Nationwide hepatitis B vaccination program in Taiwan: Effectiveness in the 20 years after it was launched

Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan.
Epidemiologic Reviews (Impact Factor: 7.33). 02/2006; 28(1):126-35. DOI: 10.1093/epirev/mxj010
Source: PubMed

ABSTRACT The national hepatitis B vaccination program in Taiwan is considered one of the most successful and effective public health programs to control chronic hepatitis B infection in the past 20 years. This review illustrates how to implement a successful hepatitis B vaccination program based on Taiwan's experience. Several important controlled randomized clinical trials on hepatitis B immunoglobulin and vaccine in Taiwan demonstrated an 80-90% protective effect among infants of mothers who were positive for either hepatitis B envelope antigen or hepatitis B surface antigen. A series of prevalence surveys on children born before and after the national vaccination program began disclosed a steady decrease in seroprevalence of hepatitis B surface antigen in Taiwan, with 78-87% effectiveness after the national vaccination program was launched. Studies on the secular trend of liver disease risk also documented a 68% decline in mortality from fulminant hepatitis in infants and a 75% decrease in the incidence of hepatocellular carcinoma in children 6-9 years of age after the national vaccination program began. In conclusion, since 1984, the national hepatitis B vaccination program has been successful in preventing acute and chronic liver diseases in Taiwan.

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    • "In Thailand, hepatitis B surface antigen (HBsAg) seroprevalence in children between 6 months and 18 years of age fell from 4.3% to 0.7%, 12 years after commencement of universal infant hepatitis B vaccination in 1992 [4]. In Taiwan where routine infant vaccination has been in place for 20 years, HBsAg seroprevalence is estimated to have declined by up to 87%, with reductions in deaths due to fulminant hepatitis and hepatocellular carcinoma of 68% and 75%, respectively [5]. Similarly, in Malaysia HBsAg seroprevalence among children fell from 3.0% in the years prior to vaccination, to 0.4% after implementation of routine infant hepatitis B vaccination [6]. "
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    ABSTRACT: Booster vaccination against hepatitis B (HBV) is not currently recommended, although debate continues on the duration of protection after priming. We assessed antibody persistence and immune memory to hepatitis B 20 years after priming with a recombinant HBV-vaccine during infancy. Infants were vaccinated at birth, 1, 2 and 12 months of age. A subset received a booster dose at Year 5. Antibody persistence was measured approximately yearly until Year 20. Immune memory was assessed by administration of HBV booster dose. At Year 20, anti-HBs seroprotection rates and GMCs tended to be higher in Year 5 boosted than unboosted recipients (83.9% versus 60.5%). After the Year 20 booster dose, anti-HBs anamnestic responses were within the same range 95.8% of subjects in both groups. Primary and booster vaccination with HBV-vaccine in infants induces sustained seroprotection and immune memory against hepatitis B for up to 20 years. Higher persisting seroprotection rates in subjects boosted at Year 5 did not translate into apparent differences in immune memory in a high endemic country.
    Vaccine 11/2009; 28(3):730-6. DOI:10.1016/j.vaccine.2009.10.074 · 3.49 Impact Factor
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    • "Other studies also indicated that giving a booster dose of hepatitis B vaccine to persons who have been vaccinated and the concentration of anti-HBs was below 10 mIU/ml, could develop a rapid rise in anti-HBs antibody [34]. Ninety-six percent of vaccines had detectable anti-HBs in their serum after the third dose of vaccine [9]. In this paper we found that 100% of 15-to 18-year- old adolescents, after receiving booster doses of recombinant HBV vaccine, developed antibody. "
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    ABSTRACT: The first universal hepatitis B vaccination program for newborns in the world was launched in Taiwan in July 1984. Most studies on the effectiveness of hepatitis B vaccination focused on the seroprevalence of HBs Ag among children under 14 years old. Only few studies focused on the seropositivity of anti-HBs among adolescents aged 15-18 years old. The present study aimed to evaluate the impact of the nationwide hepatitis B vaccination program on the immunity to HBV infection and the necessity of boost among adolescents. In this study including eight annual seroprevalence surveys from 2000 to 2007, 2342 college entrants (1589 15-year-olds in group I and 753 18-year-olds in group II) and 1851 university freshmen (18-year-olds in group III) participated. Subjects identified anti-HBs, HBs Ag and anti-HBc negative were given boost three doses of HBV vaccine. The HBs Ag seroprevalence was 11.6%, 3.5% and 1.0% for participants who were born before 1984, 1984-1986 and after 1986. The anti-HBs-seropositive rates were significantly higher in group II (83.1%) than in group I (53.0%) and group III (53.5%). All 572 participants who were seronegative for anti-HBs, HBs Ag and anti-HBc became anti-HBs-seropositive after catch-up vaccination. It is concluded that the anti-HBs-seropositive rate decreased to 50% in 15 years after vaccination, and boost vaccination was 100% effective. The necessity and age for boost among anti-HBs negative adolescents and the timing of the first immunization should be further evaluated.
    Vaccine 09/2009; 27(47):6613-8. DOI:10.1016/j.vaccine.2009.08.007 · 3.49 Impact Factor
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    • "In the first 15 months after the vaccination program was implemented, hepatitis B vaccine coverage rates for the first, second, third, and fourth doses were 88%, 86%, 84%, and 71%, respectively, among infants born to 55,620 carrier mothers [1]. The overall vaccine coverage rates during mass vaccination period until December 2002 were 96.6%, 95.2%, and 92.8% for the first, second, and third doses, respectively, among 5,188,929 newborns , according to Center for Disease Control in Taiwan [2]. The vaccination program has significantly reduced mortality 0264-410X/$ – see front matter © 2007 Elsevier Ltd. "
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    ABSTRACT: The national hepatitis B vaccination program in Taiwan began in July 1984. The purpose of this repeated survey was to investigate the levels of anti-HBs (hepatitis B surface antibody) in the first-year students of a 5-year nursing program in Taiwan. Each year during 2000-2006, the entering students of the 5-year nursing program at Fooyin University, a vocational university located in southern Taiwan, were examined for their HBsAg and anti-HBs status using commercially available microparticle enzyme immunoassay. The seroprevalence of HBsAg (+) showed a significant trend of decrease, dropping 57% from 4.9% in 2000 to 2.1% in 2006. The seroprevalence of anti-HBs (+) also showed a significant trend of decrease, dropping 49% from 77.1% in 2000 to only 39.7% in 2006. With the relatively low seroprevalence of anti-HBs (+) of the future healthcare workers and high HBV endemicity in Taiwan, recommendation of serology test before boosting to nursing students before they proceed their clinical practice is prudent.
    Vaccine 01/2008; 25(51):8508-11. DOI:10.1016/j.vaccine.2007.10.018 · 3.49 Impact Factor
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