Hepatitis B in China
Encyclopedia
Hepatitis B is endemic
in China
. Of the 350 million individuals worldwide infected with the hepatitis B virus
(HBV), one-third reside in China. As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.
(HBV), one-third reside in China, with 130 million carriers and 30 million chronically infected. Since the Expanded Program on Immunization (EPI) beginning 1992, the prevalence of HBV has declined, especially among children 3 to 12 years old. During a 5-year period, 10.0% of patients with chronic hepatitis developed cirrhosis
, and 20.3% of the cases with compensated cirrhosis progressed to decompensated cirrhosis. 6.5% of the people with cirrhosis and chronic hepatitis progressed to hepatocellular carcinoma
(HCC). 5-year survival for compensated cirrhosis is 55%, that for decompensated cirrhosis is 14%, and that for HCC is less than 5%. Every year, 300,000 people die from HBV-related diseases in China, including 180,000 patients with HCC. However, the incidence of hepatitis B is still increasing, from 21.9 in 100,000 people in 1990 to 53.3 in 100,000 in 2003. That increase has occurred despite a vaccination
program for newborn babies since the 1990s, which showed good effectiveness for reducing chronic HBV infection in children.
and horizontal transmission
during early childhood are still the most common routes. During and before the Cultural revolution many of the cases came from unsafe needles that carried the virus. This was due to the fact that medicine in that time was rather poor in quality and was reduced to one room hospitals.
and AIDS
. In some rural areas, doctors have reused
syringes and unknowingly spread the disease, particularly among children
.
(GAVI). However, China still has a long way to go before immunisation levels reach a percentage able to limit the spread of hepatitis B. China's health minister, Gao Qiang
told a Beijing press conference that the project, while effective, has covered only one third of all children born in China since the project began in 2002. This does not mean the rest of China's children went unvaccinated. However, even within the project's target area, over one million newborns went unvaccinated each year because of access issues; health-care costs, lack of birth attendants, and the remoteness of their birthplaces, such as herder's huts, mountain villages, and remote farms.
Until 2005, when a law banning the practice was passed, parents were charged fees for the administration of the vaccine. Even though the GAVI alliance (whose partners include UNICEF and the WHO
), and Chinese government were providing the vaccine and one-use needles free of charge, health-care workers charged fees that parents were unwilling or unable to pay. China is in urgent need of a comprehensive hepatitis B vaccination program. Surveillance is still poor infection rates are estimates based on a 1992 epidemiological survey. Those estimates put the disease burden at 120 million people chronically infected with hepatitis B, one third of the burden (360 million) estimated by the WHO.
China's national target is to reach greater than 85% vaccination. The joint project with the GAVI alliance has shown that this is feasible with three quarters of the 1301 project counties reporting that 85% or more children received three doses of HepB vaccine. In hospitals designated project hospitals, the percentage of newborns vaccinated within 24 hours of birth in project hospitals is now over 90%. However, the overall newborn vaccination rate in the region covered by the GAVI alliance/government joint project was 70%, lower than the 75% they hoped to achieve.
Achieving long-term success will require "assuring no new financial barriers arise", said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. "This is one of the greatest challenges and the solution lies not just within China but with a global community mobilized to ensure access to vaccine financing for all developing nations."
Home to a large population of ethnic minorities of low socioeconomic status, the Qinghai province is a remote, often neglected, rural region of China with a high prevalence of chronic hepatitis B. Since many children 5 years of age and older in Qinghai were not vaccinated against the hepatitis B virus at birth, a private-public partnership was formed between the Ping and Amy Chao Foundation, the ZeShan Foundation, the Asian Liver Center at Stanford University, the China Center for Disease Control and Prevention, the Chinese Foundation for Hepatitis Prevention and Control, and the Qinghai government. Using the existing provincial China CDC structure, this private-public partnership in Qinghai resulted in a unique two-part school-based immunization program to educate and provide free Hep B vaccination for all children in kindergarten and grade school within the region.
Between 2006 and 2008, this program demonstrated the feasibility and successful implementation of:
Impact: The success of this large scale province-wide demonstration program led the Chinese government to announce the adoption of a new policy beginning in 2009 to provide free catch-up hepatitis B vaccination for all children in China under the age of 15 who have not been vaccinated.
