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Hepatitis B (HBV) is one of the most common infectious diseases, with a worldwide annual incidence of over 250 million people. About one-third of the cases are in China. While China made significant efforts to implement a nationwide HBV vaccination program for newborns, a significant number of susceptible adults and teens remain. In this paper, we analyze a game-theoretical model of HBV dynamics that incorporates government-provided vaccination at birth coupled with voluntary vaccinations of susceptible adults and teens. We show that the optimal voluntary vaccination brings the disease incidence to very low levels. This result is robust and, in particular, due to a high HBV treatment cost, essentially independent from the vaccine cost.

BACKGROUND To explore the correlation between serum uric acid (UA) level and liver function indexes in patients with hepatitis B, so as to provide guidance for the prediction and treatment of liver function damage in patients with hepatitis B. METHODS Four hundred and eighty-five patients with hepatitis B were selected as the case group and 312 patients without hepatitis B matched in the same period as the control group. The difference of blood UA level in each group was analyzed, and the correlation between UA and ALT, AST and CREA in each group was analyzed. RESULTS UA in the hepatitis B group was significantly higher than that in non-hepatitis B group, and the difference was statistically significant (p = 0.000). Correlation analysis showed that UA was correlated with ALT in non-hepatitis B group (p < 0.001), while UA was significantly correlated with ALT and AST in hepatitis B group (p < 0.001). Correlation analysis showed that UA was correlated with ALT in male group, but not in female group. The results of logistic multivariate regression analysis showed that the increase of serum UA level was a risk factor for liver function damage in patients with hepatitis B. CONCLUSIONS The level of UA in patients with hepatitis B was significantly higher than that in patients without hepatitis B. The level of UA was positively correlated with the damage of liver function indexes. The correlation between UA and liver function indexes was stronger in males than that in females.

Hepatitis B virus (HBV) infection is a major public health problem worldwide. China has the world's largest burden of HBV infection and will be a major contributor towards the global elimination of hepatitis B disease by 2030. The country has made good progress in reducing incidence of HBV infection in the past three decades. The achievements are mainly due to high vaccination coverages among children and high coverage of timely birth-dose vaccine for prevention of mother-to-child transmission of HBV (both 95%). However, China still faces challenges in achieving its target of 65% reduction in mortality from hepatitis B by 2030. Based on targets of the World Health Organization'sLes infections par le virus de l'hépatite B (VHB) constituent un problème de santé publique majeur à l'échelle mondiale. La Chine est le pays le plus lourdement touché par les infections par le VHB et sa contribution sera donc essentielle pour atteindre l'objectif d'élimination de l'hépatite B dans le monde à l'horizon 2030. Au cours des trente dernières années, le pays a fait des progrès notables en matière de réduction de l'incidence des infections par le VHB. Ces avancées sont principalement dues aux forts niveaux de couverture vaccinale des enfants et d'administration de la dose vaccinale à la naissance visant à prévenir la transmission du VHB de la mère à l'enfant (95% dans les deux cas). Néanmoins, la Chine doit encore relever des défis de taille pour atteindre l'objectif de réduction de 65% de la mortalité due à l'hépatite B d'ici à 2030. À partir des cibles définies dans laLa infección por el virus de la hepatitis B (VHB) es un gran problema de sanidad pública en todo el mundo. China tiene la mayor carga de infección por VHB en el mundo y será uno de los principales contribuyentes a la eliminación mundial de la enfermedad de la hepatitis B para 2030. En las últimas tres décadas, el país ha hecho grandes progresos en la reducción de la incidencia de la infección por el VHB. Los logros se deben principalmente a la alta cobertura de vacunación entre los niños y a la alta cobertura de la vacuna de dosis oportuna al nacer para la prevención de la transmisión maternoinfantil del VHB (ambas95 %). Sin embargo, China sigue teniendo dificultades para alcanzar su objetivo de reducir en un 65 % la mortalidad por hepatitis B para 2030. Basados en los objetivos de la Organización Mundial de la Salud sobre laتمثل عدوى فيروس الالتهاب الكبدي ب (HBV) إحدى المشكلات الصحية العامة الكبيرة حول العالم. تنوء الصين بأكبر حصة عالمية من عدوى فيروس الالتهاب الكبدي، وستكون مساهماً رئيسياً في القضاء على مرض الالتهاب الكبدي ب حول العالم بحلول عام 2030. لقد حققت الدولة تقدماً جيداً في الحد من انتشار عدوى فيروس الالتهاب الكبدي ب في العقود الثلاثة الماضية. وتعود تلك الإنجازات بشكل رئيسي إلى ارتفاع التغطية بالتطعيم بين الأطفال، والتغطية العالية لتطعيم جرعة الولادة في وقتها المناسب، للوقاية من انتقال فيروس الالتهاب الكبدي ب من الأم إلى الطفل (كلاهما95٪). ومع ذلك، لا تزال الصين تواجه تحديات في تحقيق هدفها بتخفيض نسبة الوفيات الناجمة عن الالتهاب الكبدي ب بنسبة 65٪ بحلول عام 2030. واستناداً إلى أهداف استراتيجية قطاع الصحة العامة لمنظمة الصحة العالمية بشأن الالتهاب الكبدي الفيروسي للفترة من 2016 إلى 2021، فإننا نسلط الضوء على أولويات إضافية للعمل على التخلص من فيروس الالتهاب الكبدي ب في الصين. ولتحقيق هدف التأثير المتمثل في خفض معدل الوفيات، نقترح منح أولوية أهداف تغطية الخدمة لكل من التشخيص والعلاج. أولاً، هناك حاجة إلى التحسينات في قدرات التشخيص والعلاج للمؤسسات الطبية والعاملين الصحيين. ثانيا، تحتاج الحكومة إلى الحد من العبء المالي للرعاية الصحية على المرضى. ثالثاً، هناك حاجة إلى تنسيق أفضل عبر البرامج والموارد الوطنية الحالية لإنشاء نظام متكامل للوقاية والتحكم يغطي الوقاية من فيروس الالتهاب الكبدي ب وفحصه وتشخيصه وعلاجه طوال دورة الحياة. وبهذه الطريقة، يمكن إحراز تقدم نحو تحقيق هدف القضاء على الالتهاب الكبدي ب في الصين بحلول عام 2030.乙型肝炎病毒 (HBV) 感染是一个严重的全球公共卫生问题。中国是世界上乙型肝炎病毒 (HBV) 感染负担最重的国家，也是实现 2030 年前全球消除乙肝目标的主要贡献者。近 30 年来，我国的乙肝病毒感染发生率呈现显著下降趋势。取得这些成就的主要原因在于儿童疫苗接种的覆盖率高，以及新生儿在出生时及时接种疫苗【预防乙型肝炎病毒 (HBV) 母婴传播】的覆盖率高（均高于 95%）。然而，中国要在 2030 年前实现乙肝死亡率降低 65% 这一目标，仍面临巨大挑战。根据世界卫生组织《2016-2021 年全球卫生部门病毒性肝炎战略》目标，我们强调在中国进一步消除乙型肝炎病毒 (HBV) 的重点行动。为了实现降低死亡率的影响指标，我们建议优先考虑诊断与治疗的服务覆盖率目标。首先，提高医疗机构和医疗工作者的诊断与治疗能力。其次，政府需要减轻患者接受治疗的经济负担。第三，更好地协调现有国家规划与资源之间的关系，以建立涵盖整个生命周期的乙型肝炎病毒 (HBV) 感染的预防、筛查、诊断和治疗的综合预防和控制系统。这样，中国才能在 2030 年消除乙肝的目标上取得进步。.Инфекция вирусом гепатита В (HBV) представляет собой одну из самых серьезных проблем общественного здравоохранения во всем мире. Бремя этого заболевания в Китае крупнейшее в мире, и эта страна должна будет внести основной вклад в ликвидацию гепатита В в масштабах планеты к 2030 году. Китай хорошо продвинулся на пути снижения уровня инфицирования HBV за последние три десятилетия. Этими достижениями он обязан в основном высокому покрытию вакцинированием среди детей и высокому уровню своевременной вакцинации в момент рождения для предотвращения передачи гепатита В от матери ребенку (оба показателя превышают 95%). Однако Китай все еще сталкивается с затруднениями в достижении своей цели — снижения смертности от гепатита В на 65% к 2030 году. Основываясь на целях

