COMMENT:

There's lots of evidence the vaccine will prevent some fraction of
hepatocellular carcinoma (HCC), though it's indirect evidence, since
the virus takes 30-40 years or more to do this, and so the study would
need to be a run a very long one. Very occasionally one sees in
children, and the rates of this have declined a great deal in countries
like Taiwan where vaccination was instituted first.

If you know anything about hepadnaviruses in animals and how they are
connected with liver cancer, you'll have little doubt that the
epidemiology in humans vis a vis our own particular hepadnavirus (hep
B) is real.

In any case, the vaccine is of very very little risk (as seen in
controlled studies in China), and there are many many reasons other
than cancer to give it. Such as prevention of acute and chronic
hepatitis B :).  Duh.

COMMENT:
They weren't done at the same time, you ninny. Please look at your
facts. While hep B was being made from human blood it was WAY to
expensive to be shipping to Africa, I assure you.

COMMENT:

Yeah, you missed it. There was nothing to miss. The two cases didn't
involve the same vaccine.

I personally, BTW, wouldn't give a patient any standard preventive
thing I wasn't willing to take myself. I've had every vaccine you can
name, and some you've never heard of.

COMMENT:

Thimerosol's a political problem. Epidemiologically it's a no-show.

COMMENT:

Robert Kennedy's a no-show, too. Sucked into one of the stupider
liberal causes, when the world is full of very genuine problems that
need fixing. Such as how to vaccine the third world cheaply. Here we
have one child die of preventable measles EVERY MINUTE OF EVERY DAY in
Africa, and this moron JFK,Jr is worried that we might be giving them
**autism**? Of the 1.8 million vaccine preventable deaths in the third
world, HALF are measles. Screw the thimerosal. Those kids need MMR and
they need it *yesterday.* And RFK,Jr seems something to keep him busy,
like organized crime.

Say, if he could just get a brother elected president, maybe he could
get to be attorney general....   Meanwhile he's a pretty pathetic
characature of his relatives.

This is where liberalism really bugs me. Liberals are the poison
paranoia people. Somebody finds some kind of politically correct
"poison" like thimerosal, and regardless of the evidence for, or
against, liberals will try to hamstring a program that will save 3/4
million kids a year, to keep it from being used. Unintended
consequences.  They don't care. If the solution doesn't fit their
utopian vision, they'd rather *prevent* a reasonable version of it used
at all.

Disgusting!

SBH

1: Baillieres Best Pract Res Clin Gastroenterol. 1999 Dec;13(4):511-7.

Prospects for hepatitis B virus eradication and control of
hepatocellular
carcinoma.

Chang MH, Chen DS.

Department of Pediatrics and Internal Medicine, College of Medicine,
National
Taiwan University, Taipei.

Hepatitis B virus infection is the most common cause of chronic
hepatitis, liver
cirrhosis and hepatocellular carcinoma worldwide. In areas hyperendemic
for HBV
infection, the related complications occur mostly during adulthood.
However,
nearly half of all primary infection in chronic carriers occurs in the
perinatal
period through maternal transmission, the other half arising from
horizontal
transmission mainly through intrafamilial spread or injection using
unsterilized
needles. A universal vaccination programme is better than immunization
for
at-risk groups. Hepatitis B vaccination should be integrated into the
Expanded
Programme on Immunization in children. Universal immunization against
hepatitis
B virus has proved to be effective in reducing the hepatitis B carrier
rate to
one-tenth of the prevalence before the vaccination programme in highly
endemic
areas, and the incidence of hepatocellular carcinoma in children has
also been
shown to be significantly reduced. Continued efforts to implement
universal
vaccination programmes worldwide will very likely reduce the incidence
of
hepatitis B virus-related diseases, particularly liver cirrhosis and
hepatocellular carcinoma.

Publication Types:
   Review
   Review, Tutorial

PMID: 10654916 [PubMed - indexed for MEDLINE]

2: JAMA. 2000 Dec 20;284(23):3040-2.

Hepatitis B vaccination and hepatocellular carcinoma rates in boys and
girls.

Chang MH, Shau WY, Chen CJ, Wu TC, Kong MS, Liang DC, Hsu HM, Chen HL,
Hsu HY,
Chen DS; Taiwan Childhood Hepatoma Study Group.

