What is the best surveillance for hepatocellular carcinoma in chronic carriers of hepatitis B?

Screening patients with chronic hepatitis B infection (HBsAg+) for hepatocellular carcinoma by alpha-fetoprotein (AFP) or by AFP plus ultrasound (AFP/US) detects hepatocellular carcinoma tumors at earlier stages and increases resection rates (strength of recommendation [SOR]: B, based on a systematic review of fair-quality randomized controlled trials). It is unclear whether screening with AFP or AFP/US improves disease-specific or all-cause mortality (SOR: B).     

Hepatitis B immunisation programmes in European Union,Norway and Iceland: Where we were in 2009?

In January 2009 25 European Union (EU) Member States (MSs), Norway and Iceland, participated in a survey seeking information on national hepatitis B vaccination programmes. Details of vaccination policy, schedule, population groups targeted for vaccination, programme funding, vaccine coverage and methods of monitoring of vaccine coverage were obtained. Twenty (74%) countries reported that they have a universal hepatitis B vaccination programme, in addition to immunisation of at risk groups; seven (26%) countries recommend HBV for high risk groups only (with some inter-country variation on groups considered at high risk). Among countries without universal hepatitis B vaccination programmes, the major factor for non-introduction is low disease endemicity.     

Reforming pharmaceutical policies in the European Union: a "penguin effect"?

Pharmaceutical policies form a substantial part of health care services, from the point of view of both equity and efficiency goals. Expenditure on pharmaceuticals has been growing steadily over the last few decades, and countries are finding the financing of drugs increasingly difficult. This article surveys the changes in pharmaceutical policies in the E.U. countries from the mid-1980s through the 1990s. It focuses primarily on policies dealing with cost control of publicly funded pharmaceuticals. In their analysis of these changes, the authors classify policies (or "packages of measures"), map out their incidence in each country, and assess their impact on the control of public pharmaceutical spending. They conclude that the E.U. countries are taking up apparently similar measures--dressing like penguins in a row--despite the limited effectiveness and limited evaluation of many of the measures adopted. The authors also analyze the role of national and international actors (most prominently, the European Union) in defining public pharmaceutical policies; look at how innovative policy ideas could be connected with the economic, political, and social interests that mold public action in this field; and propose new lines of investigation.     

Long-term seropositivity,safety, and impact of inactivated and live,attenuated hepatitis a vaccines in China – A cross-sectional study

BackgroundIn 2008, China introduced live, attenuated hepatitis A vaccine (L-HepA, licensed in 1992) and inactivated hepatitis A vaccine (I-HepA, licensed in 2002) nationwide, and is currently the only country using L-HepA in routine immunization. We assessed seropositivity and its duration following vaccination, safety, and association with hepatitis A incidence and population seroprevalence for I-HepA and L-HepA.MethodsWe obtained seroprevalence data from two nationwide serosurveys (in 1992 and 2014), vaccination status from the 2014 serosurvey, and vaccine safety and disease incidence data from the national surveillance system. We compared long-term HAV seropositivity among vaccine recipients and described safety profiles of both vaccines. We categorized the 31 provinces into those predominately using I-HepA and achieving high coverage (n = 4), those predominately using L-HepA achieving high coverage (n = 4), and those predominately using L-HepA achieving lower coverage (n = 23). We compared population HAV seropositivity, coverage, and disease incidence among the three groups.ResultsOne year after vaccination, seropositivity from I-HepA was significantly higher than from L-HepA (97.8% vs 90.7%), and seropositivity declined to 73.5% for L-HepA and 75.4% for I-HepA after 10 years – not significantly different by vaccine. The annual incidence of serious AEFI was <0.5/100 000 for both vaccines. Prior to licensure of either HepA vaccine, provinces that would go on to predominantly use I-HepA had lower incidences of hepatitis A and lower seropositivity levels to HAV than provinces that would go on to use L-HepA. By 2014, these differences were significantly diminished. Regardless of vaccine selection, all three province groups had lower immunity to HAV among individuals born during the 10 years prior to nationwide vaccine introduction – individuals who were 10 to 24 years old in 2014.ConclusionEvidence of good immunogenicity, safety, and impact on incidence supports continued use of both I-HepA and L-HepA in the EPI system. These results may be useful for countries considering integrating HepA vaccines into their routine programs.     

Does the development of new medicinal products in the European Union address global and regional health concerns?

Background  

Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective.     

Is there still a problem with lead in drinking water in the European Union?