Unfortunately, there are no agents available with high enough efficacy
and safety to fully eradicate HBV. Neither interferon alpha, including standard and pegylated forms, nor nucleotide analogues (including lamivudine
, adefovir dipivoxil, and most recently, entecavir) could eradicate HBV covalently-closed-circular DNA
in liver
cells
, which is the replication model for HBV recurrence. However, no agents are available to break through the host's immune tolerance to HBV, which is another important reason for persistent infection with HBV, although some patients respond well temporarily to administration of interferon and nucleotide analogues alone or in combination regimens. Some traditional Chinese herbs, such as kushenin (Sophora flavescens
) and some complex prescriptions, have some efficacy as antivirals
and in the protection of liver function, although the specific mechanism and components need to be identified. The current treatment in China is the combination of antiviral agents (lamivudine
, adefovir dipivoxil), immune modulators (interferon alpha, peginterferon alpha, thymosin
), and hepatic protectors (such as glycyrrhizin
, essentiale, glucurolactone). The Chinese spend around Ɲ900 billion (US$110 billion) on these regimens every year. Apart from cost, patients and carriers of HBV infection are often confronted with tough conditions and social pressures, although such discrimination is illegal
in China.
Chinese drug regulation authorities have approved Swiss pharmaceutical firm Novartis AG's drug Sebivo, a brand name for telbivudine
, as a treatment for chronic hepatitis B in February 2007. The decision comes shortly after Sebivo was recommended for approval in the European Union
. The medicine was developed jointly by Novartis and U.S. biotech firm Idenix Pharmaceuticals Inc and has been shown in trials to produce significantly greater viral suppression compared to the commonly used treatment lamivudine
. Sebivo won its first major approval in Switzerland
in September 2006.
within the first 24 hours after birth is considered the best way to prevent the disease from spreading from mother to child. But it was not until 1992 that China included it as part of a routine immunization
program. Even then, the price was relatively high compared with other postnatal
vaccinations, and families had to pay for it privately. Many have suffered and their families, especially in the poor countryside, decided to go without.
According to China's Ministry of Health
website, in 2005 the PRC government
belatedly passed a regulation
making the vaccination free. The PRC government has set a goal of reducing the overall hepatitis B infection rate
to less than 7% over the next five years, and the rate of infection for children younger than 5 to less than 1%. It has been said by medical observers of prevention programs in the country that the program can be a viable model for other developing countries trying to stop the spread of diseases (including hepatitis B) that can be prevented by vaccines. But a study of some campaigns shows that more than 1 million Chinese babies born each year in the area covered by the government initiated programs are not receiving the vaccination. Officials involved in the hepatitis B vaccination programs say that in many of China's poverty
-stricken rural areas, children are delivered at home in remote mountain villages or nomadic herders' tents, far from hospitals and access to medical information. The Chinese Center for Disease Control and Prevention
(China CDC) have conducted research that supports the evidence that "there was and is still a huge bottleneck to ensure the delivery of the timely birth dosage
to home births".
Another problem is the growing size of China's migrant labor force or "floating population." Farmers or peasants who become urban laborers move frequently around the country and often do not seek medical attention. The immunization rate among them remains low, said China CDC. One major problem facing Chinese people infected with hepatitis B is that illegal blood testing is required by most employers in China. Anyone that tests positive for hepatitis B is either denied employment or fired. Laws do exist to protect the privacy of employees and job seekers but they are not enforced.
issues in China, which not only presents challenges for doctors and scientists but also increases the burden for the government. Last year, the Chinese Government
funded research with around Ɲ3 billion (US$390 million), mainly against hepatitis B and related diseases over the next decade.
Research will include: large retrospective
and prospective
studies of the population vaccinated against hepatitis B and the incidence of HCC; genetic variation
in HBV and its subtypes, and mutations in HBV DNA in the response to interferon and nucleotide analogues; host-gene variation and the therapeutic response, including single-nuclear polymorphisms
and gene copy-number variations; virus mutation
and the mechanism of the immune response in fulminant
liver failure, and the immunological factors which cause liver injury and the markers which predict reduction in liver function; assessment and prediction of liver fibrosis by non-invasive biomarkers, and interference with fibrosis from small chemical compounds or traditional Chinese medicines; prediction of the development, metastasis
, and prognosis
of HCC by molecular typing; and the identification of important signal transduction pathways in HCC and the development of new small chemical compounds to target HCC.