Department of Pediatrics, National Taiwan University Hospital, No. 7,
Chung-Shan
S. Road, Taipei, Taiwan, Republic of China. mhchang@ha.mc.ntu.edu.tw

CONTEXT: Hepatocellular carcinoma (HCC) has a male predominance and is
closely
related to hepatitis B virus (HBV) infection. Hepatitis B virus
vaccination was
launched in 1984 in Taiwan for neonates of mothers carrying hepatitis B
e
antigen, resulting in a decreased incidence of HCC in children. The
effect on
boys vs girls is not known. OBJECTIVE: To evaluate the association
between a HBV
vaccination program with incidence of childhood HCC by sex. DESIGN AND
SETTING:
Analysis of data collected from Taiwan's National Cancer Registry
System and the
Taiwan Childhood Hepatoma Study Group between 1981 and 1996.
PARTICIPANTS:
Children aged 6 to 14 years who were diagnosed as having HCC (201 boys
and 70
girls). MAIN OUTCOME MEASURE: Incidence of HCC in boys and girls before
and
after implementation of the vaccination program. RESULTS: The boy-girl
incidence
ratio decreased steadily from 4.5 in 1981-1984 (before the program's
introduction) to 1.9 in 1990-1996 (6-12 years after the vaccination
program was
launched). The incidence of HCC in boys born after 1984 was
significantly
reduced in comparison with those born before 1978 (relative risk [RR],
0.72; P
=.002). No significant decrease in HCC incidence was observed in girls
born in
the same periods (RR, 0.77; P =.20). The incidence of HCC in boys
remained
stable with increasing age, while an increase of HCC incidence with age
in girls
was observed. These age and sex effects remained the same regardless of
birth
before or after the vaccination program. CONCLUSION: Our results
suggest that
boys may benefit more from HBV vaccination than girls in the prevention
of HCC.

PMID: 11122592 [PubMed - indexed for MEDLINE]

3: Cancer J. 2004 Mar-Apr;10(2):67-73.

Hepatocellular carcinoma: paradigm of preventive oncology.

O'Brien TR, Kirk G, Zhang M.

Viral Epidemiology Branch, Division of Cancer Epidemiology and
Genetics,
National Cancer Institute, National Institutes of Health, Department of
Health
and Human Services, Rockville, Maryland 20852, USA.
obrient@exchange.nih.gov

Morbidity and mortality from hepatocellular carcinoma (HCC), which is
primarily
caused by hepatitis B virus or hepatitis C virus, can be prevented.
Public
health interventions have eliminated transfusion transmission of these
viruses
and, in endemic countries with effective hepatitis B virus vaccination
programs,
have greatly reduced incident hepatitis B virus infections (and HCC) in
children. Antiviral treatment can eliminate detectable hepatitis C
virus in
50%-80% of chronically infected patients, presumably reducing their
risk of
cancer. HCC survival rates remain universally poor, but early detection
and
treatment in developed countries has improved survival in selected
patients.
Despite these advances, worldwide HCC rates remain high, and additional
preventive efforts are needed. The most important opportunity is wider
distribution of hepatitis B virus vaccine in endemic areas. Development
of an
HCV vaccine, improved antiviral therapies, and better methods for HCC
detection
would also help decrease morbidity and mortality from HCC. HCC
prevention
efforts provide a paradigm for preventive oncology in cancers of viral
etiology.

Publication Types:
   Review
   Review, Tutorial

PMID: 15130266 [PubMed - indexed for MEDLINE]

4: Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1998
Nov-Dec;39(6):366-70.

Hepatocellular carcinoma in children.

Chang MH.

Department of Pediatrics, National Taiwan University Hospital, Taipei,
Taiwan.
mhchang@ha.mc.ntu.edu.tw

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies
in
humans. Although it occurs mainly in adults of 40 to 60 years of age,
it may
develop in children. It mainly occurs in children older than six years
of age,
with male predominance. Children with chronic hepatitis B virus (HBV)
infection
and underlying metabolic diseases are the two main high risk groups for
childhood HCC. HBV infection is the main cause of childhood HCC in
areas
hyperendemic for HBV infection. In Taiwan, nearly 100% of HCC children
were
hepatitis B surface antigen seropositive. Maternal transmission (94%)
is the
most important route of transmission of HBV infection in HCC children.
For HBV
related HCC in children, immunization is the most effective way for the
control
of childhood HCC. The first universal vaccination against HBV in the
world was
launched in Taiwan in July 1984. The prevalence of hepatitis B surface
antigenemia in children declined from 10% in 1984, prior to the
vaccination
program, to < 1% in 1994, 10 years after the implementation of the
program, in
children less than 9 years of age. The annual incidence of HCC in
children aged
6 to 9 years of age also decreased from 0.52 per 100,000 born in
1974-1984 to
0.13 per 100,000 born in 1984-1986.

Publication Types:
   Review
   Review, Tutorial

PMID: 9926508 [PubMed - indexed for MEDLINE]

5: N Engl J Med. 1997 Jun 26;336(26):1855-9.

Comment in:
   N Engl J Med. 1997 Jun 26;336(26):1906-7.

Universal hepatitis B vaccination in Taiwan and the incidence of
hepatocellular
carcinoma in children. Taiwan Childhood Hepatoma Study Group.

Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, Liang DC, Shau WY,
Chen DS.

Department of Pediatrics, National Taiwan University Hospital, Taipei.

