原住民A型與B型肝炎盛行率之調查

The Prevalence of Hepatitis A and B Infection among Aboriginal Tribes in Taiwan

病毒性肝炎目前仍為禍世界，90%開發中國家與工業社會對B型肝炎採取免疫政策。A型肝炎盛行率較低的地區，感染年齡層已經逐漸升高，導致另一種致病危機。過去台灣為A型肝炎盛行率較高的地區，大部分人口在兒童時期已經感染過A型肝炎。近數十年亞洲地區的感染率逐年下降，台灣因公共衛生大力提倡，兒童感染率更是大幅下滑。台灣山地原住民其平均餘命比起台灣一般民眾仍差十年壽命，健康問題的改善狀況與台灣平地約有25－30年差距，因此調查其A型與B型肝炎盛行率有其必要性，並藉以了解台灣原住民公共衛生現況。本研究調查原住民包括14位魯凱族、32位泰雅族、58位布農族、44位排灣族共148位，並且篩檢22l位一般民眾血清中HAV IgG的效價，500位一般民眾的血清中HBsAg與Anti-HBs的效價，分別觀察樣本民眾與原住民其A、B型肝炎罹患率。結果發現魯凱族、泰雅族、布農族與排灣族樣本原住民，四個族群100%具有Anti-HAV IgG，而一般樣本民眾僅68%有Anti-HAV IgG。樣本原住民A型肝炎盛行率明顯高於一般樣本民眾（p=0.014）。魯凱族、泰雅族、布農族與排灣族HBsAg陽性率分別為0% （0/14）、9%（3/32）、31%（18/58）與11%（5/44）。魯凱族、泰雅族、布農族與排灣族其未曾感染過或不能產生抗體的盛行率分別為79%（11/l4）、44%（14/32）、26%（15/58）與48%（21/44）。整體而論，本調查的樣本原住民HBsAg陽性率為18%與一般樣本民眾的12%（59/500）並無統計學差異（p=0.068），樣本原住民其未曾感染過或無法產生抗體的盛行率為41%，與一般本本民眾的32%具統計學差異（p=0.034）。

Viral hepatitis is a world wide epidemic. Ninety percent of developing industrial countries have vaccination programs for the hepatitis B virus. In some areas classified as having a low prevalence rate of hepatitis A, there has been a clear shift in the peak age of infection from childhood to adulthood, which will lead to another kind of crsis of disease. In the past, Taiwan was recognized as area with a high prevalence of hepatitis A and most of the population had already been infected by hepatitis A in their early childhood. On account of the public health policy, the prevalence of hepatitis A infection. especially for children, has gradually decreased in the last ten years, Current investigations point out that the life expectancy for aboriginals is on average 10 years less than that of the general population. Compared with general participants living on the plains, the improvement in health issues for aboriginals are considered to 25 to 30 years behind. It is necessary to survey the prevalence of hepatitis A and B in order to figure out the public health condition of aboriginals in Taiwan. This study surveyed a total of 148 aborigines including the 14 Rukai tribes, 32 Atayal tribes, 58 Bunun tribes and 44 Paiwan tribes. We also recruited 221 general participants for HAV IgG test and 500 general participants for HBsAg and Anti-HBs test as the normal control. The results showed that all 148 aborigines were positive for Anti-HAVIgG, whereas the general participants (non-aborigines) indeed had a lower rate of prevalence of 68%. The positive rate of HBsAg for Rukai, Atayal, Bunun and Paiwan tribes were 0%(0/14), 9%(3/32), 31%(18/58) and 11%(5/44). The rate of prevalence for aborigines who were never infected or with no immunity were79%(11/14) for Rukai, 44%(14/32) for Atayal, 26%(15/58) for Bunun and 48%(21/44) for Paiwan. The HBsAg positive rates of aborigines(18%) and general participants(12%) wre not significantly different (p= 0.068) but the prevalence of aborigines (41%) and general particpants (32%) who were never infected or who were without immunity were significantly different.