also set goals that corresponded to these research projects. The goals include: completion of the immunoprophylaxis strategy, such as HBV vaccine, to decrease the incidence of HCC by more than 10%; identification of molecular biomarkers, and the creation of molecular-typing diagnostic kits for the prediction of the therapeutic response; the development of regimens to treat HBV; the identification of biomarkers to predict the aggressiveness of severe hepatitis B and the development of a kit for early diagnosis of liver cirrhosis; the identification of markers (biological and genomic, and small molecules) for early diagnosis and to predict recurrence
and metastasis
, and the development of new drugs for HCC, to increase the rate of early diagnosis by more than 20% and 5-year survival by more than 5%. The fight against HBV and its related disorders is now thought of as a long-term one by the health authorities.
in all aspects of life and work. For example, many Chinese employers and universities refuse to accept anyone who tests positive. Some kindergartens refuse admission to children who are carriers
of the virus. The hepatitis problem is a reflection of the vast developmental gap between China's rural
and urban
areas. The largest problem facing Chinese people infected with HBV is that illegal blood testing is required by most employers in China. According to a report by PBS, faking blood tests by hiring uninfected individuals to take them has become widespread. Following an incident involving a Hepatitis B carrier's killing of an employer and other calls against discriminatory employment practices, China's ministries of health and personnel announced that Hepatitis B carriers must not be discriminated against when seeking employment and education. While the laws exist to protect the privacy of employees and job seekers, many believe that they are not enforced.
at the Great Wall of China
. An official had told the head of the rights group, Lu Jun, at the time that the closure was due to the Beijing Olympic Games.
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
in China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...
. Of the 350 million individuals worldwide infected with the hepatitis B virus
Hepatitis B virus
Hepatitis B is an infectious illness caused by hepatitis B virus which infects the liver of hominoidea, including humans, and causes an inflammation called hepatitis. Originally known as "serum hepatitis", the disease has caused epidemics in parts of Asia and Africa, and it is endemic in China...
(HBV), one-third reside in China. As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.
Prevalence
Of the 350 million to 400 million individuals worldwide infected with the hepatitis B virusHepatitis B virus
Hepatitis B is an infectious illness caused by hepatitis B virus which infects the liver of hominoidea, including humans, and causes an inflammation called hepatitis. Originally known as "serum hepatitis", the disease has caused epidemics in parts of Asia and Africa, and it is endemic in China...
(HBV), one-third reside in China, with 130 million carriers and 30 million chronically infected. Since the Expanded Program on Immunization (EPI) beginning 1992, the prevalence of HBV has declined, especially among children 3 to 12 years old. During a 5-year period, 10.0% of patients with chronic hepatitis developed cirrhosis
Cirrhosis
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules , leading to loss of liver function...
, and 20.3% of the cases with compensated cirrhosis progressed to decompensated cirrhosis. 6.5% of the people with cirrhosis and chronic hepatitis progressed to hepatocellular carcinoma
Hepatocellular carcinoma
Hepatocellular carcinoma is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitide infection or cirrhosis .Compared to other cancers, HCC is quite a rare tumor in the United States...
(HCC). 5-year survival for compensated cirrhosis is 55%, that for decompensated cirrhosis is 14%, and that for HCC is less than 5%. Every year, 300,000 people die from HBV-related diseases in China, including 180,000 patients with HCC. However, the incidence of hepatitis B is still increasing, from 21.9 in 100,000 people in 1990 to 53.3 in 100,000 in 2003. That increase has occurred despite a vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
program for newborn babies since the 1990s, which showed good effectiveness for reducing chronic HBV infection in children.
Transmission
The reason for this increased HBV infection is unknown, because hepatitis B has no clear transmission routes in many people in China, although both neonatal infectionInfection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
and horizontal transmission
Horizontal transmission
Horizontal transmission is the transmission of a bacterial, fungal, or viral infection between members of the same species that are not in a parent-child relationship....
during early childhood are still the most common routes. During and before the Cultural revolution many of the cases came from unsafe needles that carried the virus. This was due to the fact that medicine in that time was rather poor in quality and was reduced to one room hospitals.
Public awareness
Public awareness of the disease, which is spread through the exchange of bodily fluids, is not as high as it is for HIVHIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
and AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
. In some rural areas, doctors have reused
Needle sharing
Needle sharing is the practice of intravenous drug-users by which a syringe is shared by multiple individuals to administer intravenous drugs, and is a primary vector for diseases which can be transmitted through blood ....
syringes and unknowingly spread the disease, particularly among children
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
.
