Progress towards achieving viral hepatitis B and C elimination in the Asia and Pacific region: Results from modelling and global reporting.

In 2016, Asia and Pacific countries endorsed action plans for reaching viral hepatitis elimination targets set in the Global Health Sector Strategy (GHSS) for Viral Hepatitis 2016-2021. We examine the region's progress by modelling disease burden and constructing the cascade of care. Between 2015 and 2020, chronic HBV prevalence declined from 4.69% to 4.30%, and HCV prevalence declined from 0.64% to 0.58%. The region achieved the 2020 target of 30% incidence reduction for HBV, whereas HCV incidence declined by 6%. Hepatocellular carcinoma incidence for HBV and HCV increased by 9% and 7%, respectively. Liver-related deaths from HBV rose by 8%, and mortality attributable to HCV plateaued. Large testing and treatment gaps remained in 2019: only 13% of chronic HBV infections were diagnosed and 25% treated; 21% of chronic HCV infection were diagnosed and 11% treated. Viral hepatitis must become national priority with adequate funding to reach elimination goals by 2030.

Evaluation of the reliability and validity of a vaccine hesitancy scale on knowledge, attitude, trust and vaccination environment (KATE-S) in Chinese parents.

OBJECTIVE: To verify the reliability and validity of a vaccine hesitancy scale about knowledge, attitude, trust and vaccination environment (KATE-S) among the Chinese parents. METHODS: A questionnaire survey was conducted by convenience sampling in China using the KATE-S to assess knowledge of vaccines, attitudes towards vaccines, trust in acquired information and vaccination environment and vaccination status of vaccine introduced in immunization program among children. RESULT: A total of 199 valid questionnaires were collected from the parents. Among those, 83 (41.7%) parents accepted all vaccines without hesitancy, 111 (55.8%) parents accepted all but had hesitancy intention, and 5 (2.5%) had hesitancy behaviour of refusing or delaying vaccination. The overall test-retest reliability, split-half reliability and Cronbach's coefficient values were 0.924, 0.885 and 0.823, respectively. The scale-level content validity index (S-CVI) of universal agreement was 0.867, and the average S-CVI was 0.978. Exploratory factor analysis extracted seven common factors from the scale, and the cumulative contribution rate was 56.8%. The correlation coefficients between the items and their dimensions ranged from 0.405 to 0.760, with a calibration success rate of 100% for convergent and discriminant validity. After adjusting for the basic characteristics, the knowledge level of hesitancy intention group and hesitancy behavior group were both lower than accept all group (OR = 0.78, 95% CI: 0.65-0.94; OR = 0.26, 95 %CI: 0.07-0.94). CONCLUSION: The KATE-S has good reliability and validity in Chinese parents and would be considered to expand the sample size and survey areas to obtain more representative results.

The impact of hepatitis B vaccine in China and in the China GAVI Project.

The China GAVI Project (CGP) was initiated in 2002 to provide hepatitis B (HB) vaccine to infants born in the less developed areas of China including the Western provinces and poverty counties of Middle provinces, to prevent the consequences of hepatitis B virus infection. By 2009, the project areas had raised coverage of 3 doses of HB vaccine and timely birth doses to almost 90% among infants, comparable to those in wealthier Eastern provinces, and reduced HBV prevalence to <1% among children in these areas. We estimated the impact in disease prevented by HB vaccine in China between 1992, when the vaccine was routinely recommended, and 2009, and in CGP areas for the years 2003-2009, when the CGP was active. A published model was used to estimate the burden of chronic and acute HBV infection and death prevented due to HB vaccination in China and the CGP areas using data from national serosurveys in China in 1992 and 2006, and HB vaccine coverage from surveys in 2004, 2006 and 2010. We used sigmoid modeling to estimate vaccine coverage nationally, regionally, and CGP areas. We also estimated the incremental impact of the CGP on HB vaccine coverage in those underserved areas. Our findings suggest that between 1992 and 2009, HB vaccination in China has prevented 24 million chronic HBV infections and 4.3 million future deaths due to cirrhosis, hepatocellular carcinoma and acute hepatitis. During the CGP between 2003 and 2009, an estimated 3.8 million chronic HBV infections and 680,000 deaths were prevented in CGP areas. We found that the CGP funding increased HB vaccine coverage in project areas by 4-15% for HB3 and 4-27% for timely birth dose beyond the coverage expected without the CGP. The CGP represents a highly successful public health collaboration between the national government and international partners.