Patients ignore primary care clinics | Decline in Hepatitis A | Online ratings platform launched for hospitals

The government's newly created network of primary care clinics are struggling for recognition in China, according to a new survey carried out in Chengdu. More than 60% of people surveyed had not heard of the primary care clinics and didn't know where they were located, according to local media. Most people surveyed also said they would still prefer to go direct to hospital for treatment rather than go to a local community clinic, the survey showed.

China has seen huge reductions in hepatitis A over the last two decades, with rates of infection falling from 94% to 42%, a study carried out in Hebei has shown. Rising living standards, better hygiene and widespread childhood immunisation have contributed to the drop in hepatitis rates, and also resulted in most infections being delayed until adolescence rather than infancy, according to researchers from Shijiazhuang. However, the lower infection rates mean that many people now have little immunity to the disease and will benefit from immunisation, the researchers say.

A Tripadvisor-like mobile online platform has been developed that allows patients to rate their experience with hospitals and health providers in China. The Care Voice (Kangyu in Chinese) is a Shanghai-based  social platform that enables consumers to share reviews on hospital services, physicians and treatments and connect with other patients and professionals.

The two H's that cause the most common cancers in China

Pre-cancerous cirrhotic liver

by Michael Woodhead
In western countries we are quite rightly focused on the high profile cancers and how to prevent them. Lung cancer is now in decline due to the very successful campaigns to stop smoking. Likewise in sunny Australia we are starting to see declines in skin cancer thanks to the campaigns that encourage people to cover-up and avoid carcinogenic UV rays. Other common cancers that are the focus of public attention are of course breast cancer, prostate cancer and to a lesser extent cervical and bowel cancer. All of these are the focus of major screening activities - some with official blessing, others (hello prostate cancer) despite a lack of evidence that they reduce cancer deaths.
In China it's a very different story. As you'd expect given the high rates of smoking, lung cancer is the most common malignancy seen in the country, but the other common cancers are those of the liver and digestive tract - hepatic cancer, gastric cancer and oesophageal cancer, in that order. A new review finds that the incidence of these cancers has increased dramatically since the 1980s. Perhaps because Chinese people now live longer or have better access to diagnostic services, but the gastric and liver cancers are now more common than ever. And the causes? It's the "H''s  - hepatitis and H. pylori. The high rates of hepatitis B in China are the reason for the country's huge rates of liver cancer. China has some of the highest rates of hepatitis B in the world (almost one in ten people have been infected) and new infections are still a major problem. The good news is that most children are now being immunised against hepatitis B, and the government believes that there will be far fewer hepatitis cases by 2050, when the current generation of immunised kids are adults.
Gastric cancer is the third most common cancer in China, and much of this may attributable to diet and chronic infection with the carcinogenic H. pylori pathogen. It has been estimated that the number of people in China infected with H. pylori infection rate is still above 50%, and as high as 80% in rural areas. Some hospitals are now implementing a 'test and treat' H. pylori screening approach and providing antibiotic-based eradication therapy to those found to be positive. There have also been some attempts to screen patients with endcoscopy - but is going to be a resource-intensive and logistically impossible approach to adopt nationally. Oesophageal cancer is another common cancer in China. To try prevent more cases, the government is focusing on diet in rural areas, and urging pubic health services to improve nutritional campaigns and avoid agents such as nitrosamines and harmful water contamination.
For the time being, however, China will continue to have high rates of liver and gastric cancers. Eradicating hepatitis and H. pylori will help in the long run, but Chinese people should be aware of the cancers that currently pose the greatest risk to themselves and their families.
[Based on an article by Dr Wang Rui and colleagaes at the Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, published in Clinics and Research in Hepatology and Gastroenterology)

Daily Mail fake miscarriage | 120 seconds per patient | Dogs a hepatitis risk | Atrial fibrillation untreated

The Daily Mail has been running a fake story claiming that a pregnant Changsha nurse had 'lost her baby' after being attacked by relatives of a cancer patient who died. Chinese media reported the attack but said she was fortunate to have avoided a miscarriage.

A doctor at a Guangzhou hospital could only spend an average of one and a half minutes per patient when he was the only clinician on duty and had a waiting room of 100 patients to see in one morning.

About 20% of dogs and 6% of cats in Guangzhou are infected with hepatitis E, a new study has shown. The high rates of hepatitis infection should raise concern about the eating of dogs, warn researchers from the South China Agricultural University.

China should not copy the US private model of healthcare according to Nobel prize winning economist Daniel McFadden, of the University of Southern California. Professor McFadden said that when looking at healthcare systems around the world, the most efficient are those where the community medical providers are either employed by the government or employed by companies that are largely contracting to the government and not operating as private businesses.

Hospital staff in the Muslim Xinjiang province have been told not to fast during Ramadan. The request was made at a meeting on upholding ethnic minority unity, “in order not to affect normal work and life." Muslim hospital staff members were requested to sign their pledge of compliance in a “responsibility book.”

