Hepatitis B vaccine and liver cancer in Taiwan

Before vaccination began, 15 to 20 percent of people in Taiwan carried hepatitis B surface antigen. In July 1984 Taiwan became the first country to start a hepatitis B vaccination program. It first offered the vaccine to infants of mothers who carried the antigen and extended it to all infants in 1986. The vaccines were new: the first, Merck's plasma-derived Heptavax-B, had been approved by the US Food and Drug Administration in 1981, and a recombinant vaccine made in yeast followed in 1986.

M. H. Chang and colleagues in the Taiwan Childhood Hepatoma Study Group set out to measure the effect on childhood liver cancer. They gathered cases from 1981 to 1994 from the National Cancer Registry, which received reports from all 142 of the country's hospitals with more than 50 beds, and from 17 major medical centers. To exclude hepatoblastoma, the main analysis counted only children aged six or older.

The average yearly incidence of hepatocellular carcinoma in children aged 6 to 14 fell from 0.70 per 100,000 in 1981 to 1986, to 0.57 in 1986 to 1990 and 0.36 in 1990 to 1994. Deaths from the cancer fell as well. Comparing birth cohorts, incidence among children aged 6 to 9 was 0.52 per 100,000 for those born between 1974 and 1984 and 0.13 for those born between 1984 and 1986. The report appeared in the New England Journal of Medicine on 26 June 1997.

The authors concluded that childhood liver cancer had declined since universal vaccination began. A 2024 review by Mironova and Ghany calls the hepatitis B vaccine one of the first anticancer vaccines and notes that it is in the national immunization schedules of 190 countries. Antibody levels fall with time: among people in Taiwan born after the program started, 48.4 percent still had detectable antibody to the surface antigen after 20 years and 44 percent after 30.