Vaccination
By 2006, China has successfully immunised 11.1 million children living in the country's poorest provinces against hepatitis B according to the Chinese health ministry, and the Global Alliance for Vaccines and ImmunizationGlobal Alliance for Vaccines and Immunization
The GAVI Alliance is a public-private global health partnership committed to saving children’s lives and protecting people’s health by increasing access to immunisation in poor countries...
(GAVI). However, China still has a long way to go before immunisation levels reach a percentage able to limit the spread of hepatitis B. China's health minister, Gao Qiang
Gao Qiang
Gao Qiang is a Chinese politician and the former deputy minister and party secretary of the Ministry of Health of the People's Republic of China....
told a Beijing press conference that the project, while effective, has covered only one third of all children born in China since the project began in 2002. This does not mean the rest of China's children went unvaccinated. However, even within the project's target area, over one million newborns went unvaccinated each year because of access issues; health-care costs, lack of birth attendants, and the remoteness of their birthplaces, such as herder's huts, mountain villages, and remote farms.
Until 2005, when a law banning the practice was passed, parents were charged fees for the administration of the vaccine. Even though the GAVI alliance (whose partners include UNICEF and the WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
), and Chinese government were providing the vaccine and one-use needles free of charge, health-care workers charged fees that parents were unwilling or unable to pay. China is in urgent need of a comprehensive hepatitis B vaccination program. Surveillance is still poor infection rates are estimates based on a 1992 epidemiological survey. Those estimates put the disease burden at 120 million people chronically infected with hepatitis B, one third of the burden (360 million) estimated by the WHO.
China's national target is to reach greater than 85% vaccination. The joint project with the GAVI alliance has shown that this is feasible with three quarters of the 1301 project counties reporting that 85% or more children received three doses of HepB vaccine. In hospitals designated project hospitals, the percentage of newborns vaccinated within 24 hours of birth in project hospitals is now over 90%. However, the overall newborn vaccination rate in the region covered by the GAVI alliance/government joint project was 70%, lower than the 75% they hoped to achieve.
Achieving long-term success will require "assuring no new financial barriers arise", said Julian Lob-Levyt, Executive Secretary of the GAVI Alliance. "This is one of the greatest challenges and the solution lies not just within China but with a global community mobilized to ensure access to vaccine financing for all developing nations."
Home to a large population of ethnic minorities of low socioeconomic status, the Qinghai province is a remote, often neglected, rural region of China with a high prevalence of chronic hepatitis B. Since many children 5 years of age and older in Qinghai were not vaccinated against the hepatitis B virus at birth, a private-public partnership was formed between the Ping and Amy Chao Foundation, the ZeShan Foundation, the Asian Liver Center at Stanford University, the China Center for Disease Control and Prevention, the Chinese Foundation for Hepatitis Prevention and Control, and the Qinghai government. Using the existing provincial China CDC structure, this private-public partnership in Qinghai resulted in a unique two-part school-based immunization program to educate and provide free Hep B vaccination for all children in kindergarten and grade school within the region.
Between 2006 and 2008, this program demonstrated the feasibility and successful implementation of:
- A province-wide catch-up vaccination program that reached 600,000 children in 2,200 schools, and
- A hepatitis B education program incorporated into the school curriculum.
Impact: The success of this large scale province-wide demonstration program led the Chinese government to announce the adoption of a new policy beginning in 2009 to provide free catch-up hepatitis B vaccination for all children in China under the age of 15 who have not been vaccinated.
Treatment
Because a high load of HBV in patients is the main cause of hepatitis progression, the ultimate goal in treatment is to eradicate the virus before irreversible liver damage occurs.Unfortunately, there are no agents available with high enough efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
and safety to fully eradicate HBV. Neither interferon alpha, including standard and pegylated forms, nor nucleotide analogues (including lamivudine
Lamivudine
Lamivudine is a potent nucleoside analog reverse transcriptase inhibitor .It is marketed by GlaxoSmithKline with the brand names Zeffix, Heptovir, Epivir, and Epivir-HBV.Lamivudine has been used for treatment of chronic hepatitis B at a lower dose than for treatment of HIV...