BACKGROUND: A nationwide hepatitis B vaccination program was
implemented in
Taiwan in July 1984. To assess the effect of the program on the
development of
hepatocellular carcinoma, we studied the incidence of this cancer in
children in
Taiwan from 1981 to 1994. METHODS: We collected data on liver cancer in
children
from Taiwan's National Cancer Registry, which receives reports from
each of the
country's 142 hospitals with more than 50 beds. Data on childhood liver
cancer
were also obtained from Taiwan's 17 major medical centers. To prevent
the
inclusion of cases of hepatoblastoma, the primary analysis was confined
to liver
cancers in children six years of age or older. Data were also obtained
on
mortality from liver cancer among children. RESULTS: The average annual
incidence of hepatocellular carcinoma in children 6 to 14 years of age
declined
from 0.70 per 100,000 children between 1981 and 1986 to 0.57 between
1986 and
1990, and to 0.36 between 1990 and 1994 (P<0.01). The corresponding
rates of
mortality from hepatocellular carcinoma also decreased. The incidence
of
hepatocellular carcinoma in children 6 to 9 years of age declined from
0.52 for
those born between 1974 and 1984 to 0.13 for those born between 1984
and 1986
(P<0.001). CONCLUSIONS: Since the institution of Taiwan's program of
universal
hepatitis B vaccination, the incidence of hepatocellular carcinoma in
children
has declined.

PMID: 9197213 [PubMed - indexed for MEDLINE]

6: Semin Oncol. 2001 Oct;28(5):441-9.

The epidemiology and prevention of hepatocellular carcinoma.

Monto A, Wright TL.

GI Research, San Francisco Veterans Affairs Medical Center, San
Francisco, CA
94121, USA.

Hepatocellular carcinoma (HCC) is a common cancer. Its incidence is
higher in
countries where hepatitis B is endemic. HCC is substantially a
complication of
liver cirrhosis. Hepatitis B virus (HBV) and hepatitis C virus (HCV)
are the
predominant causes of cirrhosis, and as such, HCC. The link between HCC
and
alcoholic cirrhosis is less strong. Other less common forms of chronic
liver
disease can also lead to HCC. HBV is the HCC-determining disease
worldwide. In
endemic regions, it tends to be acquired early in life. The largest
strides in
prevention of HCC have been made with the HBV vaccine. HCV has a lower
global
prevalence than HBV, but HCV causes the most HCC in economically
developed
regions. In these areas, where the incidence of HCC is low, HCV now
accounts for
more than 50% of HCCs. There is no vaccine for HCV, so prevention of
HCV-associated HCC will focus on prevention of initial infection and
elimination
of infection through antiviral therapies. HBV-HCV coinfection, and the
combination of either with alcohol abuse or aflatoxin exposure seems to
raise
the risk of HCC development further. Liver transplantation and other
adjuvant
therapies may offer better options for secondary prevention of HCC than
resection alone. Copyright 2001 by W.B. Saunders Company.

Publication Types:
   Review
   Review, Tutorial

PMID: 11685737 [PubMed - indexed for MEDLINE]

7: Cancer Detect Prev. 1991;15(4):313-8.

Design and compliance of HBV vaccination trial on newborns to prevent
hepatocellular carcinoma and 5-year results of its pilot study.

Sun Z, Zhu Y, Stjernsward J, Hilleman M, Collins R, Zhen Y, Hsia CC, Lu
J, Huang
F, Ni Z, et al.

Cancer Institute, Chinese Academy of Medical Science, Beijing, PRC.

A large-scale, controlled study of universal immunization of newborns
against
HBV infection has been conducted in the high incidence area of
hepatocellular
carcinoma, Qidong County of China. This area has a stable population,
standardized cancer registration system, and an epidemiological base
for
measurements of liver cancer prevention by vaccine. Randomization was
done on
the community level. The vaccination and the control group each will
consist of
38,000 children by the end of 1990. It is anticipated that the design
will
provide high statistical power to detect 50% reduction in the
prevalence rate of
chronic hepatitis among the vaccinees vs. the controls at 6 to 10 years
of age,
and 50% reduction in the incidence rate of hepatocellular carcinoma at
35 to 40
years of age. The vaccine used is Hep-B Vax, donated by Merck and Co.
through
WHO. The vaccine was administered at 0, 1, and 6 months after birth,
the dosage
of 5 or 2.5 micrograms in the pilot study as used before 1985 and of 5
micrograms dose level during the main study starting from January 1,
1985. About
85% of the cohorts have now entered the protocol. The vaccination
coverage
during 1984 to 1989 was 98.0% (35,064/35,789). Follow-up of the
vaccinees and
the age-matched controls at 5 years has exceeded 97%. The cumulative
mortality
in the vaccinated group up to 1988 was 1.29% (354/27,450). No single
death nor
serious adverse reaction was found that was associated with
vaccination. The use
of HBV vaccine at a reduced dose was especially important for the
developing
countries at the present time in order to achieve widespread
immunization.
Five-year results of the pilot study of this vaccination project showed
that
significant protection against HBV infection was achieved with the 5 or
2.5
micrograms per dose regimen plus a booster of 5 micrograms given at 3.5
to 4
years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication Types:
   Clinical Trial
   Randomized Controlled Trial

PMID: 1665400 [PubMed - indexed for MEDLINE]