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Prevention of Hepatocellular Carcinoma by Universal Vaccination against Hepatitis B Virus: The Effect and Problems

Authors' Affiliations: ¹ Department of Pediatrics and ² Hepatitis Research Center, College of Medicine, National Taiwan University Hospital; ³ Graduate Institute of Epidemiology, College of Public Health, National Taiwan University; ⁴ Center for Disease Control; ⁵ Department of Pediatrics, Veteran General Hospital; ⁶ Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; and ⁷ Chang-Gung Children's Hospital-Linkou, Taoyuan, Taiwan

Requests for reprints: Mei-Hwei Chang, Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan. Phone: 886-2-23123456; Fax: 886-2-23938871; E-mail: mhchang{at}ha.mc.ntu.edu.tw.

Purpose: In spite of the success of hepatitis B immunization, still a significant proportion of childhood hepatocellular carcinoma (HCC) failed to be prevented by the hepatitis B immunization program. This study is aimed to investigate the problems in the HCC prevention in children.

Experimental Design: All HCC children ages 6 to 14 diagnosed between 1981 and 2000 in Taiwan were collected from two national childhood HCC registry systems. We analyzed the causes of HCC prevention failure and the risk ratio of HCC among hepatitis B carriers born before versus after the vaccination program.

Results: The incidence of HCC per 100,000 children declined from 0.54 to 0.20 in those born before versus after the vaccination program (risk ratio, 0.36). Vaccine failure (33.3-51.4%) and failure to receive hepatitis B immunoglobulin at birth (42.4-57.5%) were the main causes of HCC prevention failure. Mother-to-child transmission of hepatitis B virus infection is an important risk factor of HCC development. This is evidenced by the very high hepatitis B surface antigen seropositive rate in our HCC children (97%) and their mothers (96%). Hepatitis B carrier children born after the vaccination program had a higher risk of developing HCC than those born before the program (risk ratio, 2.3-4.5).

Conclusions: Vaccine failure and failure to receive hepatitis B immunoglobulin are the main problems preventing eradication of HCC. Hepatitis B carrier children born after the immunization program have a higher risk of developing HCC than those born before.