BackgroundThe long-term impact of sexual transmission on the hepatitis B virus (HBV) infection in China remains unclear. This study aims to estimate the independent influence of sexual transmission on HBV infection.MethodsBased on the natural history of HBV infection and three national serosurvey data of hepatitis B in China, we developed an age- and sex-specific discrete model to describe the transmission dynamics of HBV. The initial conditions of the model were determined according to the age- and sex-specific national serosurvey data in 1992. Based on the national survey data of hepatitis B in 1992 and 2006, by using the Markov Chain Monte Carlo (MCMC) method, we estimated the age- and sex-specific seroclearance rates of hepatitis B surface antigen (HBsAg) and the horizontal transmission rates as well as their 95% confidence intervals (CI). Then we used the age- and sex-specific national serosurvey data of hepatitis B in 2014 to test the accuracy of our model-based estimation. Finally, we evaluated the independent impact of sexual transmission on HBV infection and discussed the long-term effect of promotion of condom use in China.ResultsWe estimated that the annual rates of HBsAg seroclearance for males and females aged 1–59 years were respectively 1.04% (95% CI, 0.49–1.59%) and 1.92% (95% CI, 1.11–2.73%). Due to sexual transmission, in 2014, the total number of chronic HBV infections in people aged 0–100 years increased 292,581, of which males increased 189,200 and females increased 103,381. In 2006, the acute HBV infections due to sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) and in 2014, which accounted for 34.59% (male: 42.93%, female: 25.73%). However, if the condom usage rate was increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1–59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).ConclusionsSexual transmission has become the predominant route of acute HBV infection in China, especially for men. The promotion of condom use plays a significant role in reducing the cases of acute HBV infection.

Background In 2016, the first global viral hepatitis elimination targets were endorsed. An estimated one-third of the world’s population of individuals with chronic hepatitis B virus (HBV) infection live in China and liver cancer is the sixth leading cause of mortality, but coverage of first-line antiviral treatment was low. In 2015, China was one of the first countries to initiate a consultative process for a renewed approach to viral hepatitis. We present the investment case for the scale-up of a comprehensive package of HBV interventions. Methods A dynamic simulation model of HBV was developed and used to simulate the Chinese HBV epidemic. We evaluated the impact, costs, and return on investment of a comprehensive package of prevention and treatment interventions from a societal perspective, incorporating costs of management of end-stage liver disease and lost productivity costs. Results Despite the successes of historical vaccination scale-up since 1992, there will be a projected 60 million people still living with HBV in 2030 and 10 million HBV-related deaths, including 5.7 million HBV-related cancer deaths between 2015 and 2030. This could be reduced by 2.1 million by highly active case-finding and optimal antiviral treatment regimens. The package of interventions is likely to have a positive return on investment to society of US$1.57 per US dollar invested. Conclusions Increases in HBV-related deaths for the next few decades pose a major public health threat in China. Active case-finding and access to optimal antiviral treatment are required to mitigate this risk. This investment case approach provides a real-world example of how applied modeling can support national dialog and inform policy planning., Approximately one-third of the world’s population with chronic Hepatitis B Virus (HBV) live in China. A comprehensive package of interventions against HBV, including case-finding and antiviral treatment, could reduce HBV-related deaths by 2.1 million and is likely to have a positive return on investment to society over 15 years.

In this study, we formulate a model for hepatitis B virus with control strategies of newborn vaccination and treatment. Mathematical analysis is done theoretically and numerically. The results indicate that the stability of equilibria and persistence of the disease are determined by the basic reproductive number R0. Using the least squares method, the model is applied to simulate yearly new infected cases of hepatitis B in China from 2004 to 2016. Moreover, optimal control problem with newborn vaccination and treatment appearing as functions of time is analyzed by classical optimal theory. The existence of the solution to optimality system is proved, and the simulations are conducted to show the results when optimal control or current intervention is used.

The age-specific seroclearance pattern of hepatitis B surface antigen (HBsAg) in chronic hepatitis B virus (HBV) infections of China remains unclear. In this study, based on three national serosurvey data of hepatitis B in China, we propose an age- and time-dependent discrete model and use the method of non-linear least squares to estimate the age-specific annual rate of HBsAg seroclearance. We found that the HBsAg seroclearance in chronic HBV infections of China aged 1–59 years occurred at an average annual rate of 1.80% (95% CI, 1.54–2.06%) from 1993 to 2006. The HBsAg seroclearance occurred predominantly in the early childhood, 20–24 and 35–39 year age groups. Moreover, our model estimated that HBsAg seroclearance resulted in 23.38% of the decrease of total HBsAg prevalence for population aged 1–59 years in 2006. It also prevented 9.30% of new HBV infections (about 7.43 million people) and 9.95% of HBV-related deaths (about 0.25 million people) from 1993 to 2006. This study develops a new and efficient method to estimate the age-specific incidence of HBsAg seroclearance at a population-level and evaluate its effect.

