Elsevier

Vaccine

Volume 27, Issue 47, 5 November 2009, Pages 6550-6557
Vaccine

Epidemiological serosurvey of Hepatitis B in China—Declining HBV prevalence due to Hepatitis B vaccination☆

https://doi.org/10.1016/j.vaccine.2009.08.048Get rights and content

Abstract

Objective

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.

Methods

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.

Findings

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).

Conclusions

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.

Section snippets

Background

In 1992, the China national hepatitis seroepidemiological survey found that the prevalence of HBsAg for population aged 1–59 years was 9.8%. Based on this survey, it has been estimated that in China, 120 million people carry HBsAg [1], [2], [3], 20 million suffer from chronic hepatitis B, and almost 300,000 die annually from chronic consequences of HBV infection. Both liver cancer and cirrhosis are among the 10 most common causes of mortality in China; for both, hepatitis B virus causes the

Methods

Planning for this study was started in December 2005 and data analysis completed in December 2007. All field work was conducted between September and October 2006.

Results

Overall, the survey investigated 82,078 persons, from whom 82,008 blood samples were collected, and 81,963 with both investigation and blood sample available. Among houses visited, in 93.5% the occupants participated in the survey. Among these, 81,775 (99.6%) were eligible for data analysis; 178 persons were excluded due to being outside the study age range, and for 10 persons serum samples were insufficient.

Discussion

Hepatitis B is among the most important infectious diseases in China. Based on the national serosurvey in 1992, Chinese population's prevalence of HBsAg was about 10% for all age groups, including young children. The national serosurvey in 2006 shows that for population aged 1–59 years, the prevalence of HBsAg has decreased from 9.8% to 7.2%, and for children under 5 years is now only 1.0%. The findings from this survey indicate that the HBsAg prevalence in the whole population is now close to

Acknowledgements

Special thanks to health workers in Health Bureaus and Centers for Disease Control and Prevention in 31 provinces and 160 counties for their strong collaboration in this survey. And also thanks to the National Immunization Programme Committee, and the experts who contributed to the protocol design and data analysis. Dr Xiaofeng Liang, Shengli Bi,Weizhong Yang and Longde Wang made the same contribution to this paper. All authors had full access to all of the data in the study and take

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    ☆

    The survey is attributed to Ministry of Health, People's Republic of China; Chinese Center for Disease Control and Prevention, and Institute of Virology Disease Control, Chinese Center for Disease Control and Prevention.

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