Elimination of hepatocellular carcinoma and acute hepatitis B in children 25 years after a hepatitis B newborn and catch-up immunization program

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http://onlinelibrary.wiley.com/doi/10.1002/hep.24442/abstract

Viral Hepatitis

Elimination of hepatocellular carcinoma and acute hepatitis B in children 25

years after a hepatitis B newborn and catch-up immunization program†‡

J. McMahon1,2,*,§, R. Bulkow2, lyn J. Singleton1,2,

1, Snowball1, Chriss Homan1, Alan J. Parkinson2

Article first published online: 19 JUL 2011

DOI: 10.1002/hep.24442

Copyright © 2011 American Association for the Study of Liver Diseases

Issue

Hepatology

Volume 54, Issue 3, pages 801–807, 2 September 2011

Abstract

Alaska Native people experience the highest rates of acute and chronic hepatitis

B virus (HBV) infection and hepatocellular carcinoma (HCC) in the United States.

We examined the effect of a universal newborn immunization with hepatitis B

vaccine and mass population screening immunization program initiated in 1984 on

rates of HBV and HCC in children 25 years later. During this time, the

population of Alaska Native people grew from an estimated 75,000 to 130,000

persons. A surveillance system to detect acute HBV infection in Alaska Native

facilities was established in 1981. Cases of HCC in children under 20 years of

age were identified using a National Cancer Institute (NCI)-funded Cancer

Registry established in 1969 coupled with an active surveillance program of

screening persons with chronic HBV semiannually for alpha-fetoprotein since

1982. The incidence of acute symptomatic HBV infection in persons <20 years of

age fell from cases 19/100,000 in 1981-1982 to 0/100,000 in 1993-1994. No cases

of acute HBV have occurred in children since 1992. The incidence of HCC in

persons <20 years decreased from 3/100,000 in 1984-1988 to zero in 1995-1999 and

no cases have occurred since 1999. The number of identified hepatitis B surface

antigen-positive children <20 years in the Alaska Native population declined

from 657 in 1987 to two in 2008.

Conclusion: Universal newborn vaccination coupled with mass screening and

immunization of susceptible Alaska Natives has eliminated HCC and acute

symptomatic HBV infection among Alaska Native children and this approach is the

best way to prevent HBV-related disease in children. (HEPATOLOGY 2011;)