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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Available from: Chyi-Feng Jan, Oct 18, 2015
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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.
    Full-text · Article · Mar 2015 · Journal of Hepatology
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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.
    Full-text · Article · Sep 2014 · PLoS ONE
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    • "Chronic hepatitis B virus (HBV) infection is a challenging global health issue, especially in the Asia Pacific region. Although the universal vaccination program in Taiwan decreased the carrier rate of hepatitis B surface antigen (HBsAg) from 10% in 1984 to less than 1% in 2004[1,2], the disease burden there was not yet eradicated. It contributes to more than 122 million USD of TaiwanB virus (HBV DNA) lead to an increased risk of cirrhosis and hepatocellular carcinoma[3—5]. "
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    ABSTRACT: Significant hepatitis B viral load (≥10,000 copies/mL) was established to increase risk of advanced liver diseases. The aim of this study was to explore the metabolic risk factors for significant hepatitis B viral load. A campus-based cohort consisting of 146 participants of chronic hepatitis B virus (HBV) infection in Northern Taiwan was investigated in 2009. Clinical profiles including serum levels of deoxyribonucleic acid of hepatitis B virus (HBV DNA) were collected. Hepatitis B e antigen (HBeAg) serostatus, high alanine aminotransferase level, body mass index (BMI) ranges, and insulin resistance were related to significant HBV DNA levels in univariate analysis. Compared to individuals with BMI 23-24.9 kg/m(2) in multivariate analysis, those with BMI ≥25 kg/m(2) (OR = 3.86, 95% CI = 1.38-10.8, P = 0.010) and those with BMI <23 kg/m(2) (OR = 4.47, 95% CI = 1.32-15.2, P = 0.016) were at higher risk for significant HBV DNA levels. This phenomenon was also manifest in HBeAg seronegatives, who contributed to a majority of significant viral load in our study. Furthermore, insulin resistance and BMI ≥25 kg/m(2) had positive additive effects on significant HBV DNA levels (adjusted OR = 9.34, 95% CI = 1.74-50.3, P = 0.009). In conclusion, having certain BMI ranges (BMI ≥25 kg/m(2) or BMI <23 kg/m(2)) could be a risk factor of significant HBV DNA levels.:
    Full-text · Article · Mar 2012 · Obesity Research & Clinical Practice
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