公共服务场所乙型肝炎病毒感染危险性研究
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摘要
背景
中国是乙型肝炎(乙肝)病毒(HBV)感染高流行区。针对HBV高流行势态,中国政府于1992年将乙肝疫苗(HepB)纳入免疫规划管理,2002年正式纳入免疫规划,2004年新生儿免费接种,2008年青少年开展群体性接种,HepB全程接种率和首针及时接种率逐年提高。2006年全国乙型病毒性肝炎血清流行病学调查(简称乙肝调查)结果表明中国1～59岁人群HBsAg携带率7.18%,＜15岁儿童2.08%(其中1～4岁儿童0.96%),≥15岁人群8.12%;与1992年乙肝调查结果相比,＜15岁儿童HBsAg携带率下降明显(其中1～4岁儿童下降幅度最大),≥15岁人群HBsAg携带率变化不明显,表明中国以HepB免疫接种为主的综合性防治措施效果显著,也揭示了中国HBV流行特征将会发生改变,即以母婴为主的传播方式将逐渐被水平传播方式为主所取代。针对中国HBV流行特征变迁,乙肝防治策略也应相应调整。
美容美发、修脚、洗浴和按摩为主的公共服务场所人群流动大、服务复杂,易造成HBV水平传播,从业人员既是HBV感染高危人群,亦可作为传染源造成HBV水平传播。目前国内尚无针对此人群开展HBV感染状况调查和传播危险评估数据,难以评价中国公共服务场所HBV感染风险和传播风险,也缺乏制定针对公共服务场所HBV防治策略的依据。为此,我们选择青海省、湖南省、海南省和深圳部分地区开展公共服务场所HBV感染危险性研究,旨在为我国制定公共服务场所相关政策提供科学依据。
目的
一、掌握公共服务场所用具消毒方式与HBsAg污染及从业人员HBsAg携带情况,评价公共服务场所HBV感染危险性;
二、采用病例对照研究设计,分析公共服务场所HBV感染的主要危险因素及危险度;
三、评价公共服务场所HBV感染危险性,为我国调整公共服务场所乙肝防治策略提供理论依据。
方法
一、利用横断面调查方法,在湖南、海南、青海和深圳四地,按照经营面积将公共服务场所分成大型、中型、小型三层,各层随机抽取美容院、美发店、理发店和洗浴中心共84家,对684名工作人员和部分顾客开展问卷调查。用放射免疫法(RIA)检测公共场所用具HBsAg污染情况及从业人员血清HBsAg。
二、利用病例对照研究设计,在湖南、海南、青海和深圳四地的传染病医院或肝病医院随机选择2005年～2006年乙肝新发病例(200例)作为病例组,按照年龄、居住地匹配原则以1:1配对选择未感染HBV者(HBsAg和抗-HBc均阴性)作为对照组,对病例组和对照组开展问卷调查并用RIA复核血清HBsAg和抗-HBc。
三、利用Logistic回归方法分析,得出公共服务场所感染HBV的主要危险因素及OR值,运用数学模型将危险因素转化为危险分数。
四、数据分析采用SPSS 13.0软件。
结果
一、通过问卷调查发现公共服务场所用具消毒方式有酒精擦拭、紫外线照射、高压蒸汽消毒、高效含氯消毒剂浸泡和清洗设备,其中酒精擦试和紫外线照射分别占34.60%和30.79%。
二、公共服务场所用具表面HBsAg检出率2.13%,大型、中型和小型公共服务场所用具HBsAg检出率分别0.63%、2.67%和3.70%,大、小型公共服务场所用具HBsAg检出率差异显著(x~2=6.68,P＜0.05)。美容院、理发店和洗脚店用具HBsAg检出率分别2.97%、0.61%和3.42%;不同用具HBsAg检出率不同,暗疮针和镊子检出率较高,分别5.13%和4.17%。洗脚店用的刀具HBsAg检出率8.33%:美容院用的刀具HBsAg检出率4.17%。
三、公共服务场所从业人员血清HBsAg调整阳性率9.17%,大型、中型和小型公共场所从业人员HBsAg阳性率分别7.34%、8.33%和2.94%;在美容院、理发店、洗脚店和洗浴场所工作人员HBsAg阳性率分别9.01%、6.37%、4.35%和7.29%;不同服务行业从业人员HBsAg阳性率各异,纹眉、纹唇和纹身行业者最高(13.33%)、修脚者(12.68%)、按摩者8.03%。美容院从业人员HBsAg携带率随工作年限递增呈上升趋势(r=0.83);修脚、按摩和纹眉(纹身等)从业人员HBsAg携带率随工作年限递增呈上升趋势(r=0.89)。
四、公共服务场所575名工作人员和部分顾客有皮肤损伤史177人,HBsAg阳性者23人(携带率12.99%);无皮肤损伤史398人,HBsAg阳性者18人(携带率4.52%),两者有显著性统计学差异(x~2=16.07,P＜0.001),其中在美容院有皮肤损伤史HBsAg携带率15.15%,洗脚店从业人员12.50%,洗浴中心从业人员18.75%,均明显高于无皮肤损伤史(5.13%、1.89%和4.00%)。修脚从业人员中有皮肤损伤史者16人中HBsAg慢性者9人,纹眉(纹身)有皮肤损伤史者8人,其中HBsAg阳性2人。在177名有皮肤损伤史中,有120人未经包扎处理继续为顾客服务,其HBsAg携带率15.00%,57位经简单包扎后继续为顾客服务者HBsAg携带率8.77%,均明显高于“2006年乙肝调查结果”。
五、病例对照研究数据经多因素分析表明,除研究对象的职业和文化程度外,在公共服务场所有无修面美容、修脚、纹眉(纹身、打耳孔等)、剃毛(须)史是HBV感染危险因素,接种HepB V和乙肝KAP得分高是保护因素。
