Combating hepatitis B and C by 2030: achievements, gaps, and options for actions in China

Abstract

China has the highest number of hepatitis B and C cases globally. Despite remarkable achievements, China faces daunting challenges in achieving international targets for hepatitis elimination. As part of a large-scale project assessing China’s progress in achieving health-related Sustainable Development Goals using quantitative, qualitative data and mathematical modelling, this paper summarises the achievements, gaps and challenges, and proposes options for actions for hepatitis B and C control. China has made substantial progress in controlling chronic viral hepatitis. The four most successful strategies have been: (1) hepatitis B virus childhood immunisation; (2) prevention of mother-to-child transmission; (3) full coverage of nucleic acid amplification testing in blood stations and (4) effective financing strategies to support treatment. However, the total number of deaths due to hepatitis B and C is estimated to increase from 434 724 in 2017 to 527 829 in 2030 if there is no implementation of tailored interventions. Many health system barriers, including a fragmented governance system, insufficient funding, inadequate service coverage, unstandardised treatment and flawed information systems, have compromised the effective control of hepatitis B and C in China. We suggest five strategic priority actions to help eliminate hepatitis B and C in China: (1) restructure the viral hepatitis control governance system; (2) optimise health resource allocation and improve funding efficiency; (3) improve access to and the quality of the health benefits package, especially for high-risk groups; (4) strengthen information systems to obtain high-quality hepatitis epidemiological data; (5) increase investment in viral hepatitis research and development.

Epidemiologic trends of hepatitis A in different age groups and regions of China from 1990 to 2018: observational population-based study

“…We, therefore, attribute the main decline in the incidence and mortality of hepatitis A in China to the increased use of vaccination, as described previously [9]. To reduce the burden of liver diseases caused by the different hepatitis viruses, the Chinese government has continuously increased investments in prevention and control measures for prevention of infections by HAV [34], hepatitis B virus and hepatitis C virus [35]. Based on our ITS analysis, the incidence and mortality of hepatitis A significantly decreased after inclusion of hepatitis A vaccine in EPI (the average incidence of hepatitis A was 2.1617/100 000 and decreased by an average rate of 0.2571/100 000 per year), showing the EPI strategy had a continuous effect on the decreasing trend of hepatitis A burden.…”

The Chinese Society of Hepatology position statement on the redefinition of fatty liver disease

“…The challenges have negative impacts on research attention, public awareness and health policy maker considerations and can result in underfunding. Although China has released national action plans for the control of viral hepatitis that set clear targets for prevention, 9 aspects of fatty liver disease policy are either less well articulated than those for other liver diseases and related metabolic comorbidities (such as diabetes and cardiovascular disease) or are not articulated at all. In the field of gastrointestinal research, China has achieved admirable progress.…”

Association between hepatitis B virus infection and colorectal liver metastasis: a meta-analysis

“…It is reported that the number of people infected with hepatitis B worldwide is approximately 250 million, and 500,000 people die every year from the complications of this disease [ 8 ]. In China, more than 93 million people are carriers of the hepatitis B virus, and about 20 million of them have chronic hepatitis B virus infection [ 9 ].…”