Vol. 2 No. 31 Jul. 31, 2020 Preplanned Studies Burden of Acute Viral Hepatitis — China, 1990−2019 579 Supervised Analysis of Hepatitis C Virus RNA-Positive Case Reporting in County-Level Hospitals — China, 2013−2018 587 Recollection Progress Towards Hepatitis A Control and Prevention Through 2019: the National Immunization Program of China 591 Control of Chronic Hepatitis B in China: Perspective of Diagnosis and Treatment 596 Profiles Qiyong Liu, China CDC’s Chief Expert of Vector Control 601 Notifiable Infectious Diseases Reports Reported Cases and Deaths of National Notifiable Infectious Diseases — China, June, 2020 603 China CDC Weekly Editorial Board Editor-in-Chief George F. Gao Deputy Editor-in-Chief Liming Li Gabriel M Leung Zijian Feng Executive Editor Feng Tan Members of the Editorial Board Xiangsheng Chen Xiaoyou Chen Zhuo Chen (USA) Xianbin Cong Gangqiang Ding Xiaoping Dong Mengjie Han Guangxue He Xi Jin Biao Kan Haidong Kan Qun Li Tao Li Zhongjie Li Min Liu Qiyong Liu Jinxing Lu Huiming Luo Huilai Ma Jiaqi Ma Jun Ma Ron Moolenaar (USA) Daxin Ni Lance Rodewald (USA) RJ Simonds (USA) Ruitai Shao Yiming Shao Xiaoming Shi Yuelong Shu Xu Su Chengye Sun Dianjun Sun Hongqiang Sun Quanfu Sun Xin Sun Jinling Tang Kanglin Wan Huaqing Wang Linhong Wang Guizhen Wu Jing Wu Weiping Wu Xifeng Wu (USA) Zunyou Wu Fujie Xu (USA) Wenbo Xu Hong Yan Hongyan Yao Zundong Yin Hongjie Yu Shicheng Yu Xuejie Yu (USA) Jianzhong Zhan Liubo Zhang Rong Zhang Tiemei Zhang Wenhua Zhao Yanlin Zhao Zhijie Zheng (USA) Maigeng Zhou Xiaonong Zhou Baoping Zhu (USA) Advisory Board Director of the Advisory Board Xinhua Li Vice-Director of the Advisory Board Yu Wang Jianjun Liu Members of the Advisory Board Chen Fu Gauden Galea (Malta) Dongfeng Gu Qing Gu Yan Guo Ailan Li Jiafa Liu Peilong Liu Yuanli Liu (USA) Roberta Ness (USA) Guang Ning Minghui Ren Chen Wang Hua Wang Kean Wang Xiaoqi Wang Zijun Wang Fan Wu Xianping Wu Jingjing Xi Jianguo Xu Gonghuan Yang Tilahun Yilma (USA) Guang Zeng Xiaopeng Zeng Yonghui Zhang Editorial Office Directing Editor Feng Tan Managing Editors Lijie Zhang Qian Zhu Scientific Editors Ning Wang Ruotao Wang Editors Weihong Chen Yu Chen Peter Hao (USA) Xudong Li Jingxin Li Xi Xu Qing Yue Ying Zhang China CDC Weekly Preplanned Studies Burden of Acute Viral Hepatitis — China, 1990−2019 Shicheng Yu1,&; Qiqi Wang1,&; Shujun Wang1; Jiaojiao Zhang1; Yuehua Hu1; Junqi Li1; Xiaojuan Long1; Xianglong Xiang1; Maigeng Zhou2,#; Feng Tan3,# among hepatitis A, B, C, and E; percent changes of Summary YLDs in groups aged 50–69 years and 70 years or What is already known about this topic? more for acute hepatitis A, B, and E and in all age The World Health Organization’s (WHO) Global groups for acute hepatitis C were increased from 2000 Health Estimates (GHE) reported that acute hepatitis to 2019. Effective vaccines and prompt action on caused 9,213 deaths and 307,720 person years of interventions and treatments were major efforts to disability-adjusted life years (DALYs) in 2016, and tackle viral hepatitis to achieve the World Health acute hepatitis B accounted for 85.81% of all DALYs Organization’s (WHO) goal of reducing new hepatitis among acute hepatitis types A, B, C, and E in China. infections by 90% and deaths by 65% between 2016 What is added by this report? and 2030 (4). In China, the percent changes in years lived with Morbidity and mortality due to acute hepatitis disability (YLDs) due to acute hepatitis A, B, and E in resulting from the acute sequelae of hepatitis A virus groups aged 50–69 years and 70 years or more and in (HAV), hepatitis B virus (HBV), hepatitis C virus all age groups for acute hepatitis C were increased from (HCV), and hepatitis E virus (HEV) infections were 2000 to 2019. estimated by the GBD 2019. With respect to What are the implications for public health morbidity, anti-HAV IgG, hepatitis B surface antigen practices? (HBsAg), anti-HCV IgG, and anti-HEV IgG Effective vaccines, interventions, and treatments are key seroprevalence data were collected through published approaches to achieve the WHO’s goal of reducing new literature, grey literature, and surveys, and the meta- hepatitis infections by 90% and deaths by 65% regression tool (DisMod-MR) utilizing age group, between 2016 and 2030. gender, and year was used to estimate seroprevalence and instantaneous seroconversion rates due to acute About 1.4 million people died from viral hepatitis infections (5). The instantaneous seroconversion rate worldwide in 2016, and most deaths were due to was converted to the population incidence rate (the cirrhosis and hepatocellular carcinoma caused by number of infections per person in the total hepatitis B and C (1–2). In China, acute hepatitis population) using the