Some 70,000 babies in north-western China's Gansu province have been vaccinated against hepatitis B amid joint efforts by provincial health officials and WHO to minimize mother-to-child transmission of the debilitating virus.
A WHO hepatitis expert promotes the hepatitis B timely birth dose at a children's health centre in Gansu's Tianshui prefecture. By WHO China/Vivian Tan
Hepatitis B, a viral infection that attacks the liver and can cause both acute and chronic disease, is endemic in China. The World Health Organization estimates that the country is home to one-third of the world's cases. In 2008, viral hepatitis (dominated by type B) was the top infectious disease in China and the Number 4 killer, according to Ministry of Health figures.
For years, Gansu had the unenviable distinction of being the province in China with the highest rate of reported hepatitis B cases. In 2006, 228 people out of every 100,000 in this province were reported to develop the disease. The following year, Gansu dropped to second position, behind Qinghai province, but the problem remains significant today.
"The extensive spread of hepatitis B is posing a serious threat to people's health and to economic development," said Dr Gao Li, who manages the Expanded Programme on Immunization at Gansu's Centre for Disease Control and Prevention (CDC). "It has also sparked a series of social problems, and has become a leading public health problem for us."
The hepatitis B virus (HBV) is transmitted through contact with the blood or other bodily fluids of an infected person, not through casual contact. Mother-to-child transmission is one of the more common routes of transmission, in addition to unsafe injection practices, blood transfusions and sexual contact. Some 90% of infants infected in their first year of life develop chronic infections, which could lead to HBV-related liver cancer or cirrhosis.
Treatment is expensive and hard to access in developing countries, thus prevention is the best defence.
"In places where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth," said Dr Yvan Hutin, WHO's hepatitis officer in China. "If we do so within the first 24 hours of birth, we can effectively prevent the virus from being transmitted during birth and provide immunity to the baby."
Recognizing the importance of the timely birth dose, provincial authorities and WHO started a US$100,000 two-year pilot project in Gansu's Tianshui prefecture in March 2008. Since then, the province and prefecture CDCs have been working to increase the coverage of the timely birth dose through deliveries in hospitals, improving access to the vaccine for home births, training healthcare workers, and educating the public on the importance of the timely birth dose.
The project is several months away from completion, but progress is already visible. By the end of 2008, timely birth dose coverage in Tianshui prefecture had grown to 91%, an increase of over 10% compared to the previous year. By the end of August this year, coverage had increased to 96%.
Between January 2008 and August 2009, more than 70,000 newborns received the birth dose vaccine within their first 24 hours of life. This translates into 70,000 lives spared the scourge of hepatitis B – and that number is growing.
These efforts go hand-in-hand with ongoing work to improve healthcare insurance, and to increase hospital deliveries, which reduces newborn deaths through better access to skilled care.
"Overall, public awareness has increased thanks to health education and the training of health workers," said Dr Fan Duozhi, the deputy director of Tianshui CDC. "Our policy that women need to pay only 500 yuan for hospital delivery and can claim it back from the new health insurance scheme, has also helped. Closer supervision and collaboration between the different levels have all contributed towards making this project a success."
WHO's Dr Hutin added, "It is clear that these positive results can be sustained with government inputs. As a pilot project, Tianshui has taught us many lessons about what works and what doesn't. These experiences are being analyzed, shared and applied to help increase timely birth dose coverage in other parts of Gansu and China. This field interface with the Chinese public health system is a way for us to learn together."
The Tianshui project is an example of the type of close collaboration between WHO and the local health authorities. Working closely together builds trust, transfers skills and adapts solutions to local needs. WHO has also supported similar projects in Gansu's Dingxi prefecture and Ningxia autonomous region's Guyan prefecture.
In China, WHO's activities in the area of viral hepatitis prevention and control are supported by WHO's regular budget, the United States Centres for Disease Control and Prevention and the Hong Kong-based ZeShan foundation.