World Hepatitis Day 2016
Large Scale Prevention of Hepatitis B
Historically, China has had a massive hepatitis epidemic – larger than anywhere else in the world. Before 1992, more than 10% of adults were infected with chronic hepatitis B. Today, almost 6% of the population remains infected, representing an estimated 90 million people living with hepatitis B virus in China and leading to the largest number of liver cancer cases in the world. In addition to this burden of chronic hepatitis B, China also has a great burden of hepatitis C, with 200 000 newly infected people reported annually. Large-scale epidemics require large-scale responses.
Dr. Fuqiang Cui has devoted his career to battling viral hepatitis through prevention. He has played a major role in China’s effort to stop vertical and horizontal transmission of hepatitis B virus – an effort that will ultimately save millions of lives. He joined the Chinese Center for Disease Control and Prevention (China CDC) in 2005, and in 2011 became Deputy Director and Senior Researcher for the National Immunization Program. In this role, Dr Cui has been responsible for developing and implementing vaccination programmes across China, providing health education and strengthening hepatitis B surveillance.
During this time, China has made huge investments in controlling and preventing hepatitis B through its universal hepatitis B programme. China’s population comprises 80% of the population of the WHO Western Pacific Region, and China’s successful implementation of hepatitis B vaccination has therefore enormously benefited the Region’s success.
Nowhere has this work had more impact than among children. By reaching nearly every newborn and infant with hepatitis B vaccine, China has already exceeded the WHO regional goal of reducing chronic hepatitis B infection to less than 1% among five-year-old children.
“Based on a recent China CDC study, between 1992 and 2014, we estimate that China prevented 28 million people from acquiring chronic hepatitis B infection and 5 million people from dying from complications related to hepatitis B infection.”
Universal prevention initiatives can have impressive outcomes. Dr Cui says, “Based on a recent China CDC study, between 1992 and 2014, we estimate that China prevented 28 million people from acquiring chronic hepatitis B infection and 5 million people from dying from complications related to hepatitis B infection.” The work is having a significant impact in saving lives.
Key challenges that Dr Cui and his team have been working to overcome include identifying strategies to protect and vaccinate infants who live in remote, mountainous areas and have difficulty in accessing timely vaccination. In addition, infants born to mothers who test positive for hepatitis B surface antigen have a higher risk of being infected by hepatitis B – and infants infected around birth almost invariably have chronic, lifelong infection. Education is critical, since many people worry about adverse events following vaccination. Serious, vaccine-caused adverse events from hepatitis B vaccine are very rare, but coincidental (unrelated to the vaccine itself) adverse events happen, and they can lead to parents losing confidence in this very safe and effective vaccine. This loss of confidence can potentially cause parents to neglect the benefits of the birth dose within 24 hours of birth and the three routine hepatitis B vaccination doses. Dr Cui hopes that more education about the importance of vaccination will help to obtain and sustain the confidence of parents.
Now, Dr Fuqiang Cui believes that the launch of the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020 will enable even more coordinated action against hepatitis B and C. Dr Cui believes that the Regional Action Plan will enable countries to take fundamental action, including developing national action plans and treating hepatitis holistically as a multitude of diseases rather than trying to adopt a single approach.
Dr Fuqiang Cui believes that reaching the ambitious treatment goals for viral hepatitis of the Regional Action Plan in China requires improving case detection and data reporting systems to further understanding of the current drivers of transmission and to identify key ways to improve prevention and increase access to effective treatment. China must make treatment a priority, since awareness of infection and rates of treatment are very low, requiring urgent attention..
Engaging high-ranking officials in the government is critically important for aligning policy-making with the needs of the millions of people in China living with hepatitis B and C.
Dr Fuqiang Cui believes that high-level advocacy across the Western Pacific Region can control and eventually eliminate hepatitis by ensuring that all countries develop and enact national plans. National policy will drive national action and is the most effective way to empower countries in the Western Pacific, including China, to know, to treat and to prevent hepatitis.
Do Your Part!
Across the Western Pacific Region, hugely important steps and actions are taking place to help to eliminate viral hepatitis as a public health threat by 2030. This collection of stories celebrates the heroes who are leading the fight against hepatitis.
Help us to celebrate World Hepatitis Day on 28 July by sharing this story using the hashtag #HepHero. If you have been involved in the fight against hepatitis, then please share your story with us too.