六、KAP调查显示公共服务场所工作人员和顾客对乙肝普遍缺乏自我保护意识,主要表现在:(1)对HBV传播途径知晓差;(2)对HBV感染后严重性认识不足,对乙肝临床表现缺乏认识,难以做到早发现、早诊断和早治疗;(3)公共服务场所从业人员知晓接种HepB V能有效预防HBV感染,但有HepB免疫史者仅22%;(4)公共服务场所有些从业人员在为顾客服务时有皮肤破损现象,且多不经包扎等处理仍继续为顾客服务。
七、将公共服务场所感染HBV的主要危险因素转化为危险分数,根据个体情况得到了组合危险分数,从而预测该个体公共服务场所感染HBV的危险。
结论
本研究是国家科技攻关项目《我国乙型肝炎流行规律和防治对策研究》中的子课题,也是我国第一次较全面系统地开展有关公共服务场所用具消毒和HBsAg污染情况、从业人员HBsAg携带情况调查,分析了公共服务场所HBV感染的危险因素,建立了公共服务场所HBV感染危险分数表,探讨一种评价公共服务场所感染HBV危险因素的方法学。研究结果表明公共服务场所存在HBV感染(传播)的可能,尤其是修脚、美容、按摩等服务行业;研究结果还提示我们应加强公共服务场所器械消毒管理、规范消毒方法,对从业人员等高危人群开展乙肝疫苗预防接种,通过加强对公众健康教育来提高对乙肝防治知识知晓率和法律监督意识。
本研究结果为制定乙肝防治规划及《预防接种实践与管理》中乙肝预防控制相关内容提供了理论依据。
Background
China is the high prevalent region for HBV infection.To control and prevent HBV infection,Chinese government had taken many effective measures,including HepBV introduced into the national immunization programme(NIP) in 1992,integrated into the NIP in 2002,implemented free vaccination on all newborn children in 2004,and schemed vaccinating in the teenagers in 2008.The coverage rate of HepB_3 and the birthdose had gradually increased.In 2006,the national serological epidemiological survey on hepatitis B in China(the Hepatitis B survey) showed that:the prevalence rate of HBsAg is 7.18%in the population aged with 1～59 years-old,the rate is 2.08%for the children aged less than 15 years-Old(the rate is 0.96%for the children aged with 1～4 years old),the rate is 8.12%for the population aged above 15 years-old.Compared with the result of the hepatitis B survey in 1992,the rate of HBsAg among the children aged less than 15 years-old have obviously decreased(especially in the children aged with 1～4 years-old),and the rate of the population aged above 15 years-old have not significantly changed.These showed that the effect of the comprehensive prevention and control measures for Hepatitis B,which make the HepB V vaccinization as the center step among all measures,had been achieved great success in China,and it also implied that the epidemic character of the transmission way from mother to child would be gradually replaced by horizontal transmission for HBV in the future.Therefore,the strategies for hepatitis B control and prevention should be adjusted to adapt to the change of HBV prevalence characteristics in China.
