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• W2019098059 abstract "Chronic hepatitis B virus (HBV) infection is a severe health problem in China. According to a nationwide seroepidemiological survey (1992–1995), the infection rate and chronic viral carrier rate was 59.17% and 9.75%, respectively [1]. It is estimated that 20–25% of chronic HBV-infected persons will eventually die from terminal liver diseases, such as chronic liver failure, cirrhosis and hepatocellular carcinoma. Obviously, the burden of HBV-related diseases in China is very high. Investigations by the World Bank and the World Health Organization (WHO) have shown that among the 10 leading diseases in China, HBV-related diseases rank seventh, seventh and second in terms of impact on the Disability Adjusted Life Year, family financial burden and society burden, respectively. Therefore, there is an urgent need to control HBV infection to relieve the burden of its associated diseases. Comprehensive measures have been taken by the central government, academic institutions and medical societies. The strategy for control of HBV infection comprises two major tasks: prevention of new infection, and treatment of patients with existing infection. Nationwide universal vaccination in newborns is a critical measure and has achieved great success in the prevention of HBV infection. The other measures China has taken for the prevention of HBV infection include public health education campaigns, immunization with HBV vaccine, screening blood donors and high risk populations, and promoting safe injections and other medical procedures. The mode of transmission and clinical pattern of HBV infection in China are quite different from those in Western countries [2]. In China, most HBV infections were acquired in neonatal babies and young children; 9–12% of children under 5 years of age carried HBV. Therefore, China made strong efforts to implement universal infant HBV immunization. The Chinese Ministry of Health recommended HBV vaccination and integrated it into its Expanded Programme on Immunization in 1992, enforced it since 2002, and offered it as a completely free vaccination service for newborns since 2005 [3]. Following the success of nationwide HBV vaccination for newborns and pre-school children over the past several years, the chronic HBV carrier rate had dropped to 7.18% in 2006 among the general population [4]. Unsurprisingly, the HBV carrier rate has been reduced to 1.0% among children born after 1999 [3]. No doubt HBV immunization has been a great achievement for China. However, due to economic imbalances, some regions, such as western or remote rural areas, remain at a high risk of not receiving a timely dose at birth or the full course of immunization. Further efforts are still needed to assure timely birth coverage for all children and HBV vaccination in all high risk populations. In this issue of the Journal of Viral Hepatitis, Professor Zhuang reviews the epidemiology of HBV infection in China and the impact of vaccination in detail – it will be of interest for hepatologists in other countries to know the current status of HBV infection and the preventive measures that have been taken in China. Another frontier we confront in China is the urgent need for effective therapies for chronic hepatitis B (CHB). It is estimated there are about 90 million chronic HBV carriers in China, of whom at least 20–30% require safe and effective treatment to halt or even reverse existing liver damage and prevent further disease progression. At present, there are three standard interferons (alpha 1b, 2a and 2b), two pegylated interferons (alpha 2a and 2b) and four nucleos(t)ide analogues (lamivudine, adefovir, entecavir and telbuvidine) licenced and launched in mainland China. Apart from the pegylated interferons, all of the antiviral agents are manufactured in China by patents. The introduction and good acceptance of Good Clinical Practice (GCP) and Evidence Based Medicine have led to substantial progress in the management of hepatitis B in China. In 1999, the Chinese Ministry of Health issued the national GCP guideline, which adopted the major principles of the WHO and The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) guidelines. Since then, the quality of clinical trials has improved greatly. Chinese investigators independently performed Phase I to Phase IV clinical trials on the four anti-HBV nucleos(t)ides, sponsored by international pharmaceutical companies. Of note is that all of the Phase III trials were well-designed and properly conducted randomized, placebo-controlled studies. The results were published in international peer-reviewed journals [5–9]. Recently, several Chinese reports were cited in a systemic review by the National Institutes of Health Consensus Development Conference for the treatment of Hepatitis B [10]. Chinese investigators also actively took part in international multicentre trials and contributed greatly in terms of patient recruitment [11–13]. Based on these advances, and after extensive discussion and intensive revision, the Chinese practice guideline was published [14–16]. An update of this guideline will be released soon. In this issue of the Journal of Viral Hepatitis, Professor Sun and Professor Hou provide an excellent review on the treatment of hepatitis B in China. China has made a successful transition from being a high endemic region to an intermediate endemic region, but great resources and efforts are still needed to further reduce the prevalence of HBsAg carriers in the general population in China, particularly in economically under-privileged areas. As an important step in response to this demand, the Chinese Ministry of Health recently decided to offer free catch-up HBV vaccination for children less than 15 years of age. Accumulating evidence shows sustained suppression of HBV replication could prevent the disease progression and reduce the development of cirrhosis and hepatocellular carcinoma, which would ultimately improve survival and quality of life. However, the challenge is how to deliver safe, effective and yet affordable antiviral therapies for CHB patients who fulfil the therapeutic criteria. This has become a major concern for both the medical community and public health policy makers – reshaping the healthcare system is always a complex issue both technically and politically. Joint efforts by the government, medical community, pharmaceutical industry and all of society are essential to cope with this public health problem. The purpose of this special supplement of the Journal of Viral Hepatitis is to facilitate communication of the current knowledge of HBV infection between the East and the West. Due to limitations of space, from the many submitted original papers we could only select a few to publish. We hope this supplement will be an open window through which readers can view the progress we have made and challenges we are facing in the mission of resolving this major health problem. We thank the authors, editors and sponsors for their collective efforts in editing and publishing this supplement. We believe these efforts are worthwhile and will be of help for achieving ultimate control of chronic hepatitis B in China." @default.
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• W2019098059 date "2010-03-01" @default.
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• W2019098059 title "Achieving ultimate control of hepatitis B infection in China: progress and challenges" @default.
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• W2019098059 doi "https://doi.org/10.1111/j.1365-2893.2010.01265.x" @default.
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