Background Hepatitis B virus (HBV) infection is a major public health problem in China. Over a decade has passed since the last National Hepatitis Seroepidemiological Survey was conducted in 2006. The lack of updated data on hepatitis B in China makes assessing the current prevalence and burden of the disease inadequate. In response to the above situation, a systematic review and meta-analysis was conducted to provide a better understanding of hepatitis B epidemiology in the general population of China. Methods A systematic search was conducted in international databases (Medline through PubMed, EMBASE, Cochrane, Web of Science) and national databases (CBM, CNKI, WanFang Data) to retrieve primary studies published between January 1, 2013 and December 31, 2017. The pooled prevalence of HBV infection and 95% confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also performed. Results Of the 27 studies included in the meta-analysis, the pooled estimated prevalence of HBV infection in the general population of China from 2013 to 2017 was 6.89% (95% CI:5.84–7.95%), which could be extrapolated to an estimated population of 84 million living with HBsAg in 2018. The prevalence of HBV infection in males was higher than that in females (5.88% vs 5.05%), and rural areas had a higher prevalence than urban areas (5.86% vs 3.29%). The highest prevalence of HBV infection was reported in Western provinces (8.92, 95% CI: 7.19–10.64%). In adults older than 20 years, the prevalence of HBV infection was approximately 7%, which was higher than that in children. Conclusion The prevalence of HBV infection in the general population of China was classified as higher intermediate prevalence (5–7.99%), of which more than 90% of the HBV infection population included adults older than 20 years. The blocking of mother-to-infant hepatitis B transmission and plans involving timely birth dose of hepatitis B vaccine within 24 h should be implemented. Additionally, improving the quality of life and survival rate of the infected population through antiviral therapy and high-risk adult vaccination will be the priority of our future work. Moreover, various control measures should be implemented in different provinces across China.

Ethnopharmacological relevance Formula Le-Cao-Shi (LCS) is a traditional Chinese medicine (TCM), which has long been used as a folk remedy against hepatitis B in China. The present study was conducted to evaluate the anti-hepatitis B effects of aqueous extract of LCS in vivo and in vitro. Materials and method we investigated the anti-HBV effects of LCS in vivo and in vitro with duck hepatitis B model and HepG2.2.15 cell line model, respectively. The serologic and cellular biomarkers and the histopathological changes were examined. Results By a duck hepatitis B model, the extract of LCS was found to restrain the expressions of duck hepatitis B surface antigen (DHBsAg), hepatitis B e antigen (DHBeAg), and HBV-DNA (DHBV-DNA). Moreover, LCS could decrease the levels of aspartate and alanine aminotransferases (AST and ALT) and ameliorate duck liver histological lesions. Correspondingly, in a HepG2.2.15 cellular model, LCS could also significantly inhibit the secretions of HBsAg and HBeAg. Conclusion LCS exerted potent anti-hepatitis effects against the infection of HBV. The above results demonstrated the first-hand experimental evidences for the anti-hepatitis B efficiency of LCS. Our study provides a basis for further exploration and development of this promising compound prescription to treat hepatitis B disease.

Polyporus umbellatus polysaccharide (PUPS) has been identified as the major bioactive component in the mushroom Polyporus umbellatus that has immuno-enhancing, anti-tumor, anti-inflammatory, and hepatoprotective activities. Both PUPS capsule and injection are Chinese Food and Drug Administration (SFDA) approved drugs, which have been used alone or in combination with a variety of clinical drugs for treating Hepatitis B, lung and liver cancers in China since 1990. Our aim was to review both the efficacy and problem associated with PUPS mono- and combination therapy conducted in China and the underlying molecular mechanisms. To this end, the term Polyporus umbellatus polysaccharide both in English and in Chinese was used to conduct a systematic search of PubMed, VIP (Chongqing VIP Chinese Scientific Journals Database), CNKI (China National Knowledge Infrastructure), and Wanfang database. A total 11,703 clinically reported cases in China from over 100 publications during the past 27 years were evaluated, translated into English, and summarized into 3 figures and 13 tables to provide a general view of efficacy of PUPS during mono- and combination therapy. The published data showed the effectiveness of PUPS for treating hepatitis B in most reported cases. Moreover, the combined therapies for PUPS plus hepatitis B vaccine, PUPS plus interferon, PUPS plus acyclovir, and PUPS plus iRNA are better than when treated with either drug alone. Overall, when PUPS is used alone or in combination with other drugs for prevention and treatment of hepatitis B-affected patients, the efficacy is convincible.

Background: The efficacy and safety evidence of bortezomib in multiple myeloma (MM) patients with hepatitis B is vacant. This study aimed to investigate the efficacy and safety of bortezomib in MM patients with hepatitis B in China. Methods: From 2006 to 2011, 739 newly diagnosed MM patients were screened for serum hepatitis B virus (HBV) biomarkers. HBV-infected patients were followed for HBV reactivation by monitoring of serum alanine transaminase (ALT) and HBV DNA load. The pattern of HBV reactivation in relation to bortezomib was evaluated. Seven hundred thirty-nine MM patients were included in this study. Results: The prevalence of MM patients infected with HBV was 3.4% ( n = 25), of which 17 cases were treated with bortezomib. Bortezomib had no significant influence on liver function (ALT before and after treatment: 36.69 ± 8.90 U/L vs. 11.31 ± 2.74 U/L, P = 0.19) and HBV DNA of MM patients with HBV (detectable HBV DNA percentage: 5.9% vs. 11.8%, P = 0.12). Conclusions: Bortezomib can be used safely and effectively in MM patients with hepatitis B. HBV prophylaxis and surveillance are recommended during the MM treatment.

Despite a decline in the prevalence of hepatitis B in China, the disease burden remains high. Large populations unaware of infection risk often fail to meet the ideal treatment window, resulting in poor prognosis. The purpose of this study was to develop and evaluate models identifying high-risk populations who should be tested for hepatitis B surface antigen. Data came from a large community-based health screening, including 97,173 individuals, with an average age of 54.94. A total of 33 indicators were collected as model predictors, including demographic characteristics, routine blood indicators, and liver function. Borderline-Synthetic minority oversampling technique (SMOTE) was conducted to preprocess the data and then four predictive models, namely, the extreme gradient boosting (XGBoost), random forest (RF), decision tree (DT), and logistic regression (LR) algorithms, were developed. The positive rate of hepatitis B surface antigen (HBsAg) was 8.27%. The area under the receiver operating characteristic curves for XGBoost, RF, DT, and LR models were 0.779, 0.752, 0.619, and 0.742, respectively. The Borderline-SMOTE XGBoost combined model outperformed the other models, which correctly predicted 13,637/19,435 cases (sensitivity 70.8%, specificity 70.1%), and the variable importance plot of XGBoost model indicated that age was of high importance. The prediction model can be used to accurately identify populations at high risk of hepatitis B infection that should adopt timely appropriate medical treatment measures.

