Hepatitis B in China

Source: Wikipedia, the free encyclopedia.

Global Alliance for Vaccines and Immunization
(GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.

Epidemiology

Prevalence

Of the 350 million to 400 million individuals worldwide infected with the hepatitis B virus (HBV), one-third reside in China, with 130 million carriers and 30 million chronically infected.[2][3] Since the Expanded Program on Immunization (EPI) beginning 1992, the prevalence of HBV has declined, especially among children 3 to 12 years old.[4][5] During a 5-year period, 10.0% of patients with chronic hepatitis developed cirrhosis, and 20.3% of the cases with compensated cirrhosis progressed to decompensated cirrhosis. 6.5% of the people with cirrhosis and chronic hepatitis progressed to hepatocellular carcinoma (HCC). 5-year survival for compensated cirrhosis is 55%, that for decompensated cirrhosis is 14%, and that for HCC is less than 5%.[6] Every year, 300,000 people die from HBV-related diseases in China, including 180,000 patients with HCC.[7] However, the incidence of hepatitis B is still increasing, from 21.9 in 100,000 people in 1990 to 53.3 in 100,000 in 2003.[8] That increase has occurred despite a vaccination program for newborn babies since the 1990s, which showed good effectiveness for reducing chronic HBV infection in children.[9]

Transmission

The reason for this increased HBV infection is unknown, because hepatitis B has no clear transmission routes in many people in China, although both

neonatal infection and horizontal transmission
during early childhood are still the most common routes. During and before the Cultural revolution many of the cases came from re-used needles that were contaminated with HBV.

Programs

Public awareness

Public awareness of the disease, which is spread through the exchange of bodily fluids, is not as high as it is for

syringes and unknowingly spread the disease, particularly among children
.

Vaccination

By 2006, China has successfully immunised 11.1 million children living in the country's poorest provinces against hepatitis B according to the Chinese health ministry, and the

Global Alliance for Vaccines and Immunization (GAVI). However, China still has a long way to go before immunisation levels reach a percentage able to limit the spread of hepatitis B. China's health minister, Gao Qiang
told a Beijing press conference that the project, while effective, has covered only one third of all children born in China since the project began in 2002. This does not mean the rest of China's children went unvaccinated. However, even within the project's target area, over one million newborns went unvaccinated each year because of access issues; health-care costs, lack of birth attendants, and the remoteness of their birthplaces, such as herder's huts, mountain villages, and remote farms.

Until 2005, when a law banning the practice was passed, parents were charged fees for the administration of the vaccine. Even though the GAVI alliance (whose partners include

WHO
), and Chinese government were providing the vaccine and one-use needles free of charge, health-care workers charged fees that parents were unwilling or unable to pay.

Based on a 1992 epidemiological survey, the disease burden of those who are chronically infected with hepatitis B in China is estimated to be at 120 million, one third of the overall burden (360 million) as estimated by the WHO.

China's national target is to reach greater than 85% vaccination. The joint project with the GAVI alliance has shown that this is feasible with three quarters of the 1301 project counties reporting that 85% or more children received three doses of HepB vaccine. In hospitals designated as project hospitals, the percentage of newborns vaccinated within 24 hours of birth is now over 90%. However, the overall newborn vaccination rate in the region covered by the GAVI alliance/government joint project was 70%, lower than the 75% they hoped to achieve.

Achieving long-term success will require "assuring no new financial barriers arise", said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. "This is one of the greatest challenges and the solution lies not just within China but with a global community mobilized to ensure access to vaccine financing for all

developing nations
."

Home to a large population of ethnic minorities of low socioeconomic status, the Qinghai province is a remote, often neglected, rural region of China with a high prevalence of chronic hepatitis B. Since many children 5 years of age and older in Qinghai were not vaccinated against the hepatitis B virus at birth, a private-public partnership was formed between the Ping and Amy Chao Foundation, the ZeShan Foundation, the Asian Liver Center at Stanford University, the China Center for Disease Control and Prevention, the Chinese Foundation for Hepatitis Prevention and Control, and the Qinghai government. Using the existing provincial China CDC structure, this private-public partnership in Qinghai resulted in a unique two-part school-based immunization program to educate and provide free Hep B vaccination for all children in kindergarten and grade school within the region.[10][11]

Between 2006 and 2008, this program demonstrated the feasibility and successful implementation of:

  1. A province-wide catch-up vaccination program that reached 600,000 children in 2,200 schools, and
  2. A hepatitis B education program incorporated into the school curriculum.

Impact: The success of this large scale province-wide demonstration program led the Chinese government to announce the adoption of a new policy beginning in 2009 to provide free catch-up hepatitis B vaccination for all children in China under the age of 15 who have not been vaccinated.

Treatment

Because a high load of HBV in patients is the main cause of hepatitis progression, the ultimate goal in treatment is to eradicate the virus before irreversible liver damage occurs.[12]

Unfortunately, there are no agents available with high enough

peginterferon alpha, thymosin), and hepatic protectors (such as glycyrrhizin, glucuronolactone). The Chinese spend around ¥900 billion (US$110 billion) on these regimens every year.[15] Apart from cost, patients and carriers of HBV infection are often confronted with tough conditions and social pressures, although such discrimination is illegal
in China.

