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Introduction of a hepatitis B vaccine into the national routine immunisation programme of Japan

Wednesday, 4th of January 2017

The Lancet Infectious Diseases, Volume 16, No. 12, p1325, December 2016

Introduction of a hepatitis B vaccine into the national routine immunisation programme of Japan

Mugen Ujiie

Published: December 2016

© 2016 Elsevier Ltd. All rights reserved.

WHO has recommended the integration of hepatitis B vaccine into routine infant immunisation programmes, with the aim of controlling hepatitis B virus (HBV) infections worldwide to decrease the incidence of HBV-related chronic liver disease, cirrhosis, and hepatocellular carcinoma. As of 2015, 185 countries had introduced nationwide hepatitis B vaccination for infants1x1WHO. Immunization coverage. Fact sheet. Updated September 2016. http://www.who.int/mediacentre/factsheets/fs378/en/; 2016. ((accessed Oct 24, 2016).)

See all References1. However, some countries have adopted selective vaccination strategies that target only high-risk individuals.

In Japan, public programmes for the prevention of mother-to-child transmission of HBV started in 1985 with the introduction of hepatitis B surface antigen (HBsAg) tests for all pregnant women. Subsequently, selective immunisation with hepatitis B vaccine and concomitant use of immunoglobulin for infants born to HBsAg-positive mothers were adopted in 1986. As a result of these national preventive measures, the prevalence of HBV infections among children has substantially declined in Japan. According to the latest research commissioned by the Ministry of Health, Labour and Welfare (MHLW), in 2016, the estimated prevalence of HBsAg seropositivity was 0·033% among 27 240 children aged 0–15 years from whom blood was mostly taken for health check-ups.2x2National Institute of Infectious Diseases, Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labor, and Welfare. Epidemiological data of hepatitis B virus infection among children in Japan. http://www0.nih.go.jp/niid/idsc/iasr/37/438.pdf. ((accessed Oct 24, 2016; in Japanese).)

See all References, 3x3Kiyohara, T, Ishii, K, Mizokami, M, Sugiyama, M, and Wakita, T. Seroepidemiological study of hepatitis B virus markers in Japan. Vaccine. 2015; 33: 6037–6042

CrossrefSee all References However, around 200 cases of acute hepatitis caused by HBV are still reported each year, mainly among adults,4x4National Institute of Infectious Diseases, Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labor, and Welfare. Acute hepatitis B, April 2006—December 2015. Infectious Agents Surveillance Report. 2016; 37: 147–148

See all References4 and new evidence suggests an epidemiological change in HBV genotypes, which might cause more chronic infections and rare household transmission without recognised blood, sexual, or perinatal exposure, resulting in further challenges for the control of HBV infection.

Through discussions starting in 2010, the National Health Sciences Council on Immunisation concluded in February, 2016, that the hepatitis B universal vaccine should be recommended for inclusion in the national immunisation programme of Japan, in addition to the public selective vaccination programme. In response to this decision, the MHLW amended the rules under the Immunization Law to implement HBV vaccination into the routine immunisation programme from October, 2016. The objectives for this programme are to prevent horizontal infection of HBV in childhood, to bring the incidence of HBV infection closer to zero and support WHOs target of eliminating viral hepatitis as a public health threat by 2030,5x5WHO. Global health sector strategy on viral hepatitis 2016–2021. Towards ending viral hepatitis. World Health Organization, Geneva; 2016

See all References5 and to promote the domestic development of a new combination vaccine including HBsAg.

Although the decision to introduce universal vaccination could be controversial in low-endemic countries in terms of cost-effectiveness, we consider our arguments to be of value for other countries currently discussing the pros and cons of universal vaccination to improve HBV control.

We declare no competing interests. MU is currently on secondment to Gavi, the Vaccine Alliance.

References

1WHO. Immunization coverage. Fact sheet. Updated September 2016. http://www.who.int/mediacentre/factsheets/fs378/en/; 2016. ((accessed Oct 24, 2016).)

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2National Institute of Infectious Diseases, Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labor, and Welfare. Epidemiological data of hepatitis B virus infection among children in Japan. http://www0.nih.go.jp/niid/idsc/iasr/37/438.pdf. ((accessed Oct 24, 2016; in Japanese).)

View in Article 

3Kiyohara, T, Ishii, K, Mizokami, M, Sugiyama, M, and Wakita, T. Seroepidemiological study of hepatitis B virus markers in Japan. Vaccine. 2015; 33: 6037–6042

View in Article 

| Crossref

4National Institute of Infectious Diseases, Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labor, and Welfare. Acute hepatitis B, April 2006—December 2015. Infectious Agents Surveillance Report. 2016; 37: 147–148

View in Article 

5WHO. Global health sector strategy on viral hepatitis 2016–2021. Towards ending viral hepatitis. World Health Organization, Geneva; 2016