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Vaccine. 2013 Dec 27;31 Suppl 9:J79-84. doi: 10.1016/j.vaccine.2013.05.054. Epub 2013 Jun 12.

Review of hepatitis B surveillance in China: improving information to frame future directions in prevention and control.

Author information

  • 1China Center for Disease Control (CDC), Beijing, China.
  • 2Hepatitis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
  • 3World Health Organization, China Country Office, Beijing, China.
  • 4World Health Organization, China Country Office, Beijing, China. Electronic address: yvan.hutin@ecdc.europa.eu.
  • 5Jiangsu Center for Disease Control (CDC), Nanjing, China.
  • 6World Health Organization Headquarters, Geneva, Switzerland.
  • 7Beijing Center for Disease Control (CDC), Beijing, China.
  • 8Ningxia Center for Disease Control (CDC), Yinchuan, China.



As the WHO verified that China reached the target of 1% prevalence of chronic hepatitis B infection among children targeted by universal hepatitis B immunization of newborns, the country considered new options for hepatitis B prevention and control. We reviewed hepatitis B surveillance in the broader context of viral hepatitis surveillance to propose recommendations to improve the system.


We described surveillance for viral hepatitis in China with a specific focus on hepatitis B. We assessed critical attributes of the system, including data quality, predictive positive value and usefulness.


While remarkable progress in hepatitis B immunization of infants and children has likely almost eliminated transmission in younger age groups, reported rates of hepatitis B increased steadily in China between 1990 and 2008, probably because of a failure to distinguish acute from chronic infections. Elements that prevented a clearer separation between acute and chronic cases included (1) missed opportunity to report cases accurately among clinicians, (2) low availability and use of tests to detect IgM against the hepatitis B core antigen (IgM anti-HBc) and (3) lack of systems to sort, manage and analyze surveillance data.


To improve hepatitis B surveillance, China may consider (1) training clinicians to diagnose acute cases and to use IgM anti-HBc to confirm them, (2) improving access and use of validated IgM anti-HBc tests and (3) developing data management and analysis techniques that sort out acute from chronic cases.

Copyright © 2013 Elsevier Ltd. All rights reserved.


China; Hepatitis B; Laboratory diagnosis; Surveillance evaluation

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