Background & Aims
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 a higher proportion of anti-HBs and HBeAg positivity, genotype C and high viral load. The majority (85·42%) were consistently HBsAg negative while 12·65% were consistently positive, and 8·98% achieved seroclearance in a five-year period. In the vaccinated cohort, no subjects had acquired new exposure and became HBsAg positive, and only 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.
Abbreviations:HBV (hepatitis B virus), HBsAg (hepatitis B surface antigen), anti-HBs (antibody to hepatitis B surface antigen), anti-HBc (antibody to hepatitis B core antigen), HBeAg (hepatitis B e antigen), anti-HBe (antibody to hepatitis B e antigen), HBIG (hepatitis B immune globulin), HCV (hepatitis C virus), HDV (hepatitis D virus)
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- Primary liver cancer: worldwide incidence and trends.Gastroenterology. 2004; 127: S5-S16
- Hepatitis B virus infection.Lancet. 2009; 373: 582-592
- Fighting against viral hepatitis: lessons from Taiwan.Hepatology. 2011; 54: 381-392
- A mass vaccination program in Taiwan against hepatitis-B virus-infection in infants of hepatitis-B surface-antigen carrier mothers.JAMA. 1987; 257: 2597-2603
- Nationwide hepatitis B vaccination program in Taiwan: effectiveness in the 20 years after it was launched.Epidemiol Rev. 2006; 28: 126-135
- Seroepidemiologic survey for hepatitis B virus infection in Taiwan: the effect of hepatitis B mass immunization.J Infect Dis. 1999; 179: 367-370
- Incomplete hepatitis B immunization, maternal carrier status and increased risk of liver diseases: a 20-year cohort study of 3.8 million vaccinees.Hepatology. 2014; 60: 125-132
- Seroepidemiology of hepatitis B virus infection in children: ten years of mass vaccination in Taiwan.JAMA. 1996; 276: 906-908
- Base-line seroepidemiology of hepatitis-B virus-infection in children in Taipei, 1984 – A study just before mass hepatitis-B vaccination program in Taiwan.J Med Virol. 1986; 18: 301-307
- Efficacy of a mass hepatitis-B vaccination program in Taiwan – Studies on 3464 infants of hepatitis-B surface-antigen carrier mothers.JAMA. 1988; 260: 2231-2235
- Hepatitis B vaccination and hepatocellular carcinoma rates in boys and girls.JAMA. 2000; 284: 3040-3042
- Prevalence of obesity and metabolic syndrome in Taiwan.J Formos Med Assoc. 2006; 105: 626-635
- Gender difference on the development of metabolic syndrome: a population-based study in Taiwan.Eur J Epidemiol. 2007; 22: 899-906
- Uric acid level as a risk marker for metabolic syndrome: a Chinese cohort study.Atherosclerosis. 2012; 220: 525-531
- Quantification and genotyping of hepatitis B virus in a single reaction by real-time PCR and melting curve analysis.J Hepatol. 2004; 41: 659-666
- A seroepidemiologic study of hepatitis B virus infection in Taiwan.J Formos Med Assoc. 1978; 77: 908-918
- Hepatitis B virus infection and its sequelae in Taiwan.Gastroenterol Jpn. 1984; 19: 363-366
- HBsAg seroclearance in asymptomatic carriers of high endemic areas: appreciably high rates during a long-term follow-up.Hepatology. 2007; 45: 1187-1192
- HBsAg profiles in patients receiving peginterferon alfa-2a plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses.J Infect Dis. 2010; 202: 86-92
- Hepatitis viruses in southern Taiwan–mass survey of 2985 inhabitants.Gastroenterol Jpn. 1984; 19: 344-350
- Rocks along the road to the control of HBV and HCC.Ann Epidemiol. 2009; 19: 231-234
- Hepatitis B virus infection in children and adolescents in a hyperendemic area: 15 years after mass hepatitis B vaccination.Ann Intern Med. 2001; 135: 796-800
- Two decades of universal hepatitis B vaccination in Taiwan: impact and implication for future strategies.Gastroenterology. 2007; 132: 1287-1293
- Minimization of hepatitis B infection by a 25-year universal vaccination program.J Hepatol. 2012; 57: 730-735
- Hepatitis B virus infection in adolescents in a rural township – 15 Years subsequent to mass hepatitis B vaccination in Taiwan.Vaccine. 2006; 24: 759-765
- HBV serological markers of vaccinated children in remote areas of Taiwan: emphasis on factors contributing to vaccine failure.Vaccine. 2007; 25: 6326-6333
- Secular trend of the viral genotype distribution in children with chronic hepatitis B virus infection after universal infant immunization.Hepatology. 2011; 53: 429-436
- Epidemiology of hepatitis B virus infection in the Asia-Pacific region.J Gastroenterol Hepatol. 2000; 15: E3-6
- Hepatitis B virus in the United States: infection, exposure, and immunity rates in a nationally representative survey.Ann Intern Med. 2011; 154: 319-328
- Geographic and ethnic variations of long-term efficacy and immunogenicity of hepatitis B vaccination in Hualien, a HBV hyperendemic area.Vaccine. 2006; 24: 4427-4432
- Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity.Vaccine. 2012; 30: 2212-2219
Published online: March 18, 2015
Accepted: March 10, 2015
Received in revised form: March 5, 2015
Received: November 7, 2014
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.