, adefovir dipivoxil, and most recently, entecavir) could eradicate HBV covalently-closed-circular DNA
DNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
in liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
cells
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
, which is the replication model for HBV recurrence. However, no agents are available to break through the host's immune tolerance to HBV, which is another important reason for persistent infection with HBV, although some patients respond well temporarily to administration of interferon and nucleotide analogues alone or in combination regimens. Some traditional Chinese herbs, such as kushenin (Sophora flavescens
Sophora flavescens
Sophora flavescens is a species of plant in the genus Sophora. Ku shen or kushenin is a typical traditional Chinese medicine that is found in this plant...
) and some complex prescriptions, have some efficacy as antivirals
Antiviral drug
Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics for bacteria, specific antivirals are used for specific viruses...
and in the protection of liver function, although the specific mechanism and components need to be identified. The current treatment in China is the combination of antiviral agents (lamivudine
Lamivudine
Lamivudine is a potent nucleoside analog reverse transcriptase inhibitor .It is marketed by GlaxoSmithKline with the brand names Zeffix, Heptovir, Epivir, and Epivir-HBV.Lamivudine has been used for treatment of chronic hepatitis B at a lower dose than for treatment of HIV...
, adefovir dipivoxil), immune modulators (interferon alpha, peginterferon alpha, thymosin
Thymosin
Thymosins are small proteins present in many animal tissues. They are named thymosins because they were originally isolated from the thymus, but most are now known to be present in many other tissues...
), and hepatic protectors (such as glycyrrhizin
Glycyrrhizin
Glycyrrhizin is the main sweet-tasting compound from liquorice root. It is 30–50 times as sweet as sucrose . Pure glycyrrhizin is odorless....
, essentiale, glucurolactone). The Chinese spend around Ɲ900 billion (US$110 billion) on these regimens every year. Apart from cost, patients and carriers of HBV infection are often confronted with tough conditions and social pressures, although such discrimination is illegal
Law of the People's Republic of China
Law of the People's Republic of China is the legal regime of the People's Republic of China, with the separate legal traditions and systems of Mainland China, Hong Kong, and Macau....
in China.
Chinese drug regulation authorities have approved Swiss pharmaceutical firm Novartis AG's drug Sebivo, a brand name for telbivudine
Telbivudine
Telbivudine is an antiviral drug used in the treatment of hepatitis B infection. It is marketed by Swiss pharmaceutical company Novartis under the trade names Sebivo and Tyzeka...
, as a treatment for chronic hepatitis B in February 2007. The decision comes shortly after Sebivo was recommended for approval in the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
. The medicine was developed jointly by Novartis and U.S. biotech firm Idenix Pharmaceuticals Inc and has been shown in trials to produce significantly greater viral suppression compared to the commonly used treatment lamivudine
Lamivudine
Lamivudine is a potent nucleoside analog reverse transcriptase inhibitor .It is marketed by GlaxoSmithKline with the brand names Zeffix, Heptovir, Epivir, and Epivir-HBV.Lamivudine has been used for treatment of chronic hepatitis B at a lower dose than for treatment of HIV...
. Sebivo won its first major approval in Switzerland
Switzerland
Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....
in September 2006.
Problems
There have been relatively few campaigns aimed at ending the practice of reusing needles. For standard preventative practice, a vaccinationVaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
within the first 24 hours after birth is considered the best way to prevent the disease from spreading from mother to child. But it was not until 1992 that China included it as part of a routine immunization
Immunization
Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....
program. Even then, the price was relatively high compared with other postnatal
Postnatal
Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
vaccinations, and families had to pay for it privately. Many have suffered and their families, especially in the poor countryside, decided to go without.
According to China's Ministry of Health
Ministry of Health (China)
The Ministry of Health of the Government of the People's Republic of China is an executive agency of the state which plays the role of providing information, raising health awareness and education, ensuring the accessibility of health services, and monitoring the quality of health services...
website, in 2005 the PRC government
People's Republic of China
China , officially the People's Republic of China , is the most populous country in the world, with over 1.3 billion citizens. Located in East Asia, the country covers approximately 9.6 million square kilometres...
belatedly passed a regulation
Regulation
Regulation is administrative legislation that constitutes or constrains rights and allocates responsibilities. It can be distinguished from primary legislation on the one hand and judge-made law on the other...
making the vaccination free. The PRC government has set a goal of reducing the overall hepatitis B infection rate
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
to less than 7% over the next five years, and the rate of infection for children younger than 5 to less than 1%. It has been said by medical observers of prevention programs in the country that the program can be a viable model for other developing countries trying to stop the spread of diseases (including hepatitis B) that can be prevented by vaccines. But a study of some campaigns shows that more than 1 million Chinese babies born each year in the area covered by the government initiated programs are not receiving the vaccination. Officials involved in the hepatitis B vaccination programs say that in many of China's poverty
Poverty
Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...
