Neonatal HBV vaccination reduces the risk of liver cancer and other
liver diseases in young adults in China, according to a study published
by Chunfeng Qu, Taoyang Chen, Yawei Zhang and colleagues from the Cancer
Institute & Hospital at the Chinese Academy of Medical Sciences,
Qidong Liver Cancer Institute, China, and Yale School of Public Health
and School of Medicine, USA in this week's PLOS Medicine.
The researchers report long-term outcomes from the Qidong Hepatitis B
intervention Study (QHBIS), a randomized controlled trial of neonatal
HBV vaccination that was conducted between 1983 and 1990 in Qidong
County, a rural area in China with a high incidence of HBV-related
primary liver cancer (PLC) and other liver diseases. In this study, 41
rural towns (including a total of 77,658 newborns over the study period)
were randomized to the intervention (HBV vaccination for all newborns)
or control (no vaccination) groups, with two-thirds of the control group
participants receiving a catch-up vaccination at age 10-14 years.
By collecting data on new cases of liver diseases over 30 years from a population-based tumor registry, the researchers estimated that the protective efficacy of vaccination was 84% for primary liver cancer (vaccination reduced the incidence of liver cancer by 84%), 70% for death from liver diseases, and 69% for the incidence of infant fulminant hepatitis. Based on survey data collected in 1996-2000 and 2008-2012 on HBsAg seroprevalence, an indicator of current hepatitis B virus (HBV) infection, they conclude that the efficacy of the catch-up vaccination on HBsAg seroprevalence in early adulthood was weak compared to neonatal vaccination (21% versus 72%). While these findings support the importance of neonatal HBV vaccination, the small number of cases of primary liver cancer and other liver diseases observed during the 30-year follow up, the length of follow-up, and the availability of incomplete data on seroprevalence all limit the accuracy of these findings.
The authors say: "Neonatal HBV vaccination significantly decreased HBsAg seroprevalence in childhood through young adulthood and subsequently reduced the risk of PLC and other liver diseases in young adults." They continue: "Our results also suggest that an adolescence booster should be considered in people who were born to HBsAg-positive mothers and completed HBV neonatal vaccination series."
By collecting data on new cases of liver diseases over 30 years from a population-based tumor registry, the researchers estimated that the protective efficacy of vaccination was 84% for primary liver cancer (vaccination reduced the incidence of liver cancer by 84%), 70% for death from liver diseases, and 69% for the incidence of infant fulminant hepatitis. Based on survey data collected in 1996-2000 and 2008-2012 on HBsAg seroprevalence, an indicator of current hepatitis B virus (HBV) infection, they conclude that the efficacy of the catch-up vaccination on HBsAg seroprevalence in early adulthood was weak compared to neonatal vaccination (21% versus 72%). While these findings support the importance of neonatal HBV vaccination, the small number of cases of primary liver cancer and other liver diseases observed during the 30-year follow up, the length of follow-up, and the availability of incomplete data on seroprevalence all limit the accuracy of these findings.
The authors say: "Neonatal HBV vaccination significantly decreased HBsAg seroprevalence in childhood through young adulthood and subsequently reduced the risk of PLC and other liver diseases in young adults." They continue: "Our results also suggest that an adolescence booster should be considered in people who were born to HBsAg-positive mothers and completed HBV neonatal vaccination series."
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