There are many beauty salons、pedicuring,hairdressing,tattoo and massage in the public service places(PSP),where the crowds flow frequently and need special service which these special services could cause the spread of HBV between the practitioners and the customer.The practitioners worked in the PSP are both high-risk group of HBV infection and infection source which could horizontally spread HBV.In China,there hasn't launched the investigation of HBV infection in the PSP,and also lack of the relative data which could evaluate the risk of HBV infection in the PSP.Therefore,we have carried out the study on the probability of HBV infection in the PSP of Qinghai, Hunan,Hainan and Shenzhen,which purpose will provide the scientific information to formulate the strategies for the control and prevention of HBV infection in the future.
Objective
1.To master the situation of apparatus disinfection in public services place and detect the HBsAg rate of bath the apparatus and the employees in those places,explore the probability of HBV infection in the PSP;
2.To know main risk factors and risk scores about HBV infection in public service place by carrying out the case-control study;
3.To evaluate the risk of HBV infection in the public service places,and provide theoretical basis to adjust the hepatitis B control and prevention tactics and relevant law about HBsAg carriers in China.
Methods
1.In Hunan province,Hainan province,Qinghai province and Shenzhen city,where the PSP has been divided into the large-,mid- and small-sized levels on the basis of management areas.Some beauty parlors,haircuting parlors,footbathing inns and bathing centers were chosen from the large-,mid- and small scales respectively.684 staffs and partial customers were investigated in questionnaire in these PSP.The HBsAg on the appliances used in the PSP and the staff's blood serum worked in those places were detected by RIA.
2.In infectious disease hospitals and the hepatitis hospital of Hunan province, Hainan province,Qinghai province and Shenzhen city,there were 200 new hepatitis B cases(the case group) were chosen by random sampling among the patients infected by HBV in 2005～2006,and the 'control group' including 289 person was chosen from the population with the negative HBsAg and anti-HBc by the similar age,inhabited area, and the no-PSP relative risk factors with the 'control group',and the questionnaires have been carried out and HBsAg would been confirmed with RIA in both 'the case group' and 'the control group'.
3.To calculate the major risk factors of HBV infection by Logistic regression,and the odds ratio of risk factors.Different risks in PSP were converted into the risk scores by using the statistical models.
4.The data were analyzed by SPSS 13.0 software.
Results
1.The main disinfection methods of the appliances used in PSP are cleaned by alcohol,disinfected by ultraviolet ray,disinfected with steam,disinfected by chloric and disinfected by cleanout facilities;the rate of the cleaned by alcohol and disinfected by ultraviolet ray accounts for 34.60%and 30.79%respectively.
2.The HBsAg detection rate of the appliances used in the PSP is 2.13%,the detected rate of the appliances used in the large-,med- and small-sized PSP is 0.63%, 2.67%and 3.70%respectively,the detected rate of the appliances used in large- and small- scale PSP is remarkable different(x2=6.68,P＜0.05 ).The rate of the appliances used in the beauty parlors、barbering shop and footbath inns respectively is 2.97%, 0.61%and 3.42%respectively;The detection rate of the different appliances are different,the rate is higher on the acne needles(5.13%) and the forceps(4.17%).The detection rate with the knives used in footbath inns is 8.33%;and that in beauty parlors is 4.17%.
3.The adjusted positive rate of HBsAg among the employees worked in the PSP is 9.17%,the positive rate of HBsAg among the employees worked in large-,Med- and small-scale PSP is 7.34%,8.33%and 2.94%respectively;the positive rate of HBsAg among the staffs worked in beauty parlors,barbering shops,footbath inns and bathing centers is 9.01%,6.37%,4.35%and 7.29%respectively;for different service,the rate of HBsAg are different,the highest rate is 13.33%in the tattoo workers(13.33%),the pedicures workers(12.68%),the Massagists(8.03%).The rate of HBsAg among the employees worked in the beauty parlors is positive correlative with the working years (R=0.83).The rate of HBsAg among the employees with pedicuring,massaging and tattooing is positive correlative with the working years(R=0.89).
