Guangzhou, in southeastern China, exhibits the highest nationwide prevalence of Hepatitis B (HBV) nationwide, underscoring the importance of studying its incidence trends for effective public health strategies. In these past 15 years, Guangzhou has seen a decline in both chronic and acute HBV incidence rates.
From 2008 to 2022, chronic HBV decreased annually by -4.31%, and acute HBV declined more sharply at -16.87% per year in Guangzhou. Factors such as age-specific risks, changes in screening strategies, and cohort effects were identified as significant influencers of these trends. Males had higher incidence rates than females, and residents in non-central areas faced elevated risks compared to those in central areas. Particularly high-risk age groups included those aged 0-4 years and 15-24 years.
“There are 87 million people who are chronic carriers of the hepatitis B virus in China, accounting for about one-third of all hepatitis B virus chronic carriers in the world,” according to the World Health Organization (WHO).1
Researchers analyzed data from the China Information System for Disease Control and Prevention, focusing on 327,585 reported cases of HBV from 2008 to 2022. Statistical analysis included Joinpoint regression to assess temporal trends in HBV incidence, supplemented by an age-period-cohort model to understand the impacts of age, period, and birth cohort on these trends.
“Period effects typically indicate changes directly impacting the incidence of HB, such as varying screening strategies, new diagnostic methods, changes in disease registration, and improved medical interventions. We attribute this to hepatitis B vaccination coverage and prevention of mother-to-child transmission of HBV,” investigators express.2
Main Takeaways
- Guangzhou, China, has witnessed significant reductions in chronic and acute HBV incidence rates from 2008 to 2022, with chronic HBV declining by an average of -4.31% annually and acute HBV by -16.87% annually, demonstrating effective public health strategies.
- The study underscores the critical impact of early hepatitis B vaccination within 24 hours of birth in preventing mother-to-child transmission, which is pivotal in reducing HBV infections among children globally, despite challenges in achieving universal coverage.
- Analyzing data using an age-period-cohort model, the research identifies varying influences over time from age-specific risks, changes in screening strategies, and cohort effects, highlighting the multifaceted nature of factors shaping HBV incidence trends in Guangzhou.
The primary transmission routes of HBV are from mother to child at birth and through horizontal household contact. Despite the severity of the disease, there has been notable progress in preventing perinatal HBV transmission through universal infant vaccination programs. The administration of a hepatitis B vaccine within 24 hours of birth is 90-95% effective in preventing the infection and has significantly reduced the incidence among children. However, global coverage of this birth-dose vaccination is still low at 45%, and even lower in the WHO African region at 18%.3
According to Danjuma Adda, MPH, FIMS, Dip-IMS, past president of the World Hepatitis Alliance, mother-to-child HBV transmission is a key indicator in WHO efforts to eliminate Hepatitis B by 2030.3
“The WHO recommends that newborns should receive the HBV vaccine within 24 hours of birth, or as early as possible. This is a critical measure to prevent new infections and it's important to remember that this is a cancer-preventing vaccine. To ensure all babies are vaccinated, we need to strengthen immunization systems so that these vaccines are readily available, especially in delivery rooms, not just outside where access can be limited after business hours or on weekends. It's crucial that the vaccines are accessible exactly where and when the babies are born.”3
The study underscores the critical role of public health interventions, particularly the universal infant vaccination program, in reducing HBV transmission. Despite progress, challenges remain in achieving global vaccination coverage targets, emphasizing the need for strengthened immunization systems. Understanding local trends and implementing evidence-based strategies are key to improving public health outcomes in the region and beyond.
References
Zheng, Z., Lin, X., Huang, Y. et al. Trends and age-period-cohort effect on incidence of hepatitis B from 2008 to 2022 in Guangzhou, China. Sci Rep 14, 13370 (2024). https://doi.org/10.1038/s41598-024-63796-0
