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Epidemiologic Reviews Advance Access published online on June 16, 2006
Epidemiologic Reviews, doi:10.1093/epirev/mxj010
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Epidemiologic Reviews Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Accepted April 6, 2006

Article

Nationwide Hepatitis B Vaccination Program in Taiwan: Effectiveness in the 20 Years After It Was Launched

Yin-Chu Chien 1, Chyi-Feng Jan 2, Hsu-Sung Kuo 3, and Chien-Jen Chen 4 *

1 Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
2 Department of Family Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
3 Center for Disease Control, Taiwan, Republic of China
4 Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan

* To whom correspondence should be addressed.
Chien-Jen Chen, E-mail: cjchen{at}ha.mc.ntu.edu.tw


  Abstract

The national hepatitis B vaccination program in Taiwan is considered one of the most successful and effective public health programs to control chronic hepatitis B infection in the past 20 years. This review illustrates how to implement a successful hepatitis B vaccination program based on Taiwan's experience. Several important controlled randomized clinical trials on hepatitis B immunoglobulin and vaccine in Taiwan demonstrated an 80-90% protective effect among infants of mothers who were positive for either hepatitis B envelope antigen or hepatitis B surface antigen. A series of prevalence surveys on children born before and after the national vaccination program began disclosed a steady decrease in seroprevalence of hepatitis B surface antigen in Taiwan, with 78-87% effectiveness after the national vaccination program was launched. Studies on the secular trend of liver disease risk also documented a 68% decline in mortality from fulminant hepatitis in infants and a 75% decrease in the incidence of hepatocellular carcinoma in children 6-9 years of age after the national vaccination program began. In conclusion, since 1984, the national hepatitis B vaccination program has been successful in preventing acute and chronic liver diseases in Taiwan.

Keywords: hepatitis B vaccines; liver diseases; program evaluation; public health; regional health planning; Taiwan; treatment outcome; vaccination.
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