Background Hepatitis B virus (HBV) infection is a major public health threat in China for China has a hepatitis B prevalence of more than one million people in 2017 year. Disease incidence prediction may help hepatitis B prevention and control. This study intends to build and compare 2 forecasting models for hepatitis B incidence in China. Methods Autoregressive integrated moving average (ARIMA) model and grey model GM(1,1) were adopted to fit the monthly incidence of hepatitis B in China from March 2010 to October 2017. The fitting and forecasting performances of the 2 models were evaluated. The better one was adopted to predict the incidence from November 2017 to March 2018. Database was built by Excel 2016 and statistical analysis was completed using R 3.4.3 software. Results Descriptive analysis showed that the incidence of hepatitis B in China has seasonal variation and has shown a downward trend from 2010 to 2017. We selected the ARIMA (3,1,1) (0,1,2)12 model among all the ARIMA models for it has the lowest AIC value. Model expression of GM (1,1) was X(1) (k + 1) = 3386876.7478e0.0249k - 3289206.7428. The root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) of ARIMA(3,1,1)(0,1,2)12 model were lower than GM(1,1) model on fitting part and forecasting part. According to the forecast results, the incidence may have a slight fluctuation during the following months. Conclusions The ARIMA model showed better hepatitis B fitting and forecasting performance than GM(1,1) model. It is a potential decision supportive tool for controlling hepatitis B in China before a predictive hepatitis B outbreak.

Prevalence of hepatitis B is still high among adults in China, athough the prevalence in children has decreased dramatically. Immunization against hepatitis B among adults is urgently required. Through analyzing the immunogenicity of different doses, schedules and booster immunization among adults, we recommend 10 or 20 μg with a 0-1-6-month schedule or a 0-1-12-month schedule for migrant adults. For immunity failure, increasing the dose or covalent vaccine is suggested to provide protective antibodies. To enhance immunity among adults, hepatitis B vaccine should be included in health insurance.

Considering the high morbidity of hepatitis B in China, many epidemiological studies based on classic medical statistical analysis have been started but lack spatial information. However, spatial information such as the spatial distribution, autocorrelation and risk factors of the disease is of great help in studying patients with hepatitis B. This study examined 2851 cases of hepatitis B that were hospitalized in Shenzhen in 2010 and studied the spatial distribution, risk factors and spatial access to health services using spatial interpolation, Pearson correlation analysis and the improved two-step floating catchment area method. The results showed that the spatial distribution of hepatitis B, along with risk factors as well as spatial access to the regional medical resources, was uneven and mainly concentrated in the south and southwest of Shenzhen in 2010. In addition, the distribution characteristics of hepatitis B revealed a positive correlation between four types of service establishments and risk factors for the disease. The Pearson correlation coefficients are 0.566, 0.515, 0.626, 0.538 corresponding to bath centres, beauty salons, massage parlours and pedicure parlours (p &lt, 0.05). Additionally, the allocation of medical resources for hepatitis B is adequate, as most patients could be treated at nearby hospitals.

With its 78 million chronic carriers, hepatitis B virus (HBV) infection is still one of the leading public health challenges in China. Over the last two decades, China has made great progress on the prevention of HBV transmission through national vaccination programs. Zero transmission from mother to infant has been proposed as the current goal. Available anti-HBV therapy is efficacious in suppressing HBV replication; however, it fails to completely cure patients with chronic hepatitis B and even requires lifelong treatment. To reduce the costs and improve the efficacy, several trials have been recently conducted in China to optimize the current anti-HBV managements. Novel biomarkers were identified to predict treatment outcomes, and new promising treatment strategies were developed. Reports also indicate that coinfections of HBV with other hepatotropic viruses and human immunodeficiency virus are common in China and cause severe liver diseases, which should be recognized early and treated properly. Work is still needed to eliminate hepatitis B in China by 2030.

This study explores the interactions of the environmental barriers, coping behaviors, and personal characteristics of persons living with hepatitis B in China within the framework of Bandura's social cognitive theory. An analysis of 1,607 messages from an online support group revealed multiple barriers including institutional discrimination, relationship difficulty, alcohol-drinking social norm, limitations of the health care system and pharmaceutical market, and financial constraints. Major coping behaviors were identified as seeking health and reproductive advice, avoiding disclosure and discrimination, protecting legal rights, preventing transmission, and outreaching support behaviors. At the intrapersonal level, a combatant identity was constructed in the online community. The combatant identity was significantly associated with high self-efficacy, positive emotions, and outreaching support behaviors, but it was not significantly associated with environmental barriers. The constructed online combatant identity appeared to be support-focused instead of politically oriented.

Background China's Integrated Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Virus programme (iPMTCT Programme) was launched in 2010 and has been extended nationwide since 2015. China also set up the Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Syphilis, and Hepatitis B virus in 2016. This study aimed to assess the progress that has been made in eliminating mother-to-child transmission of HIV, syphilis and hepatitis B, and to identify the challenges that remain. Methods Data on testing coverage among 17·58 million pregnant women who attended antenatal care services, and services received by pregnant women with HIV, syphilis or hepatitis B infection and by children exposed to infection were extracted from the Management Information System of China's iPMTCT Programme. Document review, group discussions and field observations were conducted to assess the iPMTCT in line with the four evaluation components set out in the WHO EMTCT validation guidelines: program assessment, data quality, laboratory quality assurance, and human rights, gender equality, and community engagement. Informed consent was obtained from pregnant women when they received services in the health facilities. Findings The mother-to-child transmission rate of HIV was 4·9% (the reported number of children with HIV was 55 of 2172 children exposed to HIV, and the adjusted mother-to-child transmission rate was 4·9% [114·6 of 2333]) in 2017, which decreased from 12·8% in 2005. Between 2011 and 2017, the number of reported congenital syphilis cases declined from 13 294 to 3 846, and the reported number of children with HIV through mother-to-child transmission reduced from 79 to 55. In 2017, the coverage of HIV, syphilis and hepatitis B screening tests among pregnant women was over 99·5%. Of the pregnant women who were screened and diagnosed with HIV or syphilis, 89·6% and 80·0% received treatment, respectively. The rate of early infant diagnosis in children exposed to HIV reached 84·3% in 2017. Nearly all (99·7%) of infants exposed to hepatitis B virus received hepatitis B immune globulin vaccine at birth in 2017. The following factors were identified as the main gaps to be bridged to achieve the goals of eliminating mother-to-child transmission of HIV, syphilis and hepatitis B: inconsistency in the definitions of progress indicators; lack of a system to collect follow-up data on outcomes in children exposed to hepatitis B virus; a relatively weak laboratory network at grass-roots level (inadequate number and quality of laboratories); limited capacity of health facilities at grass-roots level; inadequate quality of reported data; and insufficient involvement of community-based organizations (CBOs). Interpretation The mother-to-child transmission rate of HIV and reported congenital syphilis cases has decreased since the program launched, and comprehensive PMTCT services are available for all pregnant women across the country. Universal coverage of screening in pregnant women and HBIG vaccination in infants exposed to infection has been achieved. To achieve elimination of mother-to-child transmission of all three viruses, efforts are needed to strengthen multisectoral collaboration, increase treatment rates among women with infection, develop a standardised indicator system in accordance with WHO EMTCT validation tools, improve reporting and quality control mechanisms, strengthen laboratory networks, improve the capacity of the private sector, and extend the involvement of CBOs. Funding The Chinese government and UNICEF China.