One in ten emergency department patients leave without being seen by a doctor, according to a study carried out in Chengdu hospitals. Those who left tended to be families who arrived on foot with children who had less serious problems.

Most Chinese people with atrial fibrillation go untreated, with only 40% receiving anticoagulants, according to a study from Fuwai Hospital and Peking Union Medical College, Beijing.The study also showed that only 26% of people treated for  atrial fibrillation received adequate treatment.

Reform of the medical school curriculum is needed in China as many medical schools are still using outdated and ineffective teaching methods that fail to keep pace with developments in medicine, according to a study from Tongji University, Shanghai.

Iron deficiency anaemia is common in rural parts of central China, where only about 40% of infants have an adequate diet, a study by the UNICEF Office for China, Beijing, shows. Malnutrition and anaemia was more of a risk for ethnic minorities and for those living in poor mountainous areas.

Six of the top medical news stories from China

1. China has a huge shortage of midwives, and would need a further 800,000 to meet the WHO standard of one for every thousand women of child-bearing age, according to a new report. Health officials say the problem will worsen as China adopts a two child policy.

2. Efforts to control pneumococcal disease and Haemophilus influenzae type b (Hib) in children by vaccination are failing due to low immunisation rates and delayed immunisation, a study from Shanghai shows. A review of vaccination records for 28,000 children up to the age of seven found that 51% had one dose of Hib vaccine and 11.4% had one dose of pneumococcal vaccine. Only 8.2% of children had Hib vaccine at the right time and only 0.5% had timely pneumococcal vaccine. Rates were particularly poor for migrant children, the study found.

3. Rates of hypertension have increased in China and yet treatment and control of the condition remain poor, according to researchers from Shandong. In a study of more than 4000 people they found that the incidence of hypertension increased from 2.9 per 100,000 people in 1991–1997 to 5.3 in 2004–2009 Antihypertensive treatment and control rates for hypertension were 5.7% and 1.7% in 1991–1997 and 19.9% and 7.6% in 2004–2009, respectively.

4. The rate of disabilities from road crashes in China has skyrocketed as the number of cars on the road has increased over the last two decades. The incidence rate for road traffic disabilities increased over time from 1.50 per 100,000 people in 1980 to 11.2 per 100 000 persons in 2005, according to Professor Zheng Xiaoying of the Institute of Population Research, Peking University.

5. Malaria is still a major problem in central China especially during floods and rainy periods of the summer. A study from Mengcheng County, Anhui found that there were 3683 malaria were notified during the study period of May to October 2007 Most of the cases occurred a week to a month after flooding and waterlogging. Public health action should be taken to control the potential risk of malaria epidemics after wet weather, the researchers from Shandong University said.

6. The recent outbreaks of H7N9 avian influenza also resulted in many mild and asymptomatic infections as well as severe life threatening cases, researchers from Guangdong have reported. Their surveillance program noted 21 cases of infection in Guangzhou, China in 2013 and 2014, of which several were mild or asymptomatic infection. Family clusters occurred, suggesting limited person-to-person transmission of the H7N9 virus, they said.

New non-interferon antivirals will not eliminate hepatitis C overnight, say Chinese experts

by Michael Woodhead
New antiviral drugs offer the chance to eliminate hepatitis C from China, but over-optimistic predictions need a reality check, says a leading Chinese virologist.
In an article in Gastroenterology, Dr Lai Wei of the Peking University People’s Hospital and the Beijing Key Laboratory for Hepatitis C and Liver Disease Immunotherapy says there has been a lot of hype about new pipeline drugs bringing about a "hepatitis C revolution". It is claimed that a whole new range of drugs soon to be released will be able to treat the intractable blood-borne viral disease much more effectively and quickly than current treatments - and most importantly without the debilitating side effects of current drug regimens based on interferon. It is said that drugs such as simeprevir and sofosbuvir will be able to cure hepatitis C infection in 95% of people after a single 12-week course of treatment. If this is true then these drugs could potentially have a major impact in China, which has one of the highest rates of hepatitis C in the world.
It is estimated at least 2% of the Chinese population - about 30 million people - have chronic hepatitis C infection. The disease burden for China in terms of hepatitis C-related cirrhosis, liver failure and liver cancer is huge.
Hepatitis C is a chronic disease, and many of those with the infection remain undiagnosed and untreated until it progresses and the severe consequences such as cirrhosis and liver cancer become apparent. In China fewer than 3% of people with the infection are diagnosed, and only half of those diagnosed get any treatment. And the treatment itself is not very effective or tolerable. The best available agents are peg-interferon and ribavarin, which can produce a 'sustained viral response' in about 70% of patients with a 24-week course - but only in people with certain types of HCV (genotypes 2 or 3). Treatment success rates are much lower for people who have HCY type 1, even with much longer treatment courses. The side effects of treatment resemble a very bad case of flu, and many patients simply cannot or will not tolerate these effects and stop treatment.
The appeal of the new anti-hepatitis C drugs is therefore obvious. They are more effective and bettwr tolerated. Within five years it is theoretically possible for all types of hepatitis C to be cured with a single course of treatment lasting as little as eight weeks.
The reality for China, however, is not so simple. There are three major barriers to eliminating hepatitis C from China.

