. "Appendix D-5: The Prospects for Immunizing Against Hepatitis B Virus." New Vaccine Development: Establishing Priorities: Volume II, Diseases of Importance in Developing Countries. Washington, DC: The National Academies Press, 1986.
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New Vaccine Development: Establishing Priorities, Volume II, Diseases of Importance in Developing Countries
TABLE D-5.3 Morbidity and Mortality due to Primary Hepatocellular Carcinoma
Population at Risk (millions)
Incidence Rate (per 100,000)
Number of Cases=Number of Deaths
High HBV Risk
South and east Asia
Moderate HBV Risk
SOURCE: Francis, personal communication, 1985.
Incidence rates of cirrhosis as a complication of hepatitis B have not been well documented. Beasley et al. (1981) found in Taiwan that for every death due to PHC there were 0.43 deaths from HBsAg-positive cirrhosis. This rate was applied to all PHC deaths. Cirrhosis deaths were assumed to equal 25 percent of cirrhosis cases. Cirrhosis cases were assigned to category E. Table D-5.5 shows the disease burden estimates for cirrhosis resulting from hepatitis B. Table D-5.6 shows the total disease burden estimates for hepatitis B.
PROBABLE VACCINE TARGET POPULATION
In highly endemic areas, the goal of HBV vaccination is to prevent both infection and the chronic carrier state. Because most population members of these areas are at risk of infection, universal vaccination is required. Furthermore, infection in these areas often occurs early in life, so the age of immunization must be adjusted accordingly. For areas of the world where perinatal infection is common, the first dose of vaccine should be given at birth (with the addition of hepatitis B immunoglobulin [HBIG] if vaccine alone is not effective in preventing perinatal infection) and subsequent doses delivered later. This approach is practical in many Asian countries because a substantial proportion of mothers deliver their infants in medical facilities. For areas of the world where perinatal infection is not a major problem, vaccination could be given simultaneously with other infant vaccinations. Thus, HBV vaccination could be incorporated into the World Health Organization Expanded Program on Immunization (WHO-EPI), with administration at the earliest current time of vaccine delivery.