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

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.

Keywords: China; hepatitis B; immunization; vaccination; vaccine; viruses.

Figure 1

Study eligibility and select characteristics of persons participating in 1992, 2006, and 2014 national serosurveys for hepatitis B virus, China. DSPs, disease surveillance points.

Figure 2

Longitudinal changes in prevalence of HBsAg (A), anti-HBs (B), and anti-HBc (C) among persons participating in 1992, 2006, and 2014 national serosurveys for hepatitis B virus, by age group, China. HBsAg, hepatitis B virus surface antigen; anti-HBs, antibody to hepatitis B virus surface antigen; anti-HBc, antibody to hepatitis B virus core antigen.

Figure 3

Prevalence of HBsAg by region, age group, and survey year (A) and by location type (urban or rural), age group, and survey year (B) among persons participating in 1992, 2006, and 2014 national serosurveys for hepatitis B virus, China. HBsAg, hepatitis B virus surface antigen.

Figure 4

Prevalence of HBsAg and 3-dose HepB coverage for each birth cohort and major vaccination program milestones for hepatitis B virus, China, 1962–2014. HBsAg prevalence is shown in 3 curves, 1 for each national serologic survey (1992, 2006, and 2014). HepB coverage is shown in bars. Type 2 vaccines are private sector vaccines that are not included in the free national EPI system but must be paid for out-of-pocket. HepB coverage was defined as the percentage of children <15 years of age who received 3 doses of HepB before reaching 12 months of age. Coverage levels of children born during 1985–1991, 1992–2005, and 2006–2013 were determined from the 1992, 2006, and 2014 surveys, respectively. TBD coverage was defined as the percentage of newborn infants who received a dose of HepB within 24 hours of birth. The iPMTCT program provides free HBsAg screening of pregnant women and free hepatitis B immunoglobulin for hepatitis B virus–exposed infants. EPI, Expanded Program on Immunization; HBsAg, hepatitis B virus surface antigen; HepB, hepatitis B vaccine; iPMTCT, integrated Prevention of Mother-to-Child Transmission, TBD, timely birth dose.