Fuqiang Cui1, Jan Drobeniuc2, Stephen C Hadler3, Yvan J Hutin4, Fubao Ma5, Steve Wiersma6, Fuzhen Wang1, Jiang Wu7, Hui Zheng1, Liwei Zhou8, Shuyan Zuo3. 1. China Center for Disease Control (CDC), Beijing, China. 2. Hepatitis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA. 3. World Health Organization, China Country Office, Beijing, China. 4. World Health Organization, China Country Office, Beijing, China. Electronic address: yvan.hutin@ecdc.europa.eu. 5. Jiangsu Center for Disease Control (CDC), Nanjing, China. 6. World Health Organization Headquarters, Geneva, Switzerland. 7. Beijing Center for Disease Control (CDC), Beijing, China. 8. Ningxia Center for Disease Control (CDC), Yinchuan, China.
Abstract
BACKGROUND: As the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system. METHODS: We described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness. RESULTS: While remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data. CONCLUSIONS: To improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases.
BACKGROUND: As the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system. METHODS: We described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness. RESULTS: While remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data. CONCLUSIONS: To improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases.
Authors: N C Tassopoulos; G V Papatheodoridis; Y Kalantzakis; E Tzala; J K Delladetsima; M G Koutelou; P Angelopoulou; A Hatzakis Journal: J Hepatol Date: 1997-01 Impact factor: 25.083
Authors: L Wang; H Hu; R Zhang; X Zheng; J Li; J Lu; Y Zhang; P Qi; W Lin; Y Wu; J Yu; J Fan; Y Peng; H Zheng Journal: Clin Exp Immunol Date: 2020-10-05 Impact factor: 4.330