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Efficacy of the nationwide hepatitis B infant vaccination program in Taiwan
Szu-Ming Chen1, Chien-Min Kung, Wen-Jen Yang
1Department of Medical Laboratory Science and Biotechnology, College of Biomedical Science and Technology, Yuanpei University, No. 306, Rd. Yuanpei, Hsinchu (300), Taiwan.
Insights
Taiwan's hepatitis B vaccination program significantly reduced HBV infection rates among young adults. However, a concerning decline in protective antibodies was observed in recent years, requiring further investigation.
Area of Science:
- Hepatology
- Immunology
- Public Health
Background:
- Taiwan initiated a universal infant hepatitis B (HB) vaccination program in 1984.
- This study assesses hepatitis B virus (HBV) seroprevalence and high alanine aminotransferase (ALT) levels in young adults.
Purpose of the Study:
- To evaluate the impact of Taiwan's nationwide HBV vaccination program on HBV seroprevalence and high ALT levels.
- To analyze trends before, during, and after the vaccination program's introduction.
Main Methods:
- A cohort of 101,584 university freshmen (birth cohorts 1977–1991) were studied between 1995 and 2009.
- Hepatitis B surface antigen (HBsAg), hepatitis e antigen (HBeAg), anti-HBs, ALT, and AST levels were measured.
- Statistical analysis was performed to determine prevalence, incidence, and associations.
Main Results:
- HBsAg and HBeAg prevalence significantly decreased from 14.3% and 5.9% in 1995 to 1.1% and 0.3% in 2009, respectively.
- Anti-HBs seroconversion rates declined to 36.6% in 2008 and 36.4% in 2009.
- High ALT levels were more common in HBV carriers (16.5%) and males (OR=4.087).
Conclusions:
- The mass vaccination program effectively reduced HBV carrier rates and chronic hepatitis B prevalence in Taiwan.
- A notable decrease in anti-HBV antibody levels in 2008-2009 warrants further research and potential intervention.
Background:
Taiwan launched a nationwide infant vaccination program for hepatitis B (HB) in 1984.
Objectives:
This study evaluated the seroprevalence of hepatitis B virus (HBV) and the incidence of high alanine aminotransferase (ALT) level among young adults prior to, during, and since the introduction of the nationwide HBV vaccination program.
Study Design:
Researchers recruited 101,584 freshmen (male:female=1.114:1; mean age, 18.5±0.5 years) from 21 universities between 1995 and 2009 (birth cohorts 1977-1991) in Taiwan, testing for serum hepatitis B surface antigens (HBsAg), hepatitis e antigens (HBeAg), antibodies against HBsAg (anti-HBs), and liver function tests, including ALT and aspartate aminotransferase (AST).
Results:
The results showed that the prevalence of HBsAg decreased significantly from 14.3% in 1995 to 1.1% in 2009 and the seroprevalence of HBeAg decreased significantly from 5.9% in 1995 to 0.3% in 2009. Seroconversion to anti-HBs maintained a steady rate above 50% between 1995 and 2007, but declined considerably to 36.6% and 36.4% in 2008 and 2009, respectively. Subject with HBeAg seropositivity was in 43.94% of HBV carriers. Double seronegativity for HBsAg and anti-HBs was observed in 2007 (47.8%), 2008 (62.3%), and 2009 (62.5%). High ALT level was observed in 5.74% of the subjects, particular among HBV-carriers (16.5% of HBV carrier vs. 5.0% of non-HBV carrier; ORs, 3.733; 95% CIs, 3.463-4.023, p<0.0001). Subjects with high ALT level were significantly positively associated with HBeAg (10.5% of HBeAg seropositive vs. 1.9% of HBeAg seronegative; ORs, 6.195; 95%CI, 5.629-6.818; p<0.0001). Male subjects were more easily infected by HBV than female subjects were (HBsAg, ORs, 1.355, 95% CI, 1.283-1.431; HBeAg, ORs, 1.324, 95% CI, 1.218-1.439, p<0.0001), and significantly more male subjects had high ALT levels than female subjects did (ORs, 4.087; 95% CI, 3.819-4.375, p<0.0001).
Conclusions:
The mass vaccination program successfully reduced the HBV carrier rate and prevalence of chronic hepatitis B in Taiwan. However, the low percentage of anti-HBV in 2008 and 2009 remains unresolved.
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