About 170 million Chinese are infected chronically with HBV and 10% suffer from chronic hepatitis. Around half a million Chinese die from hepatitis B caused hepatocellular carcinoma and endstage cirrhosis each year. From 1983 to the present, a controlled clinical trial involving 80,000 children on a universal hepatitis B vaccination programme to prevent chronic hepatitis, hepatocellular carcinoma, and endstage cirrhosis was implemented in Qidong, China. A pilot study demonstrated that the HBsAg rate reached the adult level before the fifth year of age, and neonatal vaccination with either plasma-derived or recombinant hepatitis B vaccines provided a similar 75% protective efficacy against HBV infection. The high rate of follow-up and blood tests coverage of the cohorts provided data to show 75% protection at the tenth to eleventh years of age against serum HBsAg and also against prolonged hepatic dysfunction. The strategy of controlling hepatitis B nationwide was based on the universal immunisation of newborns, beginning in cities and then the rural areas. The largescale vaccine source was provided by domestic plants through technology transfer, first providing plasma-derived vaccine replaced completely by recombinant DNA vaccine in 1997. An official survey in 1999 using a cluster sampling of 25,878 children from 31 provinces reported an average coverage rate of three dose of hepatitis B vaccination of 70.7%, being higher in urban areas. KEY WORDS: HBV; hepatitis B; vaccination; EPI HEPATITIS B INFECTION: A MAJOR HEALTH ISSUE OF CHINASeveral studies have estimated that 10 to 15% of people in China were chronically infected with HBV depending on the detection method and the way of selection and coverage size of the populations. Taking 13% as the estimated rate [Chen et al., 1990], it was calculated that about 170 million of the 1.3 billion Chinese people are chronically infected with HBV. However, the viral load by nucleic acid-based tests (NAT assays) indicate that HBV infection rates were usually underestimated. About 10% of the HBV carriers were estimated to have chronic hepatitis B, mostly in middle age. HBV was demonstrated to be the main cause of hepatocellular carcinoma (HCC) and end-stage cirrhosis. In association with the high HBV infection rate, liver cancer ranks second among the total cancer mortality in China. The age-adjusted mortality rate of HCC was reported to be 23 Â 10 À5/10 5 /yr [Li and Peto, 1996]. The annual deaths from HCC in China with 1.3-billion population was then estimated to be about 300,000. A recent study reported higher mortality rate of HCC in China, causing 384,000 deaths per year (Liu et al., unpublished data). End-stage cirrhosis, mainly HBV related, caused about 150,000 deaths per year. These data showed that HBV killed about half a million mainland Chinese each year. This virus ranks only second to tobacco as the major killer of Chinese at the present time and in the decades to come. Therefore, universal hepatitis B vaccination of neonates, the most cost-effective approach ...

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ObjectiveTo examine the extent to which effective interventions to prevent unintentional child injury are reflected in the laws and regulations of China.MethodsWe focused on the six common causes of fatal child injuries – drowning, road traffic injury, falls, poisoning, burns and suffocation. We investigated 27 interventions recommended by the United Nations Children’s Fund, the World Health Organization or the European Child Safety Alliance. We searched China National Knowledge Infrastructure and Lawyee for Chinese legislations using keywords and synonyms for the 27 interventions. We reviewed the identified legislations for statements specifying the responsible implementation department.FindingsSeven national laws, nine regulations of the State Council and 46 departmental regulations were found to relate to at least one of the interventions. Although seven of the 27 internationally recommended interventions were covered by Chinese laws, 10 were not covered by any current Chinese law or regulation. None of the interventions against drowning and falls that we investigated was covered by national laws. The implementation responsibilities for effective interventions were either not specified or were assigned to multiple governmental departments in 11 or 20 legislative documents, respectively.ConclusionIn Chinese laws and regulations, interventions proven to prevent major causes of unintentional child injuries are underrepresented and the associated implementation responsibilities are often poorly defined. China should include all such interventions in laws and regulations, and assign implementation responsibility for each to a single department of the national government.

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