Prevention and control of hepatitis B in China

Abstract

About 170 million Chinese are infected chronically with HBV and 10% suffer from chronic hepatitis. Around half a million Chinese die from hepatitis B caused hepatocellular carcinoma and endstage cirrhosis each year. From 1983 to the present, a controlled clinical trial involving 80,000 children on a universal hepatitis B vaccination programme to prevent chronic hepatitis, hepatocellular carcinoma, and endstage cirrhosis was implemented in Qidong, China. A pilot study demonstrated that the HBsAg rate reached the adult level before the fifth year of age, and neonatal vaccination with either plasma-derived or recombinant hepatitis B vaccines provided a similar 75% protective efficacy against HBV infection. The high rate of follow-up and blood tests coverage of the cohorts provided data to show 75% protection at the tenth to eleventh years of age against serum HBsAg and also against prolonged hepatic dysfunction. The strategy of controlling hepatitis B nationwide was based on the universal immunisation of newborns, beginning in cities and then the rural areas. The largescale vaccine source was provided by domestic plants through technology transfer, first providing plasma-derived vaccine replaced completely by recombinant DNA vaccine in 1997. An official survey in 1999 using a cluster sampling of 25,878 children from 31 provinces reported an average coverage rate of three dose of hepatitis B vaccination of 70.7%, being higher in urban areas. KEY WORDS: HBV; hepatitis B; vaccination; EPI HEPATITIS B INFECTION: A MAJOR HEALTH ISSUE OF CHINASeveral studies have estimated that 10 to 15% of people in China were chronically infected with HBV depending on the detection method and the way of selection and coverage size of the populations. Taking 13% as the estimated rate [Chen et al., 1990], it was calculated that about 170 million of the 1.3 billion Chinese people are chronically infected with HBV. However, the viral load by nucleic acid-based tests (NAT assays) indicate that HBV infection rates were usually underestimated. About 10% of the HBV carriers were estimated to have chronic hepatitis B, mostly in middle age. HBV was demonstrated to be the main cause of hepatocellular carcinoma (HCC) and end-stage cirrhosis. In association with the high HBV infection rate, liver cancer ranks second among the total cancer mortality in China. The age-adjusted mortality rate of HCC was reported to be 23 Â 10 À5/10 5 /yr [Li and Peto, 1996]. The annual deaths from HCC in China with 1.3-billion population was then estimated to be about 300,000. A recent study reported higher mortality rate of HCC in China, causing 384,000 deaths per year (Liu et al., unpublished data). End-stage cirrhosis, mainly HBV related, caused about 150,000 deaths per year. These data showed that HBV killed about half a million mainland Chinese each year. This virus ranks only second to tobacco as the major killer of Chinese at the present time and in the decades to come. Therefore, universal hepatitis B vaccination of neonates, the most cost-effective approach ...

Trends in the incidence of cancer in Qidong, China, 1978–2002

“…4) and an increase in oldest age group. A possible reason for this change may be the comprehensive prevention measures taken in the area, such as hepatitis B vaccination 22,23 and the control of aflatoxin. 19 Qidong has also been the site of studies into the possible effectiveness of chemoprevention of aflatoxin-induced liver cancer with oltipraz, chlorophyllin and broccoli sprouts 5,[24][25][26] and of screening for liver cancer in high-risk (HBs antigen-positive) subjects.…”

Hepatitis B Virus Infection Is Associated with Poor Prognosis in Patients with Advanced Non Small Cell Lung Cancer

“…HBV infection is endemic in some developing countries, including China, affecting nearly 15% of the population (Zhao et al, 2001;Sun et al, 2002;Lu et al, 2010). Meanwhile, Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death among men and women in China, contributing to 0.5 million deaths each year (Xie et al, 2012;She et al, 2013;Deng et al, 214;Liu et al, 2014).…”

“…Due to high prevalence of hepatitis B virus (HBV) infection and cancer in some developing countries, especially China, concurrent infection with HBV is not uncommon in cancer patients (Sun et al, 2002;Lu et al,2010;Xie et al, 2012;She et al, 2013;Deng et al, 2014;Liu et al, 2014). Recently, the association of HBV infection and cancer has been extensively investigated.…”

Circulating and Liver Resident CD4+CD25+ Regulatory T Cells Actively Influence the Antiviral Immune Response and Disease Progression in Patients with Hepatitis B

“…Ten percent of adults and 90% of children become persistent HBV carriers after the infection, and 1-2 million people died annually as the consequence of infection with the virus, such as liver cirrhosis and hepatocellular carcinoma (1,2). As the most affected area by HBV infection, China alone has 130 million carriers of HBV and 23 million patients with chronic hepatitis B (CHB) (3). It has been demonstrated that HBV-specific CTL and CD4 ϩ Th lymphocytes are essential for the control of HBV infection.…”