If the national immunization program continues with the same aggressive
proliferation, the HBsAg-carrier rates of the next generation of Taiwanese
children may be reduced to 0.1%.
Similar reductions in rates of hepatocellular cancer among children age 6
to 14 years were also noted. The rates of hepatocellular cancer fell from
0.70 per 100,000 children in 1981-1986, to 0.57 in 1986-1990, and to 0.36 in
Analysis of the incidence of hepatocellular cancer among children also
showed a slower decline for children born prior to the initiation of the
program than for those born afterward. Moreover, the hepatocellular cancer
mortality rate in children showed a similar decline following the
introduction of the national immunization program.
Although the institution of a nationwide vaccination program of this
scale is certainly costly, the cost-effectiveness of such a program is
evident. The cost of hepatitis-B-related medical care and lost wages in
Taiwan reached an estimated $318.3 million (US) for the 10-year period 1984
to 1994. The cost of hepatitis B immunizations during that same period
amounted to only one third of that cost (US $100 million).
The largest financial impact related to hepatitis B infection will be
felt when the children who participated in the vaccination program reach the
age of 50 to 60 when the incidence of hepatocellular carcinoma would be
expected to peak. Thus, the greatest effects of the national hepatitis B
vaccination program are expected to begin in 2034.
The significant decrease in hepatitis B virus infection indicates that a
nationwide vaccination program can be successful. Taiwan’s experience
should serve as an example for other countries facing similarly high levels
of hepatitis B virus infection.
In addition to decreasing the incidence of hepatitis B, the vaccination
program significantly decreased the incidence of hepatocellular carcinoma,
providing further evidence that hepatitis B is a cause of hepatocellular
carcinoma. These results suggest that the prevention of a virus can
result in a reduction in the incidence of a related cancer.
1. American Cancer Society: Cancer Facts and Figures 2002. Atlanta, ACS,
2. www.mamashealth.com/cancer/livercancer.asp. March 08, 2002.
3. Chang M-H, Chen C-J, Lai M-S, et al: Universal hepatitis B vaccination
in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl
J Med 336:1855-1859, 1997.
4. Nystedt D: Researchers test drug for liver cancer. Taipei Times, Oct
5. Department of Health: The population, in Hsu TC ed: Health and
Medicine in Taiwan Area, Republic of China. Taipei, Taiwan, Department of
Health, Executive Yuan, pp 3-4, 1985.
6. Stevens CE, Beasley RP, Tsui J: Vertical transmission of hepatitis B
antigen in Taiwan. N Engl J Med 292:771-774, 1975.
7. Chen DS: From hepatitis to hepatoma: Lessons from type B viral
hepatitis. Science 262:369-370, 1993.
8. Hsu HM, Chen DS, Chuan CH: Efficacy of a mass hepatitis B vaccination
program in Taiwan. JAMA 260:2231-2235, 1989.
9. Chen DS, Sung JL: Hepatitis B virus infection and chronic liver
diseases in Taiwan. Acta Hepatol-Gastroenterol 25:423-430, 1978.
10. Sung JL, Chen DS, Lai M, et al: Epidemiological study on hepatitis B
virus infection in Taiwan. Chin J Gastroenterol 1:1-19, 1984.
11. Beasley RP, Hwang LY, Lin CC: Hepatocellular carcinoma and hepatitis
B virus: A prospective study of 22,707 men in Taiwan. Lancet 2:1129-1133,
12. Ni YH, Chang MH, Huang LM, et al: Hepatitis B virus infection in
children and adolescents in a hyperendemic area: 15 years after mass
hepatitis B vaccination. Ann Intern Med 135:796-800, 2001.
13. Alter MJ: Protecting future generations through immunization against
hepatitis B. Ann Intern Medicine 135:835-836, 2001.
14. Chen DS, Hsu HM, Bennett CL, et al: A program for eradication of
hepatitis B from Taiwan by a 10-year, four-dose vaccination program. Cancer
Causes and Control 7:305-311, 1996.
Ms. Gibbons, Ms. Newlin, and Ms. Phan are project managers, Northwestern
University Medical School. Dr. Bennett is professor of medicine, Northwestern
University Medical School, Robert H. Lurie Comprehensive Cancer Center, and
director of HSR&D, VA Chicago Health Care SystemLakeside Division.