4.The positive rate of HBsAg among the staffs with the skin scathing history is 12.99%(23/177),and the rate is 4.25%for the staff without the skin scathing history. The HBsAg rate among staff with the skin scathing history and without the skin scathing history has statistical difference(x2=16.07,P＜0.01).Among the staff with the skin scathing history,the positive rate of HBsAg among the employees worked in the beauty parlor is 15.15%,the rate is 12.50%for the pedicuring workers and 18.75%for the bathing workers,and the rate of HBsAg is obviously higher than those without the skin scathing history(5.13%、1.89%and4.00%respectively).The HBsAg rate among the pedicuring worker with the skin scathing history is 56.25%.The HBsAg rate of the tatooing worker with the skin scathing history is obviously higher than those without the skin scathing history.Among 177 people with the skin scathing history,the rate of HBsAg is 15.00%among the 120 people who are still working without enswathing,the rate is 8.77%among the 57 people who are continued to serve for customers by easily enswathement,and the rates of both people are higher than the natural population.
5.The Multi-factors analysis of the case control study shows that:besides the occupation and education levels of the study objects,the risk factors about HBV infection in the PSP mainly have the following factors,such as shaving,hairdressing, pedicuring,and tattooing;the HepB vaccinating and KAP scores about Hepatitis B are protection factors.
6.The KAP investigation show that the staffs and customers of the PSP are lack of self-protection awareness of hepatitis B,which are mainly embodied in:(1) Knows a little about HBV dissemination methods;(2) After the HBV infection,people have little attention to severity,lacks knowledge about the hepatitis B clinical manifestation,it is difficult to discover、diagnose and treat early;(3) The employees worked in the PSP know that HepB vaccinating will prevent the HBV infection effectively,but the people with HepB vaccinating account for only 22%;(4) Some employees with the skin scathing history are continued to serve for customers by easily enswathement or without enswathement.
7.Different risk factors of HBV infection in PSP were converted into risk scores. The related risk scores were added to obtain a combined risk scores to predict the individual's risk of HBV infection in PSP.
Conclusion
This investigation is the first national system study about the appliances disinfection and HBsAg contamination situation,the rate of HBsAg among the employees and the customers in the PSP.We have analyzed the risk factors about HBV infection and achieved good data in PSP.The results show that in the public service place has the possibility of HBV infection(dissemination),and indicate that the appliances disinfection management should be strengthened,the disinfection methods should be regulated,HepB should be vaccinated among the staff worked in the PSP.The findings also suggest that we should carry out the public health education about Hepatitis B and strengthen people's legal supervision consciousness.
中国是乙型肝炎(乙肝)病毒(HBV)感染高流行区。针对HBV高流行势态,中国政府于1992年将乙肝疫苗(HepB)纳入免疫规划管理,2002年正式纳入免疫规划,2004年新生儿免费接种,2008年青少年开展群体性接种,HepB全程接种率和首针及时接种率逐年提高。2006年全国乙型病毒性肝炎血清流行病学调查(简称乙肝调查)结果表明中国1～59岁人群HBsAg携带率7.18%,＜15岁儿童2.08%(其中1～4岁儿童0.96%),≥15岁人群8.12%;与1992年乙肝调查结果相比,＜15岁儿童HBsAg携带率下降明显(其中1～4岁儿童下降幅度最大),≥15岁人群HBsAg携带率变化不明显,表明中国以HepB免疫接种为主的综合性防治措施效果显著,也揭示了中国HBV流行特征将会发生改变,即以母婴为主的传播方式将逐渐被水平传播方式为主所取代。针对中国HBV流行特征变迁,乙肝防治策略也应相应调整。
