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      Hepatitis B and C Virus Infection and Hepatocellular Carcinoma in China: A Review of Epidemiology and Control Measures

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          Abstract

          China has one of the highest carrier prevalences of hepatitis B virus (HBV) in the world: nearly 10% of the general population. The disease burden of HBV infection and hepatocellular carcinoma (HCC) is also believed to be among the world’s largest, and that of hepatitis C virus (HCV) infection is likely to be substantial as well. However, the epidemiology and measures to control HBV and HCV infection in China remain relatively unknown outside the country. We review the epidemiology of HBV and HCV infection, the disease burden of and risk factors for HCC, and current control measures against HBV and HCV infection in China. We also discuss the relevant literature and implications for future studies of hepatitis and HCC in China.

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          Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination.

          Xiaofeng Liang, Shengli Bi, Weizhong Yang … (2009)
          To determine the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc) in a representative population in China 14 years after introduction of hepatitis B vaccination of infants. National serosurvey, with participants selected by multi-stage random sampling. Demographics and hepatitis B vaccination history collected by questionnaire and review of vaccination records, and serum tested for HBsAg, antibody to anti-HBc and anti-HBs by ELISA. The weighted prevalences of HBsAg, anti-HBs and anti-HBc for Chinese population aged 1-59 years were 7.2%, 50.1%, 34.1%, respectively. HBsAg prevalence was greatly diminished among those age <15 years compared to that found in the 1992 national serosurvey, and among children age <5 years was only 1.0% (90% reduction). Reduced HBsAg prevalence was strongly associated with vaccination among all age groups. HBsAg risk in adults was associated with male sex, Western region, and certain ethnic groups and occupations while risk in children included birth at home or smaller hospitals, older age, and certain ethnic groups (Zhuang and other). China has already reached the national goal of reducing HBsAg prevalence to less than 1% among children under 5 years and has prevented an estimated 16-20 million HBV carriers through hepatitis B vaccination of infants. Immunization program should be further strengthened to reach those remaining at highest risk.
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            Risk factors for hepatocellular carcinoma among patients with chronic liver disease.

            T Yabuuchi, K. Nakanishi, S. Tanaka … (1993)
            To detect potentially curable cases of hepatocellular carcinoma, outpatients with chronic hepatitis or compensated liver cirrhosis who were seen at the Center for Adult Diseases (Osaka, Japan) were examined periodically by means of ultrasonography and measurement of serum alpha-fetoprotein. Risk factors for hepatocellular carcinoma were identified with a Cox proportional-hazards model. A total of 917 patients, 40 to 69 years old, were registered from May 1987 to March 1991. By the end of September 1991, liver cancer had developed in 54. The three-year cumulative risk of liver cancer was 12.5 percent for 240 patients with liver cirrhosis at enrollment and 3.8 percent for 677 patients with chronic hepatitis. Cox regression analysis showed that the risk of liver cancer was increased almost sevenfold in patients with hepatitis B surface antigen (rate ratio, 6.92; 95 percent confidence interval, 2.92 to 16.39) and fourfold in patients with hepatitis C antibody (rate ratio, 4.09; 95 percent confidence interval, 1.30 to 12.85). A high alpha-fetoprotein value at enrollment was also a risk marker for liver cancer. Patients with hepatitis C virus infection have a greatly increased risk of liver cancer. Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.
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              Typing hepatitis B virus by homology in nucleotide sequence: comparison of surface antigen subtypes.

              H Okamoto, F Tsuda, H Sakugawa … (1988)
              The complete nucleotide sequences of the DNA of three hepatitis B virus (HBV) genomes of subtype adw, cloned from plasma samples of asymptomatic carriers living in the mainland and Okinawa Prefecture of Japan and Indonesia were determined. All three comprised 3215 bp and differed in sequence by only 3.9 to 5.6%. When these isolates were compared with the reported sequences of two HBV genomes of the same subtype derived from American carriers, however, the differences were greater (8.3 to 9.3% to an extent comparable with the nucleotide divergence between an HBV genome of subtype adw and that of a heterotypic subtype, such as adr, ayw or ayr. A total of 18 HBV genomes of various subtypes, including the three described here, 10 reported previously and five unpublished ones, were classified into four groups based on an inter-group divergence in nucleotide sequence of 8% or greater: group A (two adw genomes), group B (four adw), group C (three adw, four adr and one ayr) and group D (four ayw). Thus, the nine genomes of HBV subtype adw were distributed into three groups with considerably different sequences. These results indicate that the four major antigenically defined subtypes of envelope polypeptide do not reflect true genotypic variation of HBV. The fact that d to y, as well as w to r, subtypic change can be induced by an A----G point mutation at nucleotides 365 and 479 in the S gene, respectively, supports this view.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Epidemiol
                Journal ID (iso-abbrev): J Epidemiol
                Journal ID (publisher-id): JE
                Title: Journal of Epidemiology
                Publisher: Japan Epidemiological Association
                ISSN (Print): 0917-5040
                ISSN (Electronic): 1349-9092
                Publication date (Electronic): 5 November 2011
                Publication date (Electronic preprint): 22 October 2011
                Publication date Collection: 2011
                Volume: 21
                Issue: 6
                Pages: 401-416
                Affiliations
                [1 ]Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
                [2 ]Osaka City General Hospital, Osaka, Japan
                [3 ]Department of International Health, University of Tokyo, Tokyo, Japan
                [4 ]Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
                [5 ]Department of Epidemiology and Prevention, Aichi Cancer Center, Aichi, Japan
                [6 ]Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
                [7 ]Department of Epidemiology, National Cancer Center, Tokyo, Japan
                Author notes
                Address for correspondence. Dr. Masahiro Tanaka, Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan (e-mail: tanakamasax@ 123456gmail.com ).

                List of abbreviations: CHO: Chinese hamster ovary; CI: 95% confidence interval; CIV: Cancer Incidence in Five Continents (a report by the International Agency for Research in Cancer on cancer incidences from cancer registries around the world); DSP: disease surveillance points; ELISA: enzyme-linked immunosorbent assay; EIA: enzyme-linked immunoassay; HB: hepatitis B; HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HBeAg: hepatitis B e antigen; HBcAg: hepatitis B core antigen; anti-HBc: antibody to hepatitis B core antigen; anti-HBs: antibody to hepatitis B surface antigen; anti-HBe: antibody to hepatitis Be antigen; Hepatitis C: Hepatitis C; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; anti-HCV: antibody to hepatitis C virus; IARC: International Agency for Research in Cancer; MOH: Ministry of Health of China; N: sample size; NPHB: the National Plan for Prevention and Treatment against Hepatitis B; OR: odds ratio; aOR: adjusted odds ratio; mOR: odds ratio obtained from meta-analysis; PLC: primary liver cancer; RIA: radioimmunoassay; RR: relative risk.

                Article
                Publisher ID: JE20100190
                DOI: 10.2188/jea.JE20100190
                PMC ID: 3899457
                PubMed ID: 22041528
                SO-VID: 3e122138-e3c4-4f43-9207-181a1c0ebdd0
                Copyright © © 2011 Japan Epidemiological Association.
                License:

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 8 January 2011
                Date accepted : 20 June 2011
                Categories
                Subject: Review Article
                Subject: Infectious Disease

                Keywords: china,hepatitis,hepatocellular carcinoma,epidemiology,control
                Data availability:
                Keywords: china, hepatitis, hepatocellular carcinoma, epidemiology, control

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