Chien YC, Jan CF, Kuo HS, Chen CJ. 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: 6.67). 02/2006; 28(1):126-35. DOI: 10.1093/epirev/mxj010
Source: PubMed


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 addition, there was a booster program that extended the HBV vaccination to the preschool children in 1987–1990, to elementary school students in 1988–1991 and to teenagers in 1989–1991 on a fee-for-service base [6]. Based on the official vaccination records from the Taiwan CDC, the coverage rates from 1984 to 2002 were 96.6%, 95.2%, and 92.8% for the first, second and the third doses, respectively [5]. HBIG was administered to 75.3% of neonates born to HBsAg positive and HBeAg positive mothers with 80.3% vaccinees received complete doses of HBV vaccines [7]. "
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    ABSTRACT: Hepatitis B virus (HBV) infection poses a global public health threat. HBV vaccination has proven highly effective in preventing the infection; however, its long-term impact on the general population has not been addressed. We conducted analysis to determine the total and changing burden of chronic HBV infection and evaluate the serological status between vaccinated and unvaccinated in Taiwan. Participants in "The Taiwanese Survey on Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension" in 2002 (n=6602), and 4088 with follow-up survey in 2007 were included. HBsAg (including titers), anti-HBs, anti-HBc, HBeAg, anti-HBe, HBV genotypes and viral loads were assayed. Prevalence and evolving patterns of these seromarkers was compared between vaccinated and unvaccinated cohorts and predictors of persistent HBsAg-positivity and -negativity were examined. The overall prevalence of chronic HBV infection was 13·7% (95% CI, 12.9% to 14.5%) and about two thirds had past exposure (anti-HBc: 68·46%) in 2002. The vaccinated cohort tended to have lower prevalence of HBsAg and anti-HBc, and higher proportion of anti-HBs and HBeAg positivity, genotype C and high viral load. The majority (85·42%) were consistently HBsAg (-) while 12·65% were consistently positive, and 8·98% achieved seroclearance in five-year period. In the vaccinated cohort, none has acquired new exposure and became HBsAg positive, and one (0.54%) cleared HBsAg, demonstrating the durability of vaccination through teenage and young adulthood. This comprehensive, population-representative-survey shows that 20 years after universal vaccination, the backlog still composed a substantial burden of chronic HBV infections in Taiwan. Copyright © 2015. Published by Elsevier B.V.
    Journal of Hepatology 03/2015; 63(2). DOI:10.1016/j.jhep.2015.03.013 · 11.34 Impact Factor
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    • "More than 2 billion people worldwide have been infected with hepatitis B virus (HBV), and about 360 million are chronic carriers at risk of severe complications [1]. The adoption of universal neonatal immunization proves to be a successful strategy to reduce chronic hepatitis B infection and the consequent chronic liver diseases and primary hepatocellular carcinoma, especially in regions with historically high endemicity [2], [3]. Frontier countries have started such immunization policy as early as mid 1980s when safety and efficacy data on neonatal immunization were just available [4], [5]. "
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    ABSTRACT: BackgroundNewborns who have received hepatitis B immunization in 1980s are now young adults joining healthcare disciplines. The need for booster, pre- and post-booster checks becomes a practical question.AimsThe aim of this study is to refine the HBV vaccination policy for newly admitted students in the future.MethodsA prospective study on medical and nursing school entrants to evaluate hepatitis B serostatus and the response to booster doses among young adults.FindingsAmong 212 students, 17–23-year-old, born after adoption of neonatal immunization, 2 (0.9%) were HBsAg positive, 40 (18.9%) were anti-HBs positive. At 1 month after a single-dose booster for anti-HBs-negative students, 14.5% had anti-HBs <10 mIU/mL, 29.0% and 56.5% were 10–100 and >100 mIU/mL, respectively. The anti-HBs levels were significantly higher for females than males (mean [SD]: 431 [418] vs. 246 [339] mIU/mL, P = 0.047). At 2–4 month after the third booster dose, 97.1% had anti-HBs >100 mIU/mL and 2.9% had 10–100 mIU/mL.ConclusionsPre-booster check is still worthwhile to identify carriers among newly recruited healthcare workers born after adoption of neonatal immunization. A 3-dose booster, rather than a single dose, is required for the majority to achieve an anti-HBs level >100 mIU/mL, as memory immunity has declined in a substantial proportion of individuals. Cost-effectiveness of post-booster check for anti-HBs is low and should be further evaluated based on contextual specific utilization of results.
    PLoS ONE 09/2014; 9(9):e107163. DOI:10.1371/journal.pone.0107163 · 3.23 Impact Factor
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    • "However, prevention (e.g. through HBV vaccination), treatment and control (which would include treatment of hepatitis associated with HCC) are within the descriptors for Access to treatment. While quality hepatitis control exists in many Asian countries [61,62], hepatitis control must be a priority in many countries not included in this study [63,64]. "
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    ABSTRACT: Liver cancer is both common and burdensome in Asia. Effective liver cancer control, however, is hindered by a complex etiology and a lack of coordination across clinical disciplines. We sought to identify strategies for inclusion in a comprehensive liver cancer control for Asia and to compare qualitative and quantitative methods for prioritization. Qualitative interviews (N = 20) with international liver cancer experts were used to identify strategies using Interpretative Phenomenological Analysis and to formulate an initial prioritization through frequency analysis. Conjoint analysis, a quantitative stated-preference method, was then applied among Asian liver cancer experts (N = 20) who completed 12 choice tasks that divided these strategies into two mutually exclusive and exhaustive subsets. Respondents' preferred plan was the primary outcome in a choice model, estimated using ordinary least squares (OLS) and logistic regression. Priorities were then compared using Spearman's Rho. Eleven strategies were identified: Access to treatments; Centers of excellence; Clinical education; Measuring social burden; Monitoring of at-risk populations; Multidisciplinary management; National guidelines; Public awareness; Research infrastructure; Risk-assessment and referral; and Transplantation infrastructure. Qualitative frequency analysis indicated that Risk-assessment and referral (85%), National guidelines (80%) and Monitoring of at-risk populations (80%) received the highest priority, while conjoint analysis pointed to Monitoring of at-risk populations (p < 0.001), Centers of excellence (p = 0.002), and Access to treatments (p = 0.004) as priorities, while Risk-assessment and referral was the lowest priority (p = 0.645). We find moderate concordance between the qualitative and quantitative methods (rho = 0.20), albeit insignificant (p = 0.554), and a strong concordance between the OLS and logistic regressions (rho = 0.979; p < 0.0001). Identified strategies can be conceptualized as the ABCs of comprehensive liver cancer control as they focus on Antecedents, Better care and Connections within a national strategy. Some concordance was found between the qualitative and quantitative methods (e.g. Monitoring of at-risk populations), but substantial differences were also identified (e.g. qualitative methods gave highest priority to risk-assessment and referral, but it was the lowest for the quantitative methods), which may be attributed to differences between the methods and study populations, and potential framing effects in choice tasks. Continued research will provide more generalizable estimates of priorities and account for variation across stakeholders and countries.
    BMC Health Services Research 11/2011; 11(1):298. DOI:10.1186/1472-6963-11-298 · 1.71 Impact Factor
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