Viral hepatitis, as one of the most serious notifiable infectious diseases in China, takes heavy tolls from the infected and causes a severe economic burden to society, yet few studies have systematically explored the spatio-temporal epidemiology of viral hepatitis in China. This study aims to explore, visualize and compare the epidemiologic trends and spatial changing patterns of different types of viral hepatitis (A, B, C, E and unspecified, based on the classification of CDC) at the provincial level in China. The growth rates of incidence are used and converted to box plots to visualize the epidemiologic trends, with the linear trend being tested by chi-square linear by linear association test. Two complementary spatial cluster methods are used to explore the overall agglomeration level and identify spatial clusters: spatial autocorrelation analysis (measured by global and local Moran’s I) and space-time scan analysis. Based on the spatial autocorrelation analysis, the hotspots of hepatitis A remain relatively stable and gradually shrunk, with Yunnan and Sichuan successively moving out the high-high (HH) cluster area. The HH clustering feature of hepatitis B in China gradually disappeared with time. However, the HH cluster area of hepatitis C has gradually moved towards the west, while for hepatitis E, the provincial units around the Yangtze River Delta region have been revealing HH cluster features since 2005. The space-time scan analysis also indicates the distinct spatial changing patterns of different types of viral hepatitis in China. It is easy to conclude that there is no one-size-fits-all plan for the prevention and control of viral hepatitis in all the provincial units. An effective response requires a package of coordinated actions, which should vary across localities regarding the spatial-temporal epidemic dynamics of each type of virus and the specific conditions of each provincial unit.

Supplemental Digital Content is available in the text, The potential impact of increasing test-and-treat coverage on hepatitis B virus (HBV) infection remains unclear in China. The objective of this study was to develop a dynamic compartmental model at a population level to estimate the long-term effect of this strategy. Based on the natural history of HBV infection and 3 serosurvey data of hepatitis B in China, we proposed an age- and time-dependent discrete model to predict the number of new HBV infection, the number of chronic HBV infection, and the number of HBV-related deaths for the time from 2018 to 2050 under 5 different test-and-treat coverage and compared them with current intervention policy. Compared with current policy, if the test-and-treat coverage was increased to 100% since 2018, the numbers of chronic HBV infection, new HBV infection, and HBV-related deaths in 2035 would be reduced by 26.60%, 24.88%, 26.55%, respectively, and in 2050 it would be reduced by 44.93%, 43.29%, 43.67%, respectively. In contrast, if the test-and-treat coverage was increased by 10% every year since 2018, then the numbers of chronic HBV infection, new HBV infection, and HBV-related deaths in 2035 would be reduced by 21.81%, 20.10%, 21.40%, respectively, and in 2050 it would be reduced by 41.53%, 39.89%, 40.32%, respectively. In particular, if the test-and-treat coverage was increased to 75% since 2018, then the annual number of HBV-related deaths would begin to decrease from 2018. If the test-and-treat coverage was increased to above 25% since 2018, then the hepatitis B surface antigen (HBsAg) prevalence for population aged 1 to 59 years in China would be reduced to below 2% in 2035. Our model also showed that in 2035, the numbers of chronic HBV infection and HBV-related deaths in 65 to 69 age group would be reduced the most (about 1.6 million and 13 thousand, respectively). Increasing test-and-treat coverage would significantly reduce HBV infection in China, especially in the middle-aged people and older people. The earlier the treatment and the longer the time, the more significant the reduction. Implementation of test-and-treat strategy is highly effective in controlling hepatitis B in China.

To determine the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc) in a representative population in China 14 years after introduction of hepatitis B vaccination of infants.National serosurvey, with participants selected by multi-stage random sampling. Demographics and hepatitis B vaccination history collected by questionnaire and review of vaccination records, and serum tested for HBsAg, antibody to anti-HBc and anti-HBs by ELISA.The weighted prevalences of HBsAg, anti-HBs and anti-HBc for Chinese population aged 1-59 years were 7.2%, 50.1%, 34.1%, respectively. HBsAg prevalence was greatly diminished among those age15 years compared to that found in the 1992 national serosurvey, and among children age5 years was only 1.0% (90% reduction). Reduced HBsAg prevalence was strongly associated with vaccination among all age groups. HBsAg risk in adults was associated with male sex, Western region, and certain ethnic groups and occupations while risk in children included birth at home or smaller hospitals, older age, and certain ethnic groups (Zhuang and other).China has already reached the national goal of reducing HBsAg prevalence to less than 1% among children under 5 years and has prevented an estimated 16-20 million HBV carriers through hepatitis B vaccination of infants. Immunization program should be further strengthened to reach those remaining at highest risk.

Chronic hepatitis B infection is a very important health problem in China, which is carrying an enormous economic and social burdens. The major routs of chronic hepatitis B infection in China are mother-infant vertical transmission and early childhood horizontal transmission. After more than 10 years implementation of universal vaccination against hepatitis B in newborns and safety injection in health care settings, the prevalence of HBsAg in general population has decreased from 9.75% to around 7%. In China, patients with hepatitis are cared by either hepatologists or physicians of infectious diseases. The Chinese Society of Hepatology, and Chinese Society of Infectious Diseases jointly issued an evidence-based guideline on the prevention and treatment of chronic hepatitis B in 2005. This guideline concisely describes the virology, epidemiology, natural history and prevention, as well as diagnosis and management of chronic hepatitis B. It also highlights the importance of active viral replication in disease progression in chronic HBV infection and explicitly states the necessity of antiviral therapy in patient care. The cornerstone of anti-hepatitis B therapy is optimal use of interferons or nucleos(t)ide analogs in those patients with active viral replication and elevated serum transaminase levels. Through an independent continue medical educational agency, a panel of selected speakers were trained to give well-formatted talks on the key points of the guideline in over 60 major cities across China. This educational campaign among health care providers has greatly improved the awareness and the stand of care for antiviral therapy.

