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纸质出版:2015
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戴晨曦,马翠,宋丽娟,王开发.我国乙型病毒性肝炎流行趋势的动力学模型拟合分析[J].陆军军医大学学报(原第三军医大学学报),2015,37(22):2301-2306.
Dai Chenxi,Ma Cui,Song Lijuan,Wang Kaifa.Dynamic model fitting analysis of hepatitis B trends in China[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(22):2301-2306.
目的 探讨中国乙型病毒性肝炎的流行趋势并对现有防控措施进行评估。 方法 首先建立数学模型并利用遗传算法拟合中国国家卫生和计划生育委员会每年发布的国家法定传染病疫情中乙肝患者人数,确定模型参数,从而得到HBV基本再生数的估计值;再利用拉丁超立方抽样和偏等级相关系数方法分析各参数对HBV传播的敏感程度。 结果 中国HBV传播的基本再生数 (95%置信区间 0.659 1~0.671 8),说明在现有防控措施下HBV疫情已得到较好控制;敏感性分析结果表明对基本再生数的影响参数从大到小依次为HBV急性患者传播系数(β)、乙肝疫苗的年失效率(ψ)、HBV疫苗接种率(γ
3
)、HBV携带者传播权重(ε)、HBV急性患者未能清除感染的平均概率(q)和HBV携带者向康复人群转化的系数(γ
2
)。 结论 现有防控措施对中国乙型病毒性肝炎的流行已产生积极作用,并且现阶段我国HBV疫情传播的主要特点是携带者的影响作用远大于急性患者的影响。加强对社会人群的健康宣教以降低感染风险、严格实施乙肝疫苗接种计划是现阶段防控措施的重点。
Objective To explore the long-term trends of hepatitis B in China and evaluate the current control measures implemented by the Chinese government. Methods A dynamic model was first proposed
and the reported data by the National Health and Family Planning Commission of the People’s Republic of China is fitted to obtain the estimations of model parameters and corresponding basic reproduction number. Then the sensitivity analysis was performed by Latin hypercube sampling and the partial rank correlation coefficient. Results The basic reproduction number was estimated as 0.671 2 (95% CI: 0.659 1-0.6
71 8)
which indicated that the epidemics of HBV was under control by the existing prevention and control measures. The sensitivity analysis results showed that there were 6 significant parameters with significant impact on the basic reproduction number
and according to the intensity from top to bottom
they were the transmission coefficient of acute infectious(β)
rate of waning vaccine-induced immunity (ψ)
vaccination rate (γ
3
)
reduced transmission rate of carriers (ε)
average probability that an acute infection fails to clear and become a carrier (q)
and rate moving from carriers to immune crowds (γ
2
). Conclusion The current prevention and control measures have played an active role in controlling the prevalence of HBV infection
and the effect of the carriers is larger than that of acute infection patients. Strengthening the health education to reduce the risk of infection and implementing strict policies of HBV vaccination are the focus to further reduce hepatitis B epidemics in China.
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