Chinese

Sebivo, a brand name for telbivudine, as a treatment for chronic hepatitis B in February 2007. The decision comes shortly after Sebivo was recommended for approval in the European Union. The medicine was developed jointly by Novartis and U.S. biotech firm Idenix Pharmaceuticals Inc and has been shown in trials to produce significantly greater viral suppression compared to the commonly used treatment lamivudine. Sebivo won its first major approval in Switzerland
in September 2006.

Governmental intervention

Problems

There have been relatively few campaigns aimed at ending the practice of reusing needles. For standard preventative practice, a

postnatal
vaccinations, and families had to pay for it privately. Many have suffered and their families, especially in the poor countryside, decided to go without.

According to China's

hospitals and access to medical information. The Chinese Center for Disease Control and Prevention (China CDC) have conducted research that supports the evidence that "there was and is still a huge bottleneck to ensure the delivery of the timely birth dosage
to home births".

Another problem is the growing size of China's

peasants
who become urban laborers move frequently around the country and often do not seek medical attention. The immunization rate among them remains low, said China CDC. One major problem facing Chinese people infected with hepatitis B is that illegal blood testing is required by most employers in China. Anyone that tests positive for hepatitis B is either denied employment or fired. Laws do exist to protect the privacy of employees and job seekers but they are not enforced.

Research

Hepatitis B and its related disorders are important

US$390 million), mainly against hepatitis B and related diseases over the next decade.[16][17]

Research will include: large

traditional Chinese medicines; prediction of the development, metastasis, and prognosis
of HCC by molecular typing; and the identification of important signal transduction pathways in HCC and the development of new small chemical compounds to target HCC.

Progress

To measure the results, the

genomic, and small molecules) for early diagnosis and to predict recurrence and metastasis
, and the development of new drugs for HCC, to increase the rate of early diagnosis by more than 20% and 5-year survival by more than 5%. The fight against HBV and its related disorders is now thought of as a long-term one by the health authorities.

Social impact

Discrimination

People with

rural and urban areas. The largest problem facing Chinese people infected with HBV is that illegal blood testing is required by most employers in China.[18] According to a report by PBS, faking blood tests by hiring uninfected individuals to take them has become widespread.[19] Following an incident involving a Hepatitis B carrier's killing of an employer and other calls against discriminatory employment practices, China's ministries of health and personnel announced that Hepatitis B carriers must not be discriminated against when seeking employment and education.[citation needed
] While the laws exist to protect the privacy of employees and job seekers, many believe that they are not enforced.

"In the Hepatitis B Camp"

"In the Hepatitis B Camp" is a popular website for hepatitis B carriers' human rights in China. Its online forum is the world's biggest such forum with over 300,000 members. The website was first shut down by the Chinese government in November 2007. Lu Jun, the head of the rights group, managed to reopen the website by moving it to an overseas server, but the authorities in May 2008 began blocking access to the website within China, only 10 days after government officials participated in an event for World Hepatitis Day at the Great Wall of China. An official had told the head of the rights group, Lu Jun, at the time that the closure was due to the Beijing Olympic Games.[20]

See also

References

  1. ^ "Hepatitis B Surveillance and control". World Health Organization. Archived from the original on 2009-12-03. Retrieved 2009-10-23.
  2. ^
    S2CID 39206739
    .
  3. S2CID 27720470
    .
  4. PMID 16471211
    .
  5. S2CID 25875631
    .
  6. ^ Si, CW (2006). "Current status and problem of chronic hepatitis B". Clin Med J (in Chinese). 4 (4): 1–2.
  7. PMID 15623388
    .
  8. ISSN 1003-9961.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link
    )
  9. ISSN 1006-916X
    .
  10. S2CID 9637008
    .
  11. ^ "Safety Shot: Three Young Americans stop at nothing to halt one of Asia's Biggest Killers". Stanford School of Medicine. 2008-04-01. Retrieved 2017-03-01.
  12. PMID 15940624
    .
  13. S2CID 19796106
    .
  14. S2CID 21294435
    .
  15. ^ Zhuang, H (2005). "The challenge of hepatitis B infection in China". Chin J Infect Dis (in Chinese) (23): 2–6.
  16. ^ "The People's Republic of China Ministry of Science and Technology" (in Chinese). Beijing, China: Chinese government. Retrieved 2009-10-23.
  17. ^ "National Natural Science Foundation of China". Chinese government. Archived from the original on 2010-01-10. Retrieved 2009-10-23.
  18. ^ "Hep B carriers allowed to join public service". China Daily. 21 May 2005. Retrieved 2 June 2013.
  19. ^ Faking Blood Tests to Avoid Discrimination in China Archived 2014-01-22 at the Wayback Machine. newshours.pbs.org. Accessed 2011-10-06.
  20. ^ Kwong, Robin (2008-06-25). "Group warns China on website shutdown". Hong Kong: Financial Times. Retrieved 2009-10-23.

External links

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