Gastroenterology

Gastroenterology

Volume 132, Issue 4, April 2007, Pages 1287-1293
Gastroenterology

Clinical–liver, pancreas, and biliary tract
Two Decades of Universal Hepatitis B Vaccination in Taiwan: Impact and Implication for Future Strategies

https://doi.org/10.1053/j.gastro.2007.02.055Get rights and content

Background & Aims: Following the world’s first successful implementation of a universal hepatitis B virus (HBV) vaccination program for infants in Taiwan 20 years ago, we performed this study to evaluate the long-term protection afforded by HBV vaccination and to rationalize further prevention strategies. Methods: HBV seromarkers, including hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) and core antigen (anti-HBc), were studied in 18,779 subjects from neonates to adults below 30 years of age in 2004. The birth cohort effect was evaluated by comparing the results of the same birth cohorts at different ages among this survey and the previous 1984, 1989, 1994, and 1999 surveys. Results: The seropositive rates for HBsAg, anti-HBs, and anti-HBc were 1.2%, 50.5%, and 3.7%, respectively, in those born after the vaccination program (<20 years of age) in 2004. A positive maternal HBsAg status was found in 89% of the HBsAg seropositive subjects born after the vaccination program. The absence of an increase in HBsAg seropositive subjects at different ages in the same birth cohorts born after the vaccination program implied no increased risk of persistent HBV infection with aging. Conclusions: Universal HBV vaccination provides long-term protection up to 20 years, and a universal booster is not indicated for the primary HBV vaccinees before adulthood. Maternal transmission is the primary reason for vaccine failure and is the challenge that needs to be addressed in future vaccination programs. This may include an appropriate hepatitis B immunoglobulin administration strategy for high-risk infants and involve efforts to minimize noncompliance.

Section snippets

Vaccination Program

The HBV universal vaccination program was launched in Taiwan on July 1, 1984.8 The vaccination covered newborns of HBsAg-carrier mothers from July 1984 to June 1986; the program was extended to all newborns since July 1986 and extended again to preschool children from July 1987 to June 1988. It was further extended to cover school children, teenagers, and then adults from 1988 to 1990.

Since 1991, the vaccination records of first-grade school children have been checked, and those children who

Vaccine Coverage

The vaccination coverage rate was high in the population of subjects in this study. Infants (<1 year of age) had a high incomplete vaccination rate because 45% (50/110) were too young to complete the schedule. The incomplete vaccination rate (defined as the percentage of persons who received <3 doses of hepatitis B vaccines divided by the number of persons with clear vaccine histories) was approximately 5% except for toddlers (1–2 years of age), which was 0% (Table 1). Because the rate of

Discussion

A high coverage rate of HBV vaccination is crucial in decreasing the prevalence of HBV infection. A coverage rate as high as 97% for younger children and infants was found in the 2004 survey (Table 1). According to the Taiwan Center of Disease Control data, the national coverage rate was increased to 97% in the 2002 birth cohort. Moreover, to ensure a high coverage rate, the government requests students to present their vaccination records when they enter primary school.19 If they do not

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    Supported by grants from the National Taiwan University Hospital (NTUH-94S004) and the Department of Health, Executive Yuan, Taipei, Taiwan (DOH94-DC-1042).

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