The presence of lead in drinking water poses a range of risks to human health, including the retardation of some aspects of child development, the inducement of abortion, and other clinical disorders. The extent of these risks has not been quantified at the European Union (EU) scale. A number of sampling methods are in use across the EU, some of which are inadequate for determining the concentrations of lead in drinking water at consumers' taps. In consequence, non-compliance with the EU standards for lead in drinking water has been under-estimated. Emerging data indicates significant non-compliance with these standards in some countries, particularly with the 10 mg l^-1 standard that will become a legal requirement in 2013; the current interim standard of 25 mg l^-1 is also exceeded in some locations. An initial estimate is that 25% of domestic dwellings in the EU have a lead pipe, either as a connection to the water main, or as part of the internal plumbing, or both, potentially putting 120 million people at risk from lead in drinking water within the EU. These issues are relevant to the implementation of the Protocol on Water and Health and to drinking water safety planning.     

Energy poverty and health: Trends in the European Union before and during the economic crisis, 2007–2016

The aim of this study is to analyse the time trends in the European Union (EU) before and during the economic crisis in 1) the energy poverty (EP) prevalence; 2) the association between EP and health and 3) the impact of EP on health. We analyse trends among women and men in two EU macro regions, defined by a novel index of structural vulnerability to EP. The study shows how EP and its impact on health worsened during the economic crisis and identifies groups at higher risk such as women and people living in Mediterranean and Eastern European countries, which have been found to be countries with higher structural vulnerability to EP.     

Searching for chronic hepatitis B patients in a low prevalence area – role of racial origin

Background

Clinical studies for testing new drugs against hepatitis B ought to be carried out in low prevalence areas despite difficulties on patient recruitment. In such areas, relatives of chronic hepatitis B patients are considered to be at risk of acquiring the hepatitis B virus (HBV). The aim of this study was to evaluate the prevalence of HBV markers (anti-HBc, HBsAg and anti-HBs) in familial members of chronic hepatitis B (CHB) patients according to their origin (Asian or Western) in a low prevalence area, the city of São Paulo, Brazil.

Methods

Twenty three Asian CHB probands and their 313 relatives plus 31 CHB probands of Western origin and their 211 relatives were screened for HBV serological markers; the study was carried out in the outpatient clinic of the University of São Paulo School of Medicine.

Results

Mother to child transmission was greater in the Asian group whereas sexual transmission was more frequent in the Western group (p < 0.0001). Anti-HBc was positive in 90% and 57% of the Asian and Western parents (p = 0.0432) and in 97% and 33% of the Asian and Western brothers (p = 0.0001), respectively. HBsAg was more frequent among the Asian (66%) than the Western (15%) mothers (p = 0.0260) as well as among the Asian (81%) than the Western (19%) brothers (p = 0.0001). We could detect 110 new HBsAg-positive subjects related to the 54 index patients, being the majority (81%) of Asian origin.

Conclusion

In low prevalence area of hepatitis B, family members and household contacts of chronic HBV carriers are at high risk for acquiring hepatitis B.

     

More politics,stronger consumers? A new division of responsibility for food in the European Union

In less than a decade, European food institutions have gone through a period of important reform. This reform was intended to address new challenges posed by a succession of food safety crises, the entry into the world markets of novel foods, and general public distrust of the actions of the European Commission. This paper sketches the most salient institutional changes that have occurred in the history of the European Union (EU). It also maps the redistribution of responsibilities in the European food system. After years of harmonisation in the name of free trade, in the mid-1990s food safety and consumer protection became the guiding principles of European food policy. Having described these changes, the paper suggests that a specifically European food policy style is emerging in juxtaposition with 'transatlantic' food policy.     

Basic ethical principles in European bioethics and biolaw: Autonomy,dignity, integrity and vulnerability – Towards a foundation of bioethics and biolaw

This article summarizes some of the results of the BIOMED II project “Basic Ethical Principles in European Bioethics and Biolaw” (1995–1998)connected to a research project of the Danish Research Councils “Bioethics and Law” (1993–1998). The BIOMED project was based on cooperation between 22 partners in most EU countries. The aim of the project was to identify the ethical principles of respect for autonomy, dignity, integrity and vulnerability as four important ideas or values for a European bioethics and biolaw. The research concluded that the basic ethical principles cannot be understood as universal everlasting ideas or transcendental truths but they rather function reflective guidelines and important values in European culture. The method of the research was conceptual, philosophical analysis of the cultural background of the four values or normative ideas that people use and find important in their existence. Moreover, this was combined with analysis of empirical legal material and policy documents. Also, a number of qualitative interviews with relevant experts were carried out. Another important result of the BIOMED project was the partner's Policy Proposals to the European Commission, the Barcelona Declaration, unique as a philosophical and political agreement between experts in bioethics and biolaw from many different countries. The Policy Proposals are reprinted here at the end of the article. This revised version was published online in July 2006 with corrections to the Cover Date.     

