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      Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China

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          Abstract

          China’s hepatitis B virus (HBV) prevention policy has been evaluated through nationally representative serologic surveys conducted in 1992 and 2006. We report results of a 2014 serologic survey and reanalysis of the 1992 and 2006 surveys in the context of program policy. The 2014 survey used a 2-stage sample strategy in which townships were selected from 160 longstanding, nationally representative, county-level disease surveillance points, and persons 1–29 years of age were invited to participate. The 2014 sample size was 31,713; the response rate was 83.3%. Compared with the 1992 pre–recombinant vaccine survey, HBV surface antigen prevalence declined 46% by 2006 and by 52% by 2014. Among children <5 years of age, the decline was 97%. China’s HBV prevention program, targeted toward interrupting perinatal transmission, has been highly successful and increasingly effective. However, this progress must be sustained for decades to come, and elimination of HBV transmission will require augmented strategies.

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          Most cited references30

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

          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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            Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China.

            Endemic hepatitis B virus (HBV) infection is a serious health problem in China. Hepatitis B vaccination of infants was introduced in 1992 and was progressively expanded during the subsequent 15 years. We conducted a national serosurvey, with participants selected by multiple-stage random sampling. Demographic characteristics and hepatitis B vaccination history were collected by a questionnaire and a review of vaccination records, and serum specimens were tested for hepatitis B surface antigen, antibody to hepatitis B core antigen, and hepatitis B surface antibody by enzyme-linked immunosorbent assay. Hepatitis B vaccine coverage (3 doses) increased from 30.0% for children born in 1992 to 93.4% for children born in 2005. Receipt of a timely birth dose increased from 22.2% to 82.6% for children born during this interval. Multivariate analysis showed that older age, western and rural residence, birth at home, and certain ethnicities were risk factors for under vaccination with both full vaccine series and timely birth dose. The prevalence of hepatitis B surface antigen was reduced to 2.1% among all children and 1.0% among children born after 1999. The efficacy of hepatitis B vaccination with a timely birth dose was 88.3%. Hepatitis B vaccine has been successfully integrated into routine infant immunization in China, now reaching most infants within 24 h after birth, and the prevalence of hepatitis B surface antigen has been greatly reduced among children born after 1992.
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              Seroepidemiology of hepatitis B virus infection in 2 million men aged 21-49 years in rural China: a population-based, cross-sectional study.

              Hepatitis B virus (HBV) infection is highly endemic (7-8% prevalence) in rural China, causing high mortality and societal burden. Data from men of reproductive age is scarce and last reported in 2006. We assessed the seroepidemiology of men in rural China, aiming to provide updated baseline data for the prevalence of HBV infection.
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                Author and article information

                Journal
                Emerg Infect Dis
                Emerging Infect. Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                May 2017
                : 23
                : 5
                : 765-772
                Affiliations
                [1]Peking University Health Science Center, Beijing, China (F. Cui);
                [2]Chinese Center for Disease Control and Prevention, Beijing (L. Shen, L. Li, H. Wang, F. Wang, S. Bi, G. Zhang, F. Wang, H. Zheng, X. Sun, N. Miao, Z. Yin, Z. Feng, X. Liang, Y. Wang);
                [3]Guangzhou Center for Disease Control and Prevention, Guangzhou, China (J. Liu)
                Author notes
                Address for correspondence: Yu Wang, Chinese Center for Disease Control and Prevention, No. 155 Changbai Rd, Changping District, Beijing 102206, China; email: wangyu@ 123456chinacdc.cn , Xiaofeng Liang; email: liangxf@ 123456chinacdc.cn , or Zijian Feng; email: fengzj@ 123456chinacdc.cn
                Article
                16-1477
                10.3201/eid2305.161477
                5403029
                28418296
                5ba11832-1bfc-43f5-8798-ee8ca092467a
                History
                Categories
                Research
                Research
                Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China

                Infectious disease & Microbiology
                hepatitis b,vaccine,vaccination,immunization,china,viruses
                Infectious disease & Microbiology
                hepatitis b, vaccine, vaccination, immunization, china, viruses

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