Decreasing Incidence of Hepatocellular Carcinoma Among Children Following Universal Hepatitis B Immunization

Mei-Hwei Chang


Liver International. 2003;23(5) 

In This Article

Conclusions and Future Prospects on HCC Control

HBV is an important etiologic agent of HCC, and prevention of HBV infection can prevent HCC. The universal hepatitis B vaccination program should be integrated into the expanded program of immunization (EPI) in infancy. It is particularly urgent in areas where HBV infection and HCC are hyperendemic. The World Health Organization (WHO) has recommended that universal hepatitis B immunization should be introduced in all countries at the end of 1997.[28] More than 120 countries have followed this recommendation up to now. WHO has established the objective of reducing the incidence of new HBV carriers among children by 80% by 2001, and eventually to eliminate the more than a million deaths that occur annually from HBV-associated cirrhosis and HCC.[29]

Universal vaccination is better than immunization of high-risk groups. Universal immunization for HBV has been proved to be effective in reducing the hepatitis B carrier rate to one-tenth of the prevalence before the vaccination program in highly endemic areas, and the incidence of HCC in children has also been reduced significantly. Continued efforts to implement universal vaccination programs in the world will hopefully reduce HBV-related diseases, particularly cirrhosis and HCC.

Hepatitis B vaccine adoption was limited in the poorest countries. The contributions of international organizations, such as the Global Alliance for Vaccines and Immunizations that began in 1999, are needed for people in poor countries. It is expected that within 5 years, the hepatitis B vaccine will be almost universally available to the world's children, saving an estimated one million lives per year.[30]

Continuous monitoring of the incidence of HCC is mandatory. Since the peak age of HCC in adults is around 40-60 years, theoretically we may expect a reduction of HCC in adults 30-40 years after universal vaccination. However, based on the data in children, which demonstrated a herd immunity in older children born before the implementation of the universal vaccination program, we predict that the reduction of HCC in adults may come earlier. Furthermore, we hope that the impact of HBV vaccination on the control of hepatitis B and its related complication can be extended to other infectious agents and their related diseases and cancers.


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