Changing Epidemiology of Hepatitis A in China: Evidence From Three National Serological Surveys and the National Notifiable Disease Reporting System

Background and Aims China has conducted surveillance for hepatitis A since 1990, and hepatitis A was highly‐to‐intermediately endemic in 1992 when a Chinese hepatitis A vaccine (HepA) was licensed and introduced as a family‐pay vaccine. In 2008, HepA was introduced into the Expanded Program on Immunization as a free childhood vaccine. Approach and Results Three nationally representative surveys conducted in 1992, 2006, and 2014 assessed hepatitis B serology. The 1992 survey included hepatitis A virus (HAV) serology, and we tested sera from the 2006 and 2014 surveys for HAV antibodies. We used surveillance, seroprevalence, and vaccination status data to describe the changing epidemiology of hepatitis A in China from 1990 through 2014. Before HepA licensure, anti‐HAV seroprevalence was 60% at 4 years of age, 70% at 10 years, and 90% at 59 years; incidence was 52/100,000 and peaked at 4 years. In 2006, after >10 years of private sector vaccination, HepA coverage was