Mini-review Control of hepatocellular carcinoma through Hepatitis B vaccination in areas of high endemicity: Perspectives for global liver cancer prevention Amelie Plymoth a , Simonetta Viviani a,b , Pierre Hainaut a, * a International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France b Meningitis Vaccine Project, PATH Europe, Ferney-Voltaire, France article info Keywords: Hepatitis B vaccination Vaccination programmes Field efficacy trials Hepatocellular carcinoma abstract There are approximately 360 millions chronic carriers of Hepatitis B virus worldwide. Pat- terns of HB carriage are variable from one region to the other. Regions with rates of carriage over 8% are commonly considered as ‘‘high endemicity” regions. HB carriers have a very significant lifetime risk of developing chronic liver diseases such as cirrhosis and/or liver cancer (hepatocellular carcinoma, HCC). An efficient HB vaccine is available since the early eighties and has been used since for universal infant vaccination in regions of high ende- micity. Observations from Taiwan, where universal infant vaccination was introduced from 1984, show a remarkable, long-lasting protection against carriage and reduction of HCC rates in adolescent and young adults born after the initiation of the programme. Two pop- ulation-based trials have been set up in the mid-eighties to evaluate lifelong protective effects of infant HB vaccine against liver cancer, in The Gambia (West Africa) and in the area of Qidong, China. In other high-endemicity regions of Asia and Africa, universal infants vaccination has consistently showed a long-lasting high protection against chronic carriage and this is expected to lead to a dramatic decrease of chronic liver disease and liver cancer within the next decades. Here we briefly review the lessons of vaccination programmes and trials in high-endemicity regions, based on data gathered during 15–20 years of implementation. Ó 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Hepatitis B (HB) is one of the major diseases of man- kind. It is estimated that more than two billion people have serological evidence of current or prior Hepatitis B virus (HBV) infection, resulting in a pool of approximately more than 360 million chronic HB carriers worldwide. In 2004, WHO estimated that between 500,000 and 700,000 deaths worldwide each year are due to chronic diseases caused by HBV, mainly liver cirrhosis and hepatocellular carcinoma (HCC) [1]. However, rates of infection and chronic carriage show dramatic geographic variations across regions. In many low- and middle-resource countries, historical rates of chronic carriage over 8%, and sometimes as high as 10– 15% have been consistently reported. These areas include large regions of Sub-Saharan Africa and of South-East Asia including China. These regions can be defined as areas of high endemicity. Hepatitis B infection and chronic carriage acquisition is preventable with safe and effective vaccines that have been available since 1982. It is a non-infectious viral parti- cle that contains purified surface antigen (HBsAg) of the virus. Early vaccines were plasma-derived. Second genera- tion vaccines are produced by recombinant DNA technol- ogy using modified yeast cultures. The vaccine is given as a series of three intramuscular doses. Studies have shown that three doses of HepB vaccine are 95% effective in pre- venting children and adults from developing chronic infec- tion if they have not yet been infected. Efficacy is long lasting [2]. 0304-3835/$ - see front matter Ó 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.canlet.2009.08.024 * Corresponding author. Fax: +33 4 72 73 83 22. E-mail address: hainaut@iarc.fr (P. Hainaut). Cancer Letters 286 (2009) 15–21 Contents lists available at ScienceDirect Cancer Letters journal homepage: www.elsevier.com/locate/canlet