Incomplete hepatitis B immunization, maternal carrier status, and increased risk of liver diseases: A 20-year cohort study of 3.8 million vaccinees
Journal
Hepatology
Journal Volume
60
Journal Issue
1
Pages
125-132
Date Issued
2014
Author(s)
Abstract
Hepatitis B immunization has been documented to prevent fulminant hepatic failure (FHF) and hepatocellular carcinoma (HCC) by historical comparison studies in Taiwan. This study aimed to assess long-term risks and predictors of various liver diseases associated with incomplete immunization in 3.8 million vaccinees. Profiles of the National Hepatitis B Immunization Registry, National Cancer Registry, and National Death Certification Registry were linked to ascertain newly diagnosed cases of HCC and deaths from FHF and chronic liver diseases (CLDs) from infancy to early adulthood of 3,836,988 newborn vaccinees. Cox's proportional hazards models were used to estimate hazard ratios (HRs) for various risk predictors. There were 49 newly developed cases of HCC, 73 deaths from FHF, and 74 deaths from CLDs during the follow-up of 41,854,715 person-years. There were striking differences between unvaccinated and vaccinated newborns after the launch of a national immunization program for HCC incidence (0.293 vs. 0.117 per 100,000 person-years), FHF mortality (0.733 vs. 0.174 per 100,000 person-years), and CLD mortality (2.206 vs. 0.177 per 100,000 person-years). Among vaccinees, incomplete immunization was the most important risk predictor of HCC, FHF, and CLDs, showing an HR (95% confidence interval, P value) of 2.52 (1.25-5.05; P = 0.0094), 4.97 (3.05-8.11; P < 0.0001), and 6.27 (3.62-10.84; P < 0.0001), respectively, after adjustment for maternal hepatitis B serostatus. Conclusion: Hepatitis B immunization can significantly prevent the long-term risk of HCC, FHF, and CLDs from infancy to early adulthood. Incomplete immunization with hepatitis B immunoglobulin or vaccines was the most important risk predictor of the liver disease among vaccinees. (Hepatology 2014;60:125-132) ? 2014 by the American Association for the Study of Liver Diseases.
SDGs
Other Subjects
hepatitis B antibody; hepatitis B vaccine; article; child; chronic liver disease; follow up; fulminant hepatic failure; hepatitis B; human; immunization; incomplete immunization; liver cell carcinoma; liver disease; mortality; newborn; priority journal; risk; Adolescent; Carcinoma, Hepatocellular; Child; Child, Preschool; Cohort Studies; Female; Hepatitis B Vaccines; Hepatitis B, Chronic; Humans; Incidence; Infant; Infant, Newborn; Liver Failure, Acute; Liver Neoplasms; Male; Mass Vaccination; Pregnancy; Pregnancy Complications, Infectious; Proportional Hazards Models; Registries; Risk Factors; Taiwan; Young Adult
Publisher
John Wiley and Sons Inc.
Type
journal article