Since the institution of Taiwan's program of universal hepatitis B vaccination, the incidence of hepatocellular carcinoma in children has declined.

The prevention of hepatocellular carcinoma by this HBV vaccine extends from childhood to early adulthood. Failure to prevent hepatocellular carcinoma results mostly from unsuccessful control of HBV infection by highly infectious mothers.

Our results suggest that boys may benefit more from HBV vaccination than girls in the prevention of HCC.

No abstract

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 to14 diagnosed between1981and 2000 inTaiwan 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.Hepatocellular carcinoma (HCC) is one of the most common malignancies in humans. Hepatitis B virus (HBV) is a major etiologic agent responsible for HCC (1 -4). HCC occurs mainly in adults between 40 and 60 years of age with a hepatitis B surface antigen (HBsAg) seropositive rate of f70% to 80% (5). However, in areas hyperendemic for HBV infection, HCC may also develop in children (6). In our previous study, 94% of Taiwanese children with HCC were HBsAg seropositive. It suggests a very close relationship between HBV infection and childhood HCC in Taiwan (6). HCV infection has not been related to HCC in children in the world literature and in our previous study (7).Universal hepatitis B vaccination has effectively reduced the prevalence of HBV infection and chronic carrier rates (8). In addition, our previous study in Taiwan also showed that, according to birth cohort, the incidence of HCC in children ages between 6 and 9 years decreased from 0.52 to 0.13 per 100,000 in those born before versus after the vaccination program (9).However, the reduction in the incidence of HCC (75%) by the universal hepatitis B vaccination program is not as effective as that in chronic HBV infection (90%). Therefore, we are curious to know whether chronic HBsAg carriers who were born after the hepatitis B immunization program have a higher risk of developing HCC than those born before the program.Whereas we are monitoring the long-term trend of HCC in children during the 16 years after the launch of the HB...