-stricken rural areas, children are delivered at home in remote mountain villages or nomadic herders' tents, far from hospitals and access to medical information. The Chinese Center for Disease Control and Prevention
Chinese Center for Disease Control and Prevention
The Chinese Center for Disease Control and Prevention is an agency of the Ministry of Health of the People's Republic of China based in Beijing, China. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships...
(China CDC) have conducted research that supports the evidence that "there was and is still a huge bottleneck to ensure the delivery of the timely birth dosage
Effective dose (pharmacology)
An effective dose in pharmacology is the dose or amount of drug that produces a therapeutic response or desired effect in some fraction of the subjects taking it....
to home births".
Another problem is the growing size of China's migrant labor force or "floating population." Farmers or peasants who become urban laborers move frequently around the country and often do not seek medical attention. The immunization rate among them remains low, said China CDC. One major problem facing Chinese people infected with hepatitis B is that illegal blood testing is required by most employers in China. Anyone that tests positive for hepatitis B is either denied employment or fired. Laws do exist to protect the privacy of employees and job seekers but they are not enforced.
Research
Hepatitis B and its related disorders are important public healthPublic health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
issues in China, which not only presents challenges for doctors and scientists but also increases the burden for the government. Last year, the Chinese Government
Government of the People's Republic of China
All power within the government of the People's Republic of China is divided among three bodies: the People's Republic of China, State Council, and the People's Liberation Army . This article is concerned with the formal structure of the state, its departments and their responsibilities...
funded research with around Ɲ3 billion (US$390 million), mainly against hepatitis B and related diseases over the next decade.
Research will include: large retrospective
Retrospective
Retrospective generally means to take a look back at events that already have taken place. For example, the term is used in medicine, describing a look back at a patient's medical history or lifestyle.-Music:...
and prospective
Prospective
Prospective literally means "looking forward". It can also refer to an event that is likely or expected to happen in the future. For example, a prospective student is someone who is considering attending a school — typically a high school student who is seriously considering applying to a...
studies of the population vaccinated against hepatitis B and the incidence of HCC; genetic variation
Genetic variation
Genetic variation, variation in alleles of genes, occurs both within and among populations. Genetic variation is important because it provides the “raw material” for natural selection. Genetic variation is brought about by mutation, a change in a chemical structure of a gene. Polyploidy is an...
in HBV and its subtypes, and mutations in HBV DNA in the response to interferon and nucleotide analogues; host-gene variation and the therapeutic response, including single-nuclear polymorphisms
Polymorphism (biology)
Polymorphism in biology occurs when two or more clearly different phenotypes exist in the same population of a species — in other words, the occurrence of more than one form or morph...
and gene copy-number variations; virus mutation
Virus mutation
Virus mutationvirus mutation is when viruses mutate may refer to:*The feature of viruses to cause mutation in the human genome*The feature of viruses to perform viral genetic change in their own genome....
and the mechanism of the immune response in fulminant
Fulminant
Fulminant is any event or process that occurs suddenly and quickly, and is intense and severe to the point of lethality, i.e., it has an explosive character. The word comes from Latin fulmināre, to strike with lightning...
liver failure, and the immunological factors which cause liver injury and the markers which predict reduction in liver function; assessment and prediction of liver fibrosis by non-invasive biomarkers, and interference with fibrosis from small chemical compounds or traditional Chinese medicines; prediction of the development, metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
, and prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
of HCC by molecular typing; and the identification of important signal transduction pathways in HCC and the development of new small chemical compounds to target HCC.