美容美发、修脚、洗浴和按摩为主的公共服务场所人群流动大、服务复杂,易造成HBV水平传播,从业人员既是HBV感染高危人群,亦可作为传染源造成HBV水平传播。目前国内尚无针对此人群开展HBV感染状况调查和传播危险评估数据,难以评价中国公共服务场所HBV感染风险和传播风险,也缺乏制定针对公共服务场所HBV防治策略的依据。为此,我们选择青海省、湖南省、海南省和深圳部分地区开展公共服务场所HBV感染危险性研究,旨在为我国制定公共服务场所相关政策提供科学依据。
目的
一、掌握公共服务场所用具消毒方式与HBsAg污染及从业人员HBsAg携带情况,评价公共服务场所HBV感染危险性;
二、采用病例对照研究设计,分析公共服务场所HBV感染的主要危险因素及危险度;
三、评价公共服务场所HBV感染危险性,为我国调整公共服务场所乙肝防治策略提供理论依据。
方法
一、利用横断面调查方法,在湖南、海南、青海和深圳四地,按照经营面积将公共服务场所分成大型、中型、小型三层,各层随机抽取美容院、美发店、理发店和洗浴中心共84家,对684名工作人员和部分顾客开展问卷调查。用放射免疫法(RIA)检测公共场所用具HBsAg污染情况及从业人员血清HBsAg。
二、利用病例对照研究设计,在湖南、海南、青海和深圳四地的传染病医院或肝病医院随机选择2005年～2006年乙肝新发病例(200例)作为病例组,按照年龄、居住地匹配原则以1:1配对选择未感染HBV者(HBsAg和抗-HBc均阴性)作为对照组,对病例组和对照组开展问卷调查并用RIA复核血清HBsAg和抗-HBc。
三、利用Logistic回归方法分析,得出公共服务场所感染HBV的主要危险因素及OR值,运用数学模型将危险因素转化为危险分数。
四、数据分析采用SPSS 13.0软件。
结果
一、通过问卷调查发现公共服务场所用具消毒方式有酒精擦拭、紫外线照射、高压蒸汽消毒、高效含氯消毒剂浸泡和清洗设备,其中酒精擦试和紫外线照射分别占34.60%和30.79%。
二、公共服务场所用具表面HBsAg检出率2.13%,大型、中型和小型公共服务场所用具HBsAg检出率分别0.63%、2.67%和3.70%,大、小型公共服务场所用具HBsAg检出率差异显著(x~2=6.68,P＜0.05)。美容院、理发店和洗脚店用具HBsAg检出率分别2.97%、0.61%和3.42%;不同用具HBsAg检出率不同,暗疮针和镊子检出率较高,分别5.13%和4.17%。洗脚店用的刀具HBsAg检出率8.33%:美容院用的刀具HBsAg检出率4.17%。
三、公共服务场所从业人员血清HBsAg调整阳性率9.17%,大型、中型和小型公共场所从业人员HBsAg阳性率分别7.34%、8.33%和2.94%;在美容院、理发店、洗脚店和洗浴场所工作人员HBsAg阳性率分别9.01%、6.37%、4.35%和7.29%;不同服务行业从业人员HBsAg阳性率各异,纹眉、纹唇和纹身行业者最高(13.33%)、修脚者(12.68%)、按摩者8.03%。美容院从业人员HBsAg携带率随工作年限递增呈上升趋势(r=0.83);修脚、按摩和纹眉(纹身等)从业人员HBsAg携带率随工作年限递增呈上升趋势(r=0.89)。
四、公共服务场所575名工作人员和部分顾客有皮肤损伤史177人,HBsAg阳性者23人(携带率12.99%);无皮肤损伤史398人,HBsAg阳性者18人(携带率4.52%),两者有显著性统计学差异(x~2=16.07,P＜0.001),其中在美容院有皮肤损伤史HBsAg携带率15.15%,洗脚店从业人员12.50%,洗浴中心从业人员18.75%,均明显高于无皮肤损伤史(5.13%、1.89%和4.00%)。修脚从业人员中有皮肤损伤史者16人中HBsAg慢性者9人,纹眉(纹身)有皮肤损伤史者8人,其中HBsAg阳性2人。在177名有皮肤损伤史中,有120人未经包扎处理继续为顾客服务,其HBsAg携带率15.00%,57位经简单包扎后继续为顾客服务者HBsAg携带率8.77%,均明显高于“2006年乙肝调查结果”。
五、病例对照研究数据经多因素分析表明,除研究对象的职业和文化程度外,在公共服务场所有无修面美容、修脚、纹眉(纹身、打耳孔等)、剃毛(须)史是HBV感染危险因素,接种HepB V和乙肝KAP得分高是保护因素。
六、KAP调查显示公共服务场所工作人员和顾客对乙肝普遍缺乏自我保护意识,主要表现在:(1)对HBV传播途径知晓差;(2)对HBV感染后严重性认识不足,对乙肝临床表现缺乏认识,难以做到早发现、早诊断和早治疗;(3)公共服务场所从业人员知晓接种HepB V能有效预防HBV感染,但有HepB免疫史者仅22%;(4)公共服务场所有些从业人员在为顾客服务时有皮肤破损现象,且多不经包扎等处理仍继续为顾客服务。
七、将公共服务场所感染HBV的主要危险因素转化为危险分数,根据个体情况得到了组合危险分数,从而预测该个体公共服务场所感染HBV的危险。
结论
本研究是国家科技攻关项目《我国乙型肝炎流行规律和防治对策研究》中的子课题,也是我国第一次较全面系统地开展有关公共服务场所用具消毒和HBsAg污染情况、从业人员HBsAg携带情况调查,分析了公共服务场所HBV感染的危险因素,建立了公共服务场所HBV感染危险分数表,探讨一种评价公共服务场所感染HBV危险因素的方法学。研究结果表明公共服务场所存在HBV感染(传播)的可能,尤其是修脚、美容、按摩等服务行业;研究结果还提示我们应加强公共服务场所器械消毒管理、规范消毒方法,对从业人员等高危人群开展乙肝疫苗预防接种,通过加强对公众健康教育来提高对乙肝防治知识知晓率和法律监督意识。
本研究结果为制定乙肝防治规划及《预防接种实践与管理》中乙肝预防控制相关内容提供了理论依据。
Background
China is the high prevalent region for HBV infection.To control and prevent HBV infection,Chinese government had taken many effective measures,including HepBV introduced into the national immunization programme(NIP) in 1992,integrated into the NIP in 2002,implemented free vaccination on all newborn children in 2004,and schemed vaccinating in the teenagers in 2008.The coverage rate of HepB_3 and the birthdose had gradually increased.In 2006,the national serological epidemiological survey on hepatitis B in China(the Hepatitis B survey) showed that:the prevalence rate of HBsAg is 7.18%in the population aged with 1～59 years-old,the rate is 2.08%for the children aged less than 15 years-Old(the rate is 0.96%for the children aged with 1～4 years old),the rate is 8.12%for the population aged above 15 years-old.Compared with the result of the hepatitis B survey in 1992,the rate of HBsAg among the children aged less