An Evaluation Of Hepatitis B Vaccination Program Strategies

China is one of the high epidemic areas of hepatitis B Virus (HBV). The HBsAg positive rate is 9.75 percent, and HBV cumulative prevalence rate is 57.63 percent in Chinese population. Based on these indicators, it is estimated that there are around 120 million chronic carriers of the hepatitis B virus, and more than 700 million have been infected with hepatitis B virus[1]. Thus, the epidemic of hepatitis B Virus is one of major public health challenges in China.HBV vaccine program is currently one of the most effective measures to prevent hepatitis B infection. China integrated hepatitis B vaccination into the national immunization program in 1992, and in 2002 hepatitis B vaccine became part of the national routine infant immunization program. Therefore, HBV vaccination has been carried out for more than 10 years. In this context, and given the goal of reducing the HBsAg positive rate in population by one percent, it is necessary for health administration departments to evaluate the long-term effect of current immunization strategies in controlling the spread of hepatitis B in China. It is also crucial to evaluate current HBV controlling strategies by forecasting the trends of HBsAg positive rate in Chinese population. Input and output analysis of different immunization strategies can provide essential evidence for health administration departments to implement an economic, effective, and feasible HBV immunization strategy to control the spread of HBV in China. ObjectivesThe general objective of this study is to select the best HBV immunization strategy to reduce the HBsAg positive rate by one percent in Chinese population through the input and output analysis of two different immunization strategies. This study also aims to provide evidence for health administration departments to formulate HBV prevention policies.The specific objectives are the followings:1. Develop mathematical models for HBV vaccination intervention, and forecast the trends of HBsAg positive rate using different immunization strategies;Analyze cost-effectiveness, cost-utility, and cost-benefit of two2. immunization strategies;3. Choose the best immunization strategy that enables China to achieve the goal of reducing the HBsAg positive rate by one percent.Research strategy1. Establish mathematical models for HBV vaccination intervention, and use them to forecast the trends of population HBsAg positive rate, intervention time and immunization coverage.2. Calculate the vaccination cost of two immunization strategies, including strategy A (universal infant vaccination) and strategy B (universal infant and partial population vaccination).3. Calculate lifetime disability adjusted life year (DALY) , lifetime treatment cost and indirect economic losses of chronic hepatitis B, cirrhosis and liver cancer patients.4. Compare cost-effectiveness, cost-utility, and cost-benefit of two immunization strategies using the principle of input and output analysis, and carry out a comprehensive evaluation of input and output of the two immunization strategies.Data collectionWe collected data from several sources: 1. Division of Immunization and Prevention in Shanghai Municipal Center for Disease Control. Our research team collected data on the quantity of vaccine inoculation and inoculating cost; immunization strategies, target population, number of inoculating subjects, immunization coverage, and HBV infection among pregnant women from 1990 to 2001.2. Division of Epidemic Prevention in Shanghai Municipal Center for Disease Control. We collected monitoring data on population HBsAg positive rate, and incidence of HBV and liver cancer.3. Division of Immunization Program in Minhang Center for Disease Control in Shanghai. We obtained data on the quantity of vaccine inoculation and inoculating cost in 2001. 4. Yangpu Center for Disease Control and Zhabei Center for Disease Control in Shanghai. We gathered information on population, deaths of cirrhosis and liver cancer patients from 1...