Progress
To measure the results, the GovernmentGovernment of the People's Republic of China
All power within the government of the People's Republic of China is divided among three bodies: the People's Republic of China, State Council, and the People's Liberation Army . This article is concerned with the formal structure of the state, its departments and their responsibilities...
also set goals that corresponded to these research projects. The goals include: completion of the immunoprophylaxis strategy, such as HBV vaccine, to decrease the incidence of HCC by more than 10%; identification of molecular biomarkers, and the creation of molecular-typing diagnostic kits for the prediction of the therapeutic response; the development of regimens to treat HBV; the identification of biomarkers to predict the aggressiveness of severe hepatitis B and the development of a kit for early diagnosis of liver cirrhosis; the identification of markers (biological and genomic, and small molecules) for early diagnosis and to predict recurrence
Recurrence
Recurrence and recurrent may refer to:*Recurrence relation, an equation which defines a sequence recursively*Poincaré recurrence theorem, Henri Poincaré's theorem on dynamical systems...
and metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
, and the development of new drugs for HCC, to increase the rate of early diagnosis by more than 20% and 5-year survival by more than 5%. The fight against HBV and its related disorders is now thought of as a long-term one by the health authorities.
Discrimination
Hepatitis B sufferers in China frequently face discriminationDiscrimination
Discrimination is the prejudicial treatment of an individual based on their membership in a certain group or category. It involves the actual behaviors towards groups such as excluding or restricting members of one group from opportunities that are available to another group. The term began to be...
in all aspects of life and work. For example, many Chinese employers and universities refuse to accept anyone who tests positive. Some kindergartens refuse admission to children who are carriers
Disease carrier
Disease carrier could refer to:* Asymptomatic carrier, a person or organism infected with an infectious disease agent, but displaying no symptoms* Genetic carrier, a person or organism that has inherited a genetic trait or mutation, but displaying no symptoms...
of the virus. The hepatitis problem is a reflection of the vast developmental gap between China's rural
Rural
Rural areas or the country or countryside are areas that are not urbanized, though when large areas are described, country towns and smaller cities will be included. They have a low population density, and typically much of the land is devoted to agriculture...
and urban
Urban area
An urban area is characterized by higher population density and vast human features in comparison to areas surrounding it. Urban areas may be cities, towns or conurbations, but the term is not commonly extended to rural settlements such as villages and hamlets.Urban areas are created and further...
areas. The largest problem facing Chinese people infected with HBV is that illegal blood testing is required by most employers in China. According to a report by PBS, faking blood tests by hiring uninfected individuals to take them has become widespread. Following an incident involving a Hepatitis B carrier's killing of an employer and other calls against discriminatory employment practices, China's ministries of health and personnel announced that Hepatitis B carriers must not be discriminated against when seeking employment and education. While the laws exist to protect the privacy of employees and job seekers, many believe that they are not enforced.
"In the Hepatitis B Camp"
"In the Hepatitis B Camp" is a popular website for hepatitis B carriers' human rights in China. Its online forum is the world's biggest such forum with over 300,000 members. The website was first shut down by the Chinese government in November 2007. Lu Jun, the head of the rights group, managed to reopen the website by moving it to an overseas server, but the authorities in May 2008 began blocking access to the website within China, only 10 days after government officials participated in an event for World Hepatitis DayWorld Hepatitis Day
World Hepatitis Day, observed July 28, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis and treatment....
at the Great Wall of China
Great Wall of China
The Great Wall of China is a series of stone and earthen fortifications in northern China, built originally to protect the northern borders of the Chinese Empire against intrusions by various nomadic groups...
. An official had told the head of the rights group, Lu Jun, at the time that the closure was due to the Beijing Olympic Games.
See also
- Jade Ribbon CampaignJade Ribbon CampaignThe Jade Ribbon Campaign was launched by the Asian Liver Center at Stanford University in May 2001 during Asian Pacific American Heritage Month to help spread awareness internationally about hepatitis B and liver cancer in Asian and Pacific Islander communities.The objective of the Jade Ribbon...
- HIV/AIDS in the People's Republic of China
- HepatitisHepatitisHepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
- Public health in the People's Republic of China
- Tuberculosis in ChinaTuberculosis in ChinaTuberculosis is a major public health problem in China. China has the world's second largest tuberculosis epidemic , but progress in tuberculosis control was slow during the 1990s. Detection of tuberculosis had stagnated at around 30% of the estimated total of new cases, and multidrug-resistant...
External links
- WHO: China — World Health Organization Country Profile
- WHO: China Office — World Health Organization China Office 乙肝·论坛·乙肝病毒携带者的网上家园-肝胆相照 — "In the Hepatitis Camp" Hepatits B Carriers BBS — "In the Hepatitis Camp"