THIS REVIEW was written by Howard J. Worman, M.D., Departments of Medicine and of Anatomy and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, NY 10032. Dr. Worman has more reviews available at his Current Papers in Liver Disease site.
Hepatitis B By Howard J. Worman, M. D. Chang, M.-H., Chen, C.-J., Lai, M.-S., Hsu, H.-M., Wu, T.-C., Kong, M.-S., Liang, D.-C., Shau, W.-Y., Chen, D.-S., for the Taiwan Childhood Hepatoma Study Group. 1997. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. New England Journal of Medicine. 336:1855-1859.
Chronic hepatitis B virus (HBV) infection is associated with the development of hepatocellular carcinoma. In Southeast Asia, HBV infection is endemic and hepatocellular carcinoma is a common causes of cancer death. In 1984, Taiwan launched a nationwide vaccination program to control hepatitis B. This program reduced the hepatitis B surface antigen carrier rate in children from about 10% to 1% within 10 years of implementation (Chen et al. 1996. Journal of the American Medical Association. 276:906-908. In the present study, the authors report that universal hepatitis B vaccination reduces that incidence of hepatocellular carcinoma in children. The average annual incidence of hepatocellular carcinoma in children 6 to 14 years of age declined from 0.70 per 100,000 between 1981 and 1986 to 0.57 between 1986 and 1990 and 0.36 between 1990 and 1994. The rates of death from hepatocellular carcinoma similarly decreased. The incidence in children 6 to 9 years of age declined from 0.52 per 100,000 for those born between 1974 and 1984 to 0.13 per 100,000 for those born between 1984 and 1986. This landmark study shows that mass vaccination can reduce the incidence of a specific cancer in humans and further strengthens the association between HBV infection and liver cancer. The results also lend strong support to the argument for worldwide, universal hepatitis B vaccination.