Hepatitis B, liver cancer… France is swimming against the tide

[21 April 2009 - 10h00]
[mis à jour le 1 March 2010 à 14h59]

“In France a generation of children are being sacrificed – those born in the last 10 years who have not been vaccinated against hepatitis B. In countries where vaccination is efficient, the number of cases of hepatitis B and hepatic carcinoma (primary liver cancer – editor’s note) is decreasing but we must expect them to increase in France…”.

Claire-Anne Siegrist, who holds the Chair in Vaccinology at the University of Geneva heads up the Swiss Federal Vaccinations Committee. This internationally respected specialist is also the only foreigner on the committee advising the British government on these matters… And during this current European Vaccination Week her opinion takes on a special resonance.

“The day when France decided to stop vaccinating in schools, we were launching our school vaccination programmes”, she points out. “Since then we have witnessed a veritable collapse in the number of acute cases of hepatitis B in Switzerland. In the cantons where 60% of adolescents are vaccinated, hepatitis B has fallen by 90% and where only 40% of children are protected, the drop has still been as much as 60%. It makes sense: adolescents engage in sexual relations. By protecting one adolescent, we are also protecting their partners… ”.

The reverse is also true! At the end of 1998, when Bernard Kouchner decided against systematic vaccination of adolescents he was vigorously criticised by the WHO. Pointing out that “more than a billion doses (of vaccine) had been used since 1981 with an exceptional level of safety and effectiveness”, the WHO denounced the “enormous pressure exercised (in France) by groups hostile to vaccinations”.

”An disease that is anything but rare”

This decision came as a surprise because the ministry of health at that time had been stressing the safety of the vaccine but decided not to use it any longer with one of the groups of people most at risk. Yet the events mentioned in France were mentioned in France only. In 2002, the WHO reaffirmed the validity of vaccination. In 2003, an international consensus from INSERM (French Institute of Health and Medical Research) based on a new pharmacovigilance assessment, recommended “the universal vaccination of all infants, a catch-up programme (…) aimed at children and adolescents, improving vaccination of people at risk and monitoring (…) via information measures directed at the general public and healthcare professionals”. This position was reiterated in April 2008 by the French Council for Public Health.

Claire-Anne Siegrist was part of this consensus. “Nothing could have been clearer. Yet we are still waiting for it to take effect. In reality, the responses made by the health and political authorities (in France) have been relatively weak, lacking in commitment… (Yet) even in a country (like France – editor’s note) where endemic disease is low, the hepatitis B virus (HBV) is more common than the AIDS (HIV) virus. Therefore there is a greater risk of being exposed to it than to HIV”. And yet, “the hepatitis B virus is 50 to 100 times more infectious than HIV”, the WHO points out.

And this is the challenge. In countries with low endemic disease, 0.5% of the population will carry HB antigens, reflecting contamination with hepatitis B. In France however, “an InVS report published in 2004 highlights the fact that 0.78% are carriers”, our specialist points out. This means that there are 300,000 chronic carriers in France. And as “INSERM believes that each year hepatitis B causes 1,500 deaths in mainland France, (…) we are in the presence of a disease that is anything but rare”.

The hepatitis B virus is the reason behind one liver transplant in every ten in France. In Taiwan, a vaccinating country, deaths from hepatocarcinoma among the under 15s was reduced by more than half between 1984 and 1990. But as things stand at present, observers expect that the new “plan of attack” launched in France in February will essentially be little more effective than an announcement.

Source : Interview with Dr Claire-Anne Siegrist, 25 March 2009; WHO, 1998-2008; InVS, 2004

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