than 15 years-old have obviously decreased(especially in the children aged with 1～4 years-old),and the rate of the population aged above 15 years-old have not significantly changed.These showed that the effect of the comprehensive prevention and control measures for Hepatitis B,which make the HepB V vaccinization as the center step among all measures,had been achieved great success in China,and it also implied that the epidemic character of the transmission way from mother to child would be gradually replaced by horizontal transmission for HBV in the future.Therefore,the strategies for hepatitis B control and prevention should be adjusted to adapt to the change of HBV prevalence characteristics in China.
There are many beauty salons、pedicuring,hairdressing,tattoo and massage in the public service places(PSP),where the crowds flow frequently and need special service which these special services could cause the spread of HBV between the practitioners and the customer.The practitioners worked in the PSP are both high-risk group of HBV infection and infection source which could horizontally spread HBV.In China,there hasn't launched the investigation of HBV infection in the PSP,and also lack of the relative data which could evaluate the risk of HBV infection in the PSP.Therefore,we have carried out the study on the probability of HBV infection in the PSP of Qinghai, Hunan,Hainan and Shenzhen,which purpose will provide the scientific information to formulate the strategies for the control and prevention of HBV infection in the future.
Objective
1.To master the situation of apparatus disinfection in public services place and detect the HBsAg rate of bath the apparatus and the employees in those places,explore the probability of HBV infection in the PSP;
2.To know main risk factors and risk scores about HBV infection in public service place by carrying out the case-control study;
3.To evaluate the risk of HBV infection in the public service places,and provide theoretical basis to adjust the hepatitis B control and prevention tactics and relevant law about HBsAg carriers in China.
Methods
1.In Hunan province,Hainan province,Qinghai province and Shenzhen city,where the PSP has been divided into the large-,mid- and small-sized levels on the basis of management areas.Some beauty parlors,haircuting parlors,footbathing inns and bathing centers were chosen from the large-,mid- and small scales respectively.684 staffs and partial customers were investigated in questionnaire in these PSP.The HBsAg on the appliances used in the PSP and the staff's blood serum worked in those places were detected by RIA.
2.In infectious disease hospitals and the hepatitis hospital of Hunan province, Hainan province,Qinghai province and Shenzhen city,there were 200 new hepatitis B cases(the case group) were chosen by random sampling among the patients infected by HBV in 2005～2006,and the 'control group' including 289 person was chosen from the population with the negative HBsAg and anti-HBc by the similar age,inhabited area, and the no-PSP relative risk factors with the 'control group',and the questionnaires have been carried out and HBsAg would been confirmed with RIA in both 'the case group' and 'the control group'.
3.To calculate the major risk factors of HBV infection by Logistic regression,and the odds ratio of risk factors.Different risks in PSP were converted into the risk scores by using the statistical models.