Objective To evaluate the independent impact of newborn hepatitis B vaccination on reducing HBV prevalence in China, from its introduction in 1992 to 2006. Methods An age- and time-dependent discrete dynamic model was developed to simulate HBV transmission in China under the assumptions of no any change in interventions and only with newborn vaccination introduction, respectively. The initial conditions of the model were determined according to the national serosurvey in 1992. The simulated results were compared with the observed results of the national serosurvey in 2006, and the contribution rate of newborn vaccination on reducing HBV prevalence was calculated overall and by birth cohort. Results The total HBV prevalence would remain stable through the 14-year period if no any change in interventions, but decrease year by year if only with newborn vaccination introduction. Newborn vaccination could account for more than 50% of the reduction of the total HBV prevalence, although the full 3-dose and timely birth dose vaccination coverage rates were low in the early years. The results by birth cohort showed that the higher the two coverage rates, the higher contribution rate on reducing HBV prevalence. For the 2005 birth cohort which had high levels in the two coverage rates, the contribution rate could reach more than 95%. Conclusion Newborn hepatitis B vaccination from 1992 to 2006 in China had played the most important role in reducing HBV prevalence. Newborn vaccination with high full 3-dose and timely birth dose coverage rates is the decisive factor in controlling hepatitis B in China.

Hepatitis B (HB) is a serious public health problem in China. Up to now, the hepatitis B virus (HBV) vaccination was the most cost-effective way to prevent HBV infection. Since 1992, when the Chinese government prioritized implementing the HBV vaccinations for newborns, China began to see a larger reduction in HBV infections. For children under 5 years, the prevalence of hepatitis B surface antigen (HBsAg) has decreased to 1.0%. However, many additional challenges for the prevention and control of HBV infection in China remain. There is a lack of knowledge of the significant impact of the HBV vaccination for the general public with 93 million HBV carriers and chronic HBV patients as infection sources. Therefore, the HBV vaccine application should focus on the optimization of immunization strategies according to HBV prevalence characteristics, improve the public's knowledge of HBV vaccinations, and help to ensure the protective effects of the HBV vaccine.

Accurate incidence forecasting of infectious disease provides potentially valuable insights in its own right. It is critical for early prevention and may contribute to health services management and syndrome surveillance. This study investigates the use of a hybrid algorithm combining grey model (GM) and back propagation artificial neural networks (BP-ANN) to forecast hepatitis B in China based on the yearly numbers of hepatitis B and to evaluate the method’s feasibility. The results showed that the proposal method has advantages over GM (1, 1) and GM (2, 1) in all the evaluation indexes.

The aim of this study is to evaluate the effect of treatment with the Molecular Adsorbent Recirculating System (MARS) on liver failure based on HBV. In 25 patients (median age, 36.3 years, range, 22-67 years, bilirubin level > 255 micro mol/l) admitted with liver failure based on HBV, the 6-8h MARS intermittent treatments were performed without any adverse events, A significant decrease in bilirubin, ammonia and urea levels were observed (P < 0.05). All patients achieved a remarkable neurologic recovery, particularly 2 HE-III and 3 HE-IV patients regained normal consciousness, respectively. The survival rate for the patients whose treatments kept to the MARS art strategy was 76.9% (10/13), while the others only had the survival rate of 16.7% (2/12) due to their giving up sequential MARS treatments after the first time. The rebounding rate of the bilirubin level in the patients after a single MARS treatment was significantly lower than that of patients, who underwent a single plasma-exchange treatment (P < 0.01). It is concluded that MARS method can contribute to the optimistic treatment of liver failure patients based on HBV which being the major epidemic liver disease in China.

Background Hepatitis B virus (HBV) infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner (GP) system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied. Data Sources A literature search of PubMed, CNKI, Wanfang data and VIP was performed with the following key words: “general practitioner”, “family physician”, “community management”, “community health care workers”, “family practice”, “hepatitis B virus”, “HBV”, “HBV vaccination”, “HBV prevention”, “HBV management”, “HBV treatment”, “antiviral therapy” and “chronic hepatitis B (CHB)”. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed. Results The reports on the role of GPs in the prevention, diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients with CHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB. Conclusions The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs' knowledge and skills for the control of HBV infection have to be improved currently. GPs' involvement will enforce the management of CHB in China in the near future.

In a previous study we noticed that there might be co-infections of HBV and HIV by comparing incidence rates of these two diseases in China. The comparisons between the incidence data of HBV and sexually transmitted diseases (including AIDS, HIV, syphilis and gonorrhea) in China demonstrate that sexual transmission is an important route of spread of HBV in China. On the basis of this fact, in this paper we propose a compartmental model including under-aged children, male adults, and female adults. The effect of sexual transmission on the spread and prevalence of HBV in China is studied. The model is employed to simulate the HBV incidence data reported by the Chinese Center for Disease Control and Prevention for under-aged children, adult males, and adult females, respectively. The sensitivity analysis of the basic reproduction number indicates that it is important and crucial to increase the immunization rate for both under-aged children and adults in order to control the transmission of HBV in China. Our study suggests that effective control measures for hepatitis B in China include enhancing public education and awareness about hepatitis B virus, particularly about the fact that hepatitis B is a sexually transmitted disease, and increasing the immunization rate for both under-aged children and adults, especially for those groups of high risk.

The prevalence of hepatitis B is high in China. Based on the National Disease Supervision Information Management System of China, the mean reported incidence of hepatitis B was 84.3 per 100,000 in China between 2005 and 2010. There are differences in population distribution based on region and ethnic group. Here, risk factors, virological characteristics, and prophylaxis of hepatitis B in China are reviewed. Although the prevalence of HBV infection is gradually declining, there are many challenges in HBV infection control, including higher prevalence in floating population, poor compliance of antiviral therapy, and high disease burden.