formula: population incidence caused 9,213 deaths, the number of disability-adjusted rate = (instantaneous seroconversion rate) × (1 – life years (DALYs) was 307,720 person years, in which seroprevalence) (6). HBsAg seropositivity typically acute hepatitis B accounted for 85.81% of DALYs existed only in chronic carriers, and the association of among acute hepatitis types A, B, C, and E in 2016 incidence of HBV infections that resulted in chronic (3). However, the nationwide incidence and prevalence carrying was modelled to estimate the incidence from of acute hepatitis were not yet reported, and the latest HBsAg seroprevalence data (6). results were not reported. In this report, results were The prevalences of acute HAV, HBV, HCV, and obtained from the latest estimates of the Global HEV infections were calculated as the products of the Burden of Disease Study 2019 (GBD 2019); the population incidence rate and estimated durations of incidence, prevalence, deaths, and indicators of burden acute infections of HAV, HBV, HCV, and HEV, of acute hepatitis in 1990, 2000, and 2019 were used; which was four weeks for HAV and HEV, and six and the standardized rates were calculated using the weeks for HBV and HCV (6). Hereby, incidence 2010 National Census as the standard population. In meant the number of new acute infection cases of a 2019, acute hepatitis caused 3,726 deaths, 4,501,755 given hepatitis virus during a year period in a specified cases of acute hepatitis, and 214,165 person years of population; prevalence implied the proportion of the DALYs; hepatitis B accounted for 66.69% of DALYs number of cases of acute viral infections found in a Chinese Center for Disease Control and Prevention CCDC Weekly / Vol. 2 / No. 31 579 China CDC Weekly population. burden of acute hepatitis in 1990, 2000, and 2019 by To calculate mortality, the vital registration, verbal gender were obtained, and their standardized rates were autopsy, cancer registry, and mortality surveillance data calculated using the 2010 National Census as the were compiled, and the cause-of-death ensemble model standard population, expressed as number and rate (CODEm) was applied to estimate cause-specific (1/100,000), respectively. Percent change (%) was mortality by age group, gender, and year for acute calculated as the difference in quantities between 2019 HAV, HBV, HCV, and HEV infections (7). Virus and 2000 divided by the quantity in 2000. All specific mortality data for acute hepatitis were too statistical analyses were performed using SAS (version limited to direct use in the CODEm, so a two-step 9.4, SAS Institute Inc., Cary, USA). nested-model approach for acute hepatitis virus In Table 1, standardized rates of DALYs, YLLs, and infections was used to estimate cause-specific mortality. YLDs due to acute hepatitis declined when quantities First, the joint mortality from all acute hepatitis using in 2019 were compared to those in 2000, and YLLs cause-specific mortality data in the CODEm was had the largest percent decrease for males, females, and modelled; second, a separate natural history model for both genders combined, with the percent decrease for each hepatitis virus infection was developed, in which females being greater than that found in males. mortality was estimated as the product of incidence From Tables 2–5, percent changes in the number of and case fatality (6). person years and standardized rate of DALYs and YLLs YLDs were estimated as the product of an estimate in all age groups due to acute hepatitis were decreased of prevalence and a disability weight for health states of when quantities in 2019 were compared to those in each mutually exclusive sequela; years of life lost 2000. Further comparisons for 2019 and 2000 showed (YLLs) were expressed as the product of mortality that for acute hepatitis A (Table 2), percent changes in estimates and years of life lost due to premature death; the number of person years and rate of YLDs were and DALYs were calculated as the sum of YLLs and increased in groups aged 50–69 years and 70 years or YLDs. more; for hepatitis B (Table 3), percent changes in the Incidence, prevalence, deaths, and indicators of number of person years of YLDs were increased in TABLE 1. Overall incidence, prevalence, deaths, and burden indicators of acute hepatitis for the years 1990, 2000, and 2019 in China. Incidence Prevalence Deaths DALYs YLLs YLDs Gender Year N P′ N P′ N P′ N P′ N P′ N P′ Male 1990 38,603,733 5,455.48 3,788,134 555.26 16,651 3.51 887,637 149.59 825,936 139.38 61,700 10.21 2000 37,113,965 5,159.80 3,701,779 523.55 9,191 1.68 456,024 73.17 388,333 63.23 67,691 9.93 2019 27,402,638 3,880.05 2,690,260 379.58 2,661 0.33 143,697 19.11 86,490 11.00 57,207 8.11 2019 vs.