4.The data were analyzed by SPSS 13.0 software.
Results
1.The main disinfection methods of the appliances used in PSP are cleaned by alcohol,disinfected by ultraviolet ray,disinfected with steam,disinfected by chloric and disinfected by cleanout facilities;the rate of the cleaned by alcohol and disinfected by ultraviolet ray accounts for 34.60%and 30.79%respectively.
2.The HBsAg detection rate of the appliances used in the PSP is 2.13%,the detected rate of the appliances used in the large-,med- and small-sized PSP is 0.63%, 2.67%and 3.70%respectively,the detected rate of the appliances used in large- and small- scale PSP is remarkable different(x2=6.68,P＜0.05 ).The rate of the appliances used in the beauty parlors、barbering shop and footbath inns respectively is 2.97%, 0.61%and 3.42%respectively;The detection rate of the different appliances are different,the rate is higher on the acne needles(5.13%) and the forceps(4.17%).The detection rate with the knives used in footbath inns is 8.33%;and that in beauty parlors is 4.17%.
3.The adjusted positive rate of HBsAg among the employees worked in the PSP is 9.17%,the positive rate of HBsAg among the employees worked in large-,Med- and small-scale PSP is 7.34%,8.33%and 2.94%respectively;the positive rate of HBsAg among the staffs worked in beauty parlors,barbering shops,footbath inns and bathing centers is 9.01%,6.37%,4.35%and 7.29%respectively;for different service,the rate of HBsAg are different,the highest rate is 13.33%in the tattoo workers(13.33%),the pedicures workers(12.68%),the Massagists(8.03%).The rate of HBsAg among the employees worked in the beauty parlors is positive correlative with the working years (R=0.83).The rate of HBsAg among the employees with pedicuring,massaging and tattooing is positive correlative with the working years(R=0.89).
4.The positive rate of HBsAg among the staffs with the skin scathing history is 12.99%(23/177),and the rate is 4.25%for the staff without the skin scathing history. The HBsAg rate among staff with the skin scathing history and without the skin scathing history has statistical difference(x2=16.07,P＜0.01).Among the staff with the skin scathing history,the positive rate of HBsAg among the employees worked in the beauty parlor is 15.15%,the rate is 12.50%for the pedicuring workers and 18.75%for the bathing workers,and the rate of HBsAg is obviously higher than those without the skin scathing history(5.13%、1.89%and4.00%respectively).The HBsAg rate among the pedicuring worker with the skin scathing history is 56.25%.The HBsAg rate of the tatooing worker with the skin scathing history is obviously higher than those without the skin scathing history.Among 177 people with the skin scathing history,the rate of HBsAg is 15.00%among the 120 people who are still working without enswathing,the rate is 8.77%among the 57 people who are continued to serve for customers by easily enswathement,and the rates of both people are higher than the natural population.
5.The Multi-factors analysis of the case control study shows that:besides the occupation and education levels of the study objects,the risk factors about HBV infection in the PSP mainly have the following factors,such as shaving,hairdressing, pedicuring,and tattooing;the HepB vaccinating and KAP scores about Hepatitis B are protection factors.
6.The KAP investigation show that the staffs and customers of the PSP are lack of self-protection awareness of hepatitis B,which are mainly embodied in:(1) Knows a little about HBV dissemination methods;(2) After the HBV infection,people have little attention to severity,lacks knowledge about the hepatitis B clinical manifestation,it is difficult to discover、diagnose and treat early;(3) The employees worked in the PSP know that HepB vaccinating will prevent the HBV infection effectively,but the people with HepB vaccinating account for only 22%;(4) Some employees with the skin scathing history are continued to serve for customers by easily enswathement or without enswathement.
7.Different risk factors of HBV infection in PSP were converted into risk scores. The related risk scores were added to obtain a combined risk scores to predict the individual's risk of HBV infection in PSP.
Conclusion
This investigation is the first national system study about the appliances disinfection and HBsAg contamination situation,the rate of HBsAg among the employees and the customers in the PSP.We have analyzed the risk factors about HBV infection and achieved good data in PSP.The results show that in the public service place has the possibility of HBV infection(dissemination),and indicate that the appliances disinfection management should be strengthened,the disinfection methods should be regulated,HepB should be vaccinated among the staff worked in the PSP.The findings also suggest that we should carry out the public health education about Hepatitis B and strengthen people's legal supervision consciousness.
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