Abstract
Hepatitis B virus (HBV) infection is a major public health problem worldwide. China has the world’s largest burden of HBV infection and will be a major contributor towards the global elimination of hepatitis B disease by 2030. The country has made good progress in reducing incidence of HBV infection in the past three decades. The achievements are mainly due to high vaccination coverages among children and high coverage of timely birth-dose vaccine for prevention of mother-to-child transmission of HBV (both > 95%). However, China still faces challenges in achieving its target of 65% reduction in mortality from hepatitis B by 2030. Based on targets of the World Health Organization’s Global health sector strategy on viral hepatitis 2016–2021, we highlight further priorities for action towards HBV elimination in China. To achieve the impact target of reduced mortality we suggest that the service coverage targets of diagnosis and treatment should be prioritized. First, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Second, the government needs to reduce the financial burden of health care on patients. Third, better coordination is needed across existing national programmes and resources to establish an integrated prevention and control system that covers prevention, screening, diagnosis and treatment of HBV infection across the life cycle. In this way, progress can be made towards achieving the target of eliminating hepatitis B in China by 2030.
Highlights
Hepatitis B virus (HBV) infection is a major public health problem worldwide
The World Health Organization (WHO) estimated that 257 million people were living with chronic HBV infection in 2015 and that hepatitis B results in 887 000 deaths every year worldwide.[1,2]
To take action on sustainable development goal 3.3 on combating hepatitis, the World Health Assembly approved the global health sector strategy to eliminate viral hepatitis as a public health threat by 2030, with a target of reducing new infections by 90% and mortality by 65%
Summary
Hepatitis B virus (HBV) infection is a major public health problem worldwide. The World Health Organization (WHO) estimated that 257 million people were living with chronic HBV infection in 2015 and that hepatitis B results in 887 000 deaths every year worldwide.[1,2] To take action on sustainable development goal 3.3 on combating hepatitis, the World Health Assembly approved the global health sector strategy to eliminate viral hepatitis as a public health threat by 2030, with a target of reducing new infections by 90% and mortality by 65%.3 According to the global strategy, elimination of hepatitis B disease requires synergy across five core interventions: (i) immunization against hepatitis B; (ii) prevention of mother-to-child transmission (PMTCT) of HBV; (iii) blood and injection safety; (iv) harm reduction services for people who inject drugs; and (v) increased testing and treatment.[3]. Policy & practice Eliminating hepatitis B, China during antenatal care and in patients who are undergoing surgery, hospitalization, haemodialysis or invasive diagnosis and treatment.[12] The coverage of diagnosis has been improved due to the increasing proportion of pregnant women attending antenatal care (from 69.7% of 11.75 million live births in 1992 to 96.6% of 18.47 million live births in 2016) and the number of surgeries among inpatients (from 14.0 million in 2002 to 50.8 million in 2016).[13] In addition, China launched the national preconception health examination project in 2010 to provide free health check-ups for reproductive couples (including free HBV serological testing) in 100 counties and expanded it nationally in 2013.14 A study in rural China reported that nearly 1 in 10 couples preparing for pregnancy (202 816 out of 1 936 801 couples) are either discordant or both positive for HBsAg.[15] From 2010 to 2016, the Chinese government allocated 7.25 billion Chines yuan (¥; ¥ 1equivalent to 0.15 United States dollars) for the national preconception health examination project and screened around 60.5 million couples.[16,17]. Reported coverage of three doses of hepatitis B for infants has increased from 30.0% in 1992 to 99.6% in 2015, and timely birth-dose coverage has increased from 22.2% in 1992 to 95.6% in 2015 (Fig. 2).[20,21,22,23,24] timely birth-dose coverage is guaranteed by the high hospital
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