A randomised, multicentre, double-blind, placebo controlled trial was conducted in Chinese patients with chronic hepatitis B to compare the efficacy of once-daily lamivudine and placebo on serum HBV DNA, and to assess the long-term efficacy and safety of lamivudine. Patients received lamivudine 100 mg (n = 322) or placebo (n = 107) once daily for 12 weeks, and were then offered open-label lamivudine treatment for 2 years. Lamivudine therapy resulted in increased hepatitis B e antigen (HBeAg) loss and seroconversion (loss of HBeAg plus the development of antibodies to HBeAg) in patients with high baseline serum alanine aminotransferase (ALT) concentrations. At 2 years, loss of HBeAg was achieved by 27% (38/140), 38% (25/66) and 60% (9/15), and seroconversion was achieved by 17% (24/140), 24% (16/66) and 33% (5/15) of patients with baseline serum alanine aminotransferase (ALT) concentrations of >1 x upper limit of normal (ULN), >2 x ULN and >5 x ULN, respectively. With lamivudine treatment, serum HBV DNA decreased rapidly to very low concentrations and remained low throughout the 2 years of the study. At 1 year, 15% (43/295) of patients in the lamivudine group had developed YMDD (tyrosine-methionine-aspartate-aspartate amino acid motif of HBV polymerase) variant HBV. These patients derived clinical benefit with continued lamivudine therapy, demonstrated by serum HBV DNA and ALT concentrations below baseline, or normal serum ALT concentrations. Lamivudine was well tolerated and an effective once-daily oral therapy for Chinese patients with chronic hepatitis B with viral replication and liver disease.

Chronic hepatitis B (CHB) virus infection is an epidemic that is associated with cirrhosis and liver cancer.1 Management of CHB during pregnancy remains a challenge, with unique issues that involve prevention of MTCT and safe use of antiviral therapy. Previous studies indicate that mothers with CHB pose a risk of vertical transmission of hepatitis B virus (HBV) to infants.2,3 Without intervention, 80%-90% of infants who are born to hepatitis B e antigen (HBeAg)-positive mothers may develop CHB infection.3,4 Use of HBV vaccine and immunoglobulin G (HBIg) within 12 hours of birth, followed by two additional HBV vaccination inoculations, has been demonstrated to reduce the mother-to-child transmission (MTCT) rate from 90% to approximately 5%-10%.5 However, despite appropriate passive-active immunoprophylaxis, MTCT remains a concern and has been reported in approximately 8%-15% of infants who are born to highly viremic mothers, resulting in a significant incidence of infant chronic infection and adding to the large pool of patients with CHB in Asia.6–8 Previous studies indicate that use of lamivudine (LAM) or telbivudine (LdT) during late pregnancy in highly viremic mothers can reduce MTCT, although long-term fetal and infant safety has not been established.7,9,10 Currently, tenofovir disoproxil fumarate (TDF) is not approved for treatment of hepatitis B in China. A recent U.S. report suggested that TDF might be used in the third trimester of pregnancy in preventing MTCT.11 However, real-life observational data are lacking on the use of antiviral therapy in late pregnancy for preventing MTCT. In addition, the sample size in the currently published prospective trials for antiviral treatment in pregnancy involves only approximately 100 subjects in the treatment arm, which may not be large enough to capture the uncommon adverse events (AEs). We conducted a prospective study with a sample size of 700 patients to assess the safety and efficacy of third-trimester use of LdT or LAM versus no treatment, based on the patient-physician decision in a real-life MTCT prevention setting.

Viral hepatitis is a major public health problem in China and has a substantial impact on the health of people. To understand the distribution of hepatitis virus infection in the general Chinese population and provide basis for developing and evaluating preventive procedures and public health practices on viral hepatitis control, a nationwide cross-sectional seroepidemiologic study of hepatitis virus infections was carried out in China, 1992. Using two-stage cluster sampling, a total of 68 000 subjects were studied, aged 1–59 years, covering all 145 national disease surveillance points of 30 provinces, autonomous regions and municipalities. Serum specimens were assayed using commercial reagents. Tested markers include HBsAg, anti-HBc, anti-HBs, HBeAg and anti-HCV. The overall prevalence of HBsAg carrier was 9.75% of 61 702 subjects studied (range 4.49–17.85%) in 30 provinces of China. The rate in the 1–4 age group was as high as the overall rate. There were higher rates in both the 10–14 and 30–34 age groups, and lower in the 50–59 age group. There were considerable variations in the prevalence of HBsAg carrier in different regions and sex in China, with the highest rate being in middle south and lower rates in north China. The overall prevalence of HBV infection, anti-HBc and anti-HBs were 57.63%, 49.81% and 27.42%, respectively; increasing significantly with age from 38.47%, 30.08% and 15.75% in the 1–4 age group to 70.69%, 61.77% and 32.42% in 50–59 age group, respectively. The overall prevalence of HBeAg was 31.94% among HBsAg carriers. The overall prevalence of anti-HCV was 3.2% of 66975 subjects studied (range 0.9–5.1%) among 30 provinces of China, increasing significantly with age from 2.08% in the 1–4 age group to 3.96% in the 50–59 age group. There was no difference in the rate of anti-HCV by sex and living district. However, there were significant difference in rates of anti-HCV in different geographical areas and administrative divisions in China, with the highest rates being in the northeast of China. These results indicate that hepatitis B and C are hyperendemic in China. According to characteristics of distribution among age, sex and regions, we suggest that the main modes of transmission of the two virus are probably different in China.

OBJECTIVE Hepatitis B virus (HBV) infection is a highly endemic disease in China. The guidelines of the European Association for the Study of the Liver and the Asian Pacific Association for the Study of the Liver have improved in recent years. Here, we present a survey of physicians in terms of trends in the management of HBV at a teaching hospital in Southwest China. METHODS A questionnaire adopted from an earlier Spanish study was used. Physicians in an affiliated hospital of a Chinese medical university were surveyed. RESULTS A total of 120 (100%) physicians (including 68 fellows) answered the questionnaire voluntarily. Eighty percent (96/120) reported experience in the treatment of hepatopathy. Although a huge majority (90.9%, 109/120) were aware of the Chinese consensus recommendations on HBV, only 51.8% (62/120) correctly identified the indications for the treatment of chronic hepatitis B and 42.5% (51/120) correctly described the end-points in treating HBeAg-positive or HBeAg-negative chronic hepatitis. Serum HBV-DNA levels were used to monitor therapy by 84.2% (101/120) of the respondents, the HBV drug resistance test was used by 77.5% (93/120) of the responders, and antiviral prophylaxis was recommended by 65% (78/120) for HBV carriers who would receive immunosuppressive therapy. About 27.5% (33/120) recommended interferon or pegylated interferon as the initial treatment for HBeAg-positive patients; 93.3% (112/120) recommended oral antiviral therapy to HBeAg-negative patients. Physicians working at teaching hospitals were significantly more likely to recommend antiviral prophylaxis for HBV patients who receive immunosuppressive therapy than physicians working at nonuniversity hospitals (83 vs. 51%; P

In order to find out the infectious rate of hepatitis C virus (HCV) among chronic liver diseases, we investigated antibodies against hepatitis C virus and HCVRNA by method of ELISA, RIBA and RT-PCR in 410 patients with chronic liver disease. The prevalence of HCV infection was found to be 4%. Whereas the positive rate of HBsAg and HBV-DNA of these cases was 69% and 58%, respectively. There is no statistical significance between HCV infectious rate of patients with positive and negative HBsAg. The relative low infectious rate of HCV infection among chronic hepatic diseases indicates that HBV infection plays a more important role in causing chronic hepatitis than that of HCV. Thus, special emphasis should be paid to the preventive and therapeutic measures against hepatitis B in China.

