National strategy for elimination of liver diseases in Taiwan.

Abstract

Chronic liver diseases (CLD) including cirrhosis and hepatocellular carcinoma (HCC) have been major causes of death in Taiwan for at least six decades in Taiwan. Based on the long-term follow-up studies of GECC and REVEAL cohorts, chronic infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) have been well-documented as major causes of end-stage liver diseases in Taiwan. The nation-wide HBV immunization program was implemented in 1984, and the chronic viral hepatitis treatment program was launched in 2003 in Taiwan. Based on the age-period-cohort analysis of liver disease mortality in Taiwan, there was a significant reduction in the mortality from CLD (82 %) and HCC (63 %) for the immunized birth cohorts compared with unimmunized birth cohorts, showing the high effectiveness of HBV immunization program. There was also a significant reduction in the mortality from CLD (26 %) and HCC (50 %) from 2004 to 2018, showing the significant effectiveness of anti-viral treatment program. Taiwan started a national HCV elimination program in 2017 to reach 2030 targets proposed by World Health Organization (WHO) by 2025. Through the nation-wide screening of high-risk and general population, stringent follow-up of care cascade, and continuous monitoring, the WHO programmatic targets will be achieved in 2025.