Viral hepatitis represents one of the most serious public health threats in the world today. World Hepatitis Day takes place on July 28 every year and is an opportunity to step up national and international efforts to control and prevent viral hepatitis and to encourage action and engagement by individuals, partners, and the general public. July 28 was chosen for the World Hepatitis Day because it is the birthday of Nobel-prize-winning scientist Dr. Baruch Blumberg, who discovered hepatitis B virus (HBV) and developed a diagnostic test and vaccine for it (1). The World Health Organization (WHO)’s theme for World Hepatitis Day 2020 is “Hepatitis-Free Future.”
China has the heaviest burden of viral hepatitis in the world. In 1979, approximately 9% to 10% of people in China had chronic hepatitis B infection (2); in 1992, 3.2% of the population had hepatitis C (3); and in the pre-hepatitis-A-vaccine era, outbreaks of hepatitis A occurred frequently throughout the country. Hepatitis B and hepatitis A vaccines were integrated into China’s National Immunization Program in 2002 and 2008, respectively, with prompt increases in coverage (4-5). Screening of pregnant women for hepatitis B surface antigen (HBsAg) — a marker of infection that is capable of transmitting hepatitis B virus during childbirth — was started at the end of 2010 (6). In addition to the dose of hepatitis B vaccine that all newborn infants in China receive at birth, babies born to HBsAg-positive mothers are also given hepatitis B immunoglobulin (HBIG) during their first day of life (7). Because hepatitis B virus (HBV) and hepatitis C virus (HCV) can be readily transmitted by blood, blood donors began to be screened for these 2 viruses in 1998 (8), and by 2015, universal HBV and HCV nucleic acid testing has been implemented by all blood banks (9). During 2006 to 2017, the National Plan for Hepatitis B Prevention and Control, 2006–2010 (10), and the Plan for the Prevention and Control of Viral Hepatitis in China, 2017–2020, have been continuously updated and re-issued (11).
Through these and other active efforts, chronic HBV infections among children under 5 years of age have decreased 97% from the pre-vaccine era prevalence to the current prevalence of 0.32% (12). Small-molecule, direct-acting hepatitis C antiviral agents were included in China’s national medical insurance program last year (13). With properly-administered antivirals, hepatitis C can be cured more than 90% of the time (14). Prior to the introduction of universal hepatitis A vaccination, most people were infected as children, but the incidence of hepatitis A declined markedly following the introduction of the hepatitis A vaccine and improvements in sanitation and hygiene (15).
Although these achievements are impressive, there are major challenges remaining for prevention and control of viral hepatitis in China. There are many adults in China living with hepatitis B because they were infected during their birth or early childhood — before the widespread availability of hepatitis B vaccine. Since perinatal hepatitis B infection is usually asymptomatic and therefore difficult to detect, most infected babies and children become adults without realizing they are carriers of hepatitis B virus. Without antiviral treatment, many individuals with chronic hepatitis B and hepatitis C infection will go on to have liver cirrhosis and liver cancer. There are still areas with weak routine immunization programs, resulting in new hepatitis B infections and outbreaks of hepatitis A or hepatitis E.
Theme for the Hepatitis Day 2020 in China is “Active prevention, positive detection, standardized treatment, and comprehensive containment of the hazards of hepatitis” — the same theme as in 2018 and 2019. In the future, we must strengthen vaccination programs to completely stop hepatitis A and hepatitis B infections, and we need to determine the most effective way to use hepatitis E vaccines to prevent or stop outbreaks of hepatitis E. It is critically important to encourage and incentivize individuals with chronic hepatitis B and hepatitis C infection and those at high risk of infection to seek testing at medical institutions so they can receive treatment if infected.
For this special issue of China CDC Weekly, we invited experts from China CDC’s National Immunization Program and National Center for AIDS/STD Control and Prevention, Peking University’s School of Public Health and Beijing Friendship Hospital to describe key viral hepatitis research and global strategic plans.
We hope that these articles will help readers understand more about viral hepatitis and its key challenges and will illuminate pathways forward to stronger prevention, control, and management of this enormous public health problem. Let us work together for a hepatitis-free future.