A high rate of chronic HBV infection in China is mainly the result of perinatal or early childhood transmission. Therefore, universal vaccination against HBV in infants has been very successful in the control of chronic HBV infection, with the prevalence of hepatitis B surface antigen decreasing from nearly 10% to approximately 7% in the general population. Adoption of Good Clinical Practice and proper conduction of well-designed clinical trials on conventional and pegylated interferons and nucleos(t)ide analogs have generated important clinical data. The publication and promotion of the evidence-based national guidelines have greatly improved the standard of clinical practice on the prevention and treatment of chronic hepatitis B. The ongoing national key scientific projects on the optimization of vaccination strategy and current anti-HBV therapy will yield important clinical evidence. Inclusion of conventional and pegylated interferons and nucleos(t)ides into the new national reimbursement list will increase the availability and affordability of anti-HBV therapies, thereby further decreasing the morbidity and mortality associated with chronic HBV infection.

Objectives The aim of this study was to investigate the economic consequences of nucleoside analog therapy for hepatitis B treatment in China. Methods A cost-utility analysis of treatments for HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB) was conducted using a Markov model, in which patients' yearly transitions between different health states were tracked. Patients were tracked as they moved between the following health states: CHB, HBeAg seroconversion (HBeAg-positive CHB patients can have this special health state), virologic resistance, virologic response, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and death. The transition parameters were derived either from systematic reviews of the literature or from previous economic studies. Cost and utility data came from studies based on a Chinese CHB cohort. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed. Results The entecavir strategy yielded the most quality-adjusted life years (QALYs) for both HBeAg-positive and HBeAg-negative patients when compared with the "no treatment," the lamivudine, the adefovir, and the telbivudine strategies. The risks of complications and mortality also decreased. In the economic analysis, the "no treatment" strategy was the least effective, whereas the entecavir strategy was both the least expensive and the most cost-effective option, followed by telbivudine and lamivudine. The probabilistic sensitivity analysis showed that the entecavir strategy would result in improved cost-effectiveness in >90% of cases at a threshold of $20,000 per QALY. In a one-way sensitivity analysis, the most influential parameters impacting the model's robustness were the utilities of the CHB and virologic response health states. Conclusions In China, when treating both HBeAg-positive and HBeAg-negative CHB populations, entecavir is the most cost-effective option when compared with lamivudine, adefovir, and telbivudine.

Background. Endemic hepatitis B virus (HBV) infection is a serious health problem in China. Hepatitis B vaccination of infants was introduced in 1992 and was progressively expanded during the subsequent 15 years. Methods. We conducted a national serosurvey, with participants selected by multiple-stage random sampling. Demographic characteristics and hepatitis B vaccination history were collected by a questionnaire and a review of vaccination records, and serum specimens were tested for hepatitis B surface antigen, antibody to hepatitis B core antigen, and hepatitis B surface antibody by enzyme-linked immunosorbent assay. Results. Hepatitis B vaccine coverage (3 doses) increased from 30.0% for children born in 1992 to 93.4% for children born in 2005. Receipt of a timely birth dose increased from 22.2% to 82.6% for children born during this interval. Multivariate analysis showed that older age, western and rural residence, birth at home, and certain ethnicities were risk factors for undervaccination with both full vaccine series and timely birth dose. The prevalence of hepatitis B surface antigen was reduced to 2.1% among all children and 1.0% among children born after 1999. The efficacy of hepatitis B vaccination with a timely birth dose was 88.3%. Conclusions. Hepatitis B vaccine has been successfully integrated into routine infant immunization in China, now reaching most infants within 24 h after birth, and the prevalence of hepatitis B surface antigen has been greatly reduced among children born after 1992.

2346 liver samples from 17 areas in China were investigated for intrahepatic hepatitis D antigen (HDAg) by direct enzyme-labelled technique. HDAg was detected in 167 out of 1764 samples of HBsAg positive individuals with the detection rate of 9.47%. Hepatitis D virus (HDV) infection existed in all the examined areas without any significant difference regarding HDAg detection rate. A relationship of intrahepatic HDAg to the pathologic type of the liver disease was observed. The HDAg detection rate in chronic liver diseases and severe hepatitis was higher than in other liver diseases. It suggested that HDV infection was associated with the progression and chronicity of the liver disease. Studies on the relationship between HDV infection and HBV replication showed that HBV replication might be suppressed by HDV infection. Both HDV and HBV, however, could replicate in the same hepatocyte simultaneously.

About 170 million Chinese are infected chronically with HBV and 10% suffer from chronic hepatitis. Around half a million Chinese die from hepatitis B caused hepatocellular carcinoma and endstage cirrhosis each year. From 1983 to the present, a controlled clinical trial involving 80,000 children on a universal hepatitis B vaccination programme to prevent chronic hepatitis, hepatocellular carcinoma, and endstage cirrhosis was implemented in Qidong, China. A pilot study demonstrated that the HBsAg rate reached the adult level before the fifth year of age, and neonatal vaccination with either plasma-derived or recombinant hepatitis B vaccines provided a similar 75% protective efficacy against HBV infection. The high rate of follow-up and blood tests coverage of the cohorts provided data to show 75% protection at the tenth to eleventh years of age against serum HBsAg and also against prolonged hepatic dysfunction. The strategy of controlling hepatitis B nationwide was based on the universal immunisation of newborns, beginning in cities and then the rural areas. The large-scale vaccine source was provided by domestic plants through technology transfer, first providing plasma-derived vaccine replaced completely by recombinant DNA vaccine in 1997. An official survey in 1999 using a cluster sampling of 25,878 children from 31 provinces reported an average coverage rate of three dose of hepatitis B vaccination of 70.7%, being higher in urban areas. The Ministry of Public Health of China has planned to integrate hepatitis B vaccination into the nationwide EPI program with Government-provided vaccines starting January 1, 2002.