September 12, 2013
Richard T. Ellison III, MD reviewing Chiang C-J et al. JAMA 2013 Sep 4. Richard T. Ellison III, MD
Data from Taiwan show marked reduction in deaths from chronic liver disease and hepatocellular carcinoma following the launch of a nationwide HBV vaccination program for newborns in 1984. Richard T. Ellison III, MD
Because of the clear association between chronic hepatitis B virus (HBV) infection and the development of both chronic liver disease (CLD) and hepatocellular carcinoma (HCC), Taiwan began a nationwide HBV immunization program. Previous studies have shown that this program — launched in July 1984 for newborn infants at high risk for infection and extended progressively thereafter to cover all infants, preschool children, and primary school children — has reduced the incidence of HCC, the prevalence of chronic HBV carriage, and mortality from infant fulminant hepatitis (IFH) in vaccinated birth cohorts. With the program at its 30-year anniversary, researchers used national mortality and cancer registry data to assess its effects on mortality from IFH, CLD, and HCC.
The sex-adjusted mortality rate for IFH declined for children born between 1981 and 2011; for birth years 2009–2011, it was 97% lower than for birth years 1977–1980 (a baseline period before program launch). Similar declines in CLD and HCC mortality were seen for individuals born between 1981 and 2004 (the last birth year analyzed). CLD mortality was 89% lower, and HCC mortality was 92% lower, for the 2001–2004 birth cohort than for the 1997–1980 group. Protection against death from CLD (35% reduction) and HCC (30% reduction) was also noted for the children born between 1981 and 1984, who were immunized at preschool ages rather than during early infancy.
These results confirm a striking benefit from the nationwide hepatitis B virus immunization program. The steady decline in deaths from chronic liver disease and hepatocellular carcinoma suggests a herd immunity effect, with progressively fewer parents having HBV infection that could be transmitted to their children.
Chiang C-J et al. Thirty-year outcomes of the national hepatitis B immunization program in Taiwan. JAMA 2013 Sep 4; 310:974. (http://dx.doi.org/10.1001/jama.2013.276701)