological characteristics of acute viral hepatitis in Xuhui district, Shanghai in order to provide related evidence for perfecting the strategies and measures for the treatment and prevention on hepatitis; To investigate the awareness of hepatitis C in medical staff, in order to provide evidence for improving their prevention and treatment capacity for hepatitis C.To explore the risk factors for hepatitis E, as well as to suggest strategies for hepatitis E control.Methods:1. The epidemic situation data of virus hepatitis reported from2000to2010in Xuhui was analyzed. The population data was provided by Shanghai Police Bureau of Xuhui branch. The epidemiologic characteristics of viral hepatitis were analyzed in detail with incidence rate, proportion.2. Using a stratified sampling approach,800medical staff in key departments from primary to tertiary hospitals in Xuhui in all selected districts were interviewed using a structured questionnaire of the awareness of hepatitis C medical staff. Five primary hospitals were selected each40, two secondary hospitals each200and two tertiary hospitals each100,who were from the emergency department, internal medicine, surgery (including operation room), Obstetrics and Gynecology, pediatrics, laboratory, hemodialysis room, endoscopy room or traditional Chinese medicine acupuncture and moxibustion physiotherapy department, nosocomial infection, Stomatology, supply room and dermatology STD.outpatient department. The questionnaire was including medical staff general conditions, knowledge on HCV transmission, diagnosis, treatment and prognosis. anti-HCV detection and acquaintance with C whether to continue the communication content.3. Cases diagnosed as hepatitis E by clinic and serology from January2007to June2009were chosen for study altogether102and matched with204controls in1:2matched case-control study on risk factors for hepatitis E.The cases were from Longhua hospital, the sixth hospitals and the eighth hospital which were viral hepatitis surveillance hospitals in Xuhui, and the controls from the Xuhui community health. The matching conditions are same gender, younger or older2years old, similar inhabited environment, exclude the previous history of hepatitis, hepatitis virus carriers and patients with digestive system diseases. The cases and controls were interviewed using a structured questionnaire. The main contents of questionnaire included that general state of health, health habits, risk factors about hepatitis patient contact history; whether eating salad, drunk dish, eating raw shell, eating freshwater, hot pot and so on; washing hands before meals or after defacation, water sanitation, whether in health facilities and often eating outside (at the individual vendors, restaurants or buy take-away food) and travel history nearly2months before the onset.Results:1. Epidemiological analysis on acute viral hepatitis in Xuhui district,Shanghai from year2000to20102629cases of reistered residents was reported totally from2000to2010in Xuhui,Shanghai.The annual average incidence rate of acute viral hepatitis was26.88per100,000, at a historic low level. The incidence of Class A and B notifiable infectious diseases and viral hepatitis had both declined generally during11years. The downward trend of hepatitis incidence is not obvious from2006to2010, but Class A and B infectious diseases remain a significant decrease.Viral hepatitis type rate rise, remained above95%from2009to2010.Great change have taken place among viral hepatitis type in Xuhui District. Hepatitis A accounted for26.09%in the total constituent ratio of the acute viral hepatitis in2000, and tended to decrease.The proportion is reduced gradually last ten years, accounted for only8.91%in2010. The constituent ratio of HE jumped from16.03%in2000to43.56%in2010.HE incidence and proportion was both more than HA since2003,and more than HB for2consecutive years from2009to2010.There was no HE outbreak. There was obvious epidemic cycle with a spring and winter rise. HC was similarly to sporadic, but showed a steady upward trend.Hepatitis incidence of male was higher than that of females; the most of viral hepatitis occupation is the retires.The incidence peak of different hepatitis type were in different ages, HA and HB were still under the age of45young adults, HC to75-79years old.HE to60-64years old. Hepatitis generally are their high risk age for the sector, younger than the age when the incidence increased with the age increased, older than the age decreases with increasing age. The incidence of the combination of urban and rural areas (32.32/100000) was higher than that of the center city district (20.34/100000).2.Hepatitis C Awareness in Medical Staff in Xuhui DistrictThe HC awareness rate in Medical staff was71.56%totally. No one can answer all34options on the questionnaire correctly. Medical staff were familiar to HCV pathogenic knowledge relatively, but " HC can be infected by sharing towels, clothes and shaver, antiviral effective method for treatment of HC, HC can be cured, acute HC may automatically cleans " awareness rate less than50%, only49%,48%,39.75%and36%.There were significant differences of the awareness across different hospital grades and different education levels (P<0.05). The awareness rate in the medical staff in tertiary hospitals was higher than those in primary and secondary ones, and the awareness rate increased with higher education level (χ2trend=117.173, Ptrend<0.01).There was no different awareness rate between primary and secondary hospitals.The awareness rate of exact HC transmission route in Medical staff were76.88%," received a blood transfusion and blood products, sharing of syringes can spread HC" awareness rate is higher,97.81%and92.35%respectively.Different medical occupation, different awareness rate of the exact transmission route of HC (χ2=17.204, P<0.01), the doctors’were78.65%, the nurses’were74.64%,technical staff and et al were80.66%.The nurses’awareness rate lower than the doctors’ and technicians’in fact (P<0.05); there was no significant difference between the doctors’and technicians’comparely (P>0.05). Only177person answered all correctly about HC transmission route among800medical staff. The correct rate was only22.13%.In the course of medical treatment,76.88%of the staff were not aware of treatment or care whether the patient is infected with HCV.63.63%person answered never checked the hepatitis C antibody,82.71%of which were not checked because no chance.3. Case-control study on risk factors for hepatitis EUnivariate analysis showed that often eating outside (at the individual vendors, restaurants or buy take-away food), hot pot, eating raw shellfish, raw freshwater fish and having travel history during2months before onset were associated with HE. Multiple factors logistic regression showed that the risk factors of HE were Often eating outside (OR=5.466,95%CI:2.217-13.480),occasionally eating outside (OR=2.812,95%CI:1.552-5.096) and eating raw freshwater fish (OR=3.281,95%CI: 1.153-9.339).Conclusion and suggestion;:The acute viral hepatitis incidence decreased in Xuhui District from2000to2010, but nearly5years of decline is not significant. The incidence of HC was rising, HA is no longer the main type of viral hepatitis. The upward trend of HE in the constituent ratio of hepatitis suggested that should be strengthened prevention and control measures against HE and HC, as well as the good use of HA vaccine and HB vaccine.The training on HC in the medical staff should be enforced, especially to the staff in primary and secondary hospitals and with lower education.HE risk factors in Xuhui are eating out and raw freshwater fish. Measures should be taken to prevent people from HE by strengthening safety food and water source, changing bad eating habits and so on. |
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