Do private hospitals outperform public hospitals regarding efficiency,accessibility, and quality of care in the European Union? A literature review

European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social‐economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for‐profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.     

Assessment of the timely administration of the hepatitis B and BCG birth dose and the primary infant vaccination schedule in 2015–2016 in the Mekong Delta,Viet Nam

IntroductionVietnam is implementing hepatitis B (HBV) birth dose (BD) vaccination since 2003 but coverage remains low, especially in the Mekong River Delta. This study aimed to determine the coverage of the HBV BD vaccination, to identify socio-demographic factors influencing HBV BD, and to assess reasons for non-immunization of neonates.MethodsA cross-sectional survey was conducted in 2015–2016. Mothers from 526 children aged 6–11 months living in 3 provinces in the Mekong River Delta - representing respectively urban, rural and remote area - were interviewed at home and infant vaccination documents were checked. The three-stage sampling method was adapted from WHO 30-cluster sampling. Predictors of HBV BD administration were identified with multiple regression analysis.ResultsThe overall HBV BD coverage (within 24 h) was 46.6% (compared to 44.5% for BCG) and was significantly higher in remote or rural than in urban area (OR 1.87 and 3.36, respectively), and in children whose father had a higher educational level (OR 2.76; 2.29 and 1.86, respectively, for master degree, bachelor and secondary school) as compared to a lower level. Main reasons for not having received HBV BD mentioned by parents were vaccines not offered by health care workers (53.0%), and illness of the infant (27.2%).ConclusionAlthough Vietnam started HBV BD vaccination more than 10 years ago, the coverage and timeliness need to improve to reach WHO targets (95% within 24 h after birth). Better training and information of health care workers, and better protocols ensuring timely HBV BD could address these vaccine administration thresholds.     

Hepatitis B vaccine coverage in short and long stay prisons in Wales,UK 2013–2017 and the impact of the global vaccine shortage

Data on hepatitis B vaccination coverage across prisons in Wales 2013–2017 were analysed to describe coverage of one dose, and the full hepatitis B vaccine course for men in prison. Whilst vaccination coverage increased in both short and long stay prisons, annual coverage was consistently lower in short stay prisons compared to long-stay prisons, despite short-stay prisons delivering a higher numbers of vaccine doses. The exception of this pattern was in 2017, at a time of global vaccine shortage. The data demonstrate the need for all prisons to work together to ensure men in prison can receive the full hepatitis B vaccine course. Collaborative working will be required to recover from the vaccine shortage and to achieve higher coverage than the plateau in 2016.     

Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992–2015

In 2016, the Immunization Technical Advisory Group of the South-East Asia Region (SEAR) endorsed a regional goal to achieve ≤1% prevalence of hepatitis B surface antigen (HBsAg) among 5-year-old children by 2020. Chronic hepatitis B virus (HBV) infection is largely preventable with a birth dose of hepatitis B vaccine (HepB-BD) followed by two to three additional doses. We reviewed the progress towards hepatitis B control through vaccination in SEAR during 1992–2015. We summarized hepatitis B vaccination data and reviewed the literature to determine the prevalence of chronic HBV infection pre- and post-vaccine introduction. We used a mathematical model to determine post-vaccine prevalence of HBsAg among 5 year olds in countries lacking national serosurvey data and estimated the impact of vaccination on disease burden. Regional coverage with three doses of hepatitis B vaccine (HepB3) increased from 56% in 2011 to 87% in 2015. By 2016, 7 of 11 countries had introduced universal HepB-BD. Regional HepB-BD coverage increased from 9% in 2011 to 34% in 2015. In 2015, estimated HBsAg among 5 year olds was 1.1% with variability among countries. Myanmar (3.8%), Timor-Leste (2.7%), Indonesia (1.8%), and India (1%) had the highest prevalence of HBsAg. During 1992–2015, vaccination prevented approximately 16 million chronic HBV infections and 2.6 million related deaths. In 2015, around 197,640 perinatal HBV infections occurred in SEAR with majority occurring in India (62%), Bangladesh (24%), and Myanmar (8%). Myanmar had the highest rate of perinatal chronic HBV infections at 16 per 1000 live births. Despite significant progress in the control of HBV, SEAR needs to secure political commitment for elimination and consider additional strategies, such as promoting health facility births, universal birth dose administration, developing strong coordination between health sectors, and using alternative vaccine delivery methods, to improve HepB-BD coverage and subsequently achieve HBV control and elimination.