1. First and foremost is the problem of identifying the 97% of people in China who have hepatitis C infection but are not diagnosed. This will require some kind of screening program - and this may be very expensive unless there is an accurate and affordable test available. Identification of hepatitis C also requires the public to be aware of the disease and that it can be treated.

2.If patients with hepatitis C are identified they then need to be able and willing to access treatment. Many people with hepatitis C live in rural areas. Even in cities, China does not have a sufficiently large medical workforce with the skills to accurately diagnose hepatitis C and provide appropriate tailored treatment and follow up. A major medical workforce expansion and education program would be needed.

3. The new hepatitis C treatments are not affordable for a developing country like China . The costs of the new anti-hepatitis treatments are enormous. In the US a single course of sofosbuvir costs $84,000. Some countries such as India and Egypt have planned low cost programs for antiviral drugs for hepatitis C. But even if low cost versions of these new drugs are produced generically, the costs of treating 30 million people will still be huge. There is also a question of whether the new drug treatments can be used in sub-groups of patients with hepatitis C such as those with co-morbidities, cirrhosis the elderly and most importantly, in children

In summary, China has potentially much to gain from the new era of hepatitis C treatment - but huge practical problems lay ahead in identifying people with the infection and getting them into treatment.

About 50% of pig farmers in Guangdong have hepatitis E

Hepatitis E is endemic in the pig herds of Guangdong, and this is reflected in high rates of the infection among swine herders, a study shows. About 50% of pig farmers in Guangdong show serological evidence of hepatitis E infection, and 38% of the general population have been infected by the disease spread by the faecal route, according to findings published in PLOS One. The epidemiological study of Guangdong people bwas carried out by Dr Liang Huanbin and colleagues at the Ministry of Agriculture Key Laboratory of Animal Vaccine Development, College of Veterinary Medicine, South China Agricultural University, Guangzhou. It found that Hepatitis E infection rates were higher than in surrounding provinces such as Hunan (22%). The study also found that 60-90% of pig herds had the infection, which raised questions about the health risks of pork, the researchers said.

China medical news for Sunday 2 February

Cosmetic procedures a high risk for hepatitis C
Chinese people are more likely to contract hepatitis C from a cosmetic and beauty treatments than from medical procedures or blood transfusion, a study from Jilin shows.
Researchers found that hepatitis C rates had increased rapidly in Yanbian, Jilin, more than doubling from  2007 to 2011. Unexpectedly, they found that cosmetic treatments conferred the higest risk - almost five fold higher than control groups. Having someone esle in the family with HCV was also a high risk for infection, presumably through sexual transmission between spouses, the researchers said. Writing in PLOS One, the researchers for the Capital Medical University, Beijing, said cosmetic treatments had become popular in recent years and there was a risk of viral infection with procedures that broke the skin such as shaving and ear piercing.

Atherosclerosis defined in stroke
Intracranial atherosclerosis (ICAS) is the most common vascular lesion in patients with cerebrovascular disease in China, a study  has shown. Researchers at the Tiantan Hospital in Beijing assessed 2864 consecutive patients who experienced an acute cerebral ischemia and found the prevalence of ICAS was 47%. Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis. According to the study in Stroke, after 12 months, recurrent stroke occurred in 3.3% of patients with no stenosis, in 3.8% for those with 50% to 69% stenosis, in 5.2% for those with 70% to 99% stenosis, and in 7.3% for those with total occlusion.

STI risk high for men who visit prostitutes
Men who have unprotected sex with prostitutes are at high risk of HIV and syphilis, Guangxi research has shown. A study of more than 100 men who visited prostitutes found a high rate of unprotected sex (84%). The overall prevalence of HIV, hepatitis C and syphilis was 1.9%, 1.0% and 18.4%, respectively, according to the study published in Sexually Transmitted Infections.

Parasite problems on the Tibetan plateau
Worm parasites are an endemic problem for Tibetans, especially nomadic herders, a study has found.
Echinococcosis affects more than 380,000 people on the Tibet-Qinghai plateua, is spread by dogs and cattle, and is often picked up from drinking groundwater, according to a study by Chinese researchers. Those most at risk include the old and female in particular. Writing in Infectious Diseases of Poverty, the researchers said control of the parasites should focus on deworming both owned and stray dogs and health education activities n Tibetan language.

China medical news for Thursday 30 January

Blood lead levels still hazardous for Chinese children
Blood lead levels for children have decreased in recent years but are still at unhealthy levels, a study carried out in 11 cities has found. The blood sampling survey of 12 000 children under six years of age found that average blood lead levels dropped by 16% (from 46μg/L in 2004 to 39μg/L in 2010). The prevalence of elevated blood lead levels dropped by 87% (from 9.8% in 2004 to 1.3% in 2010). Factors associated with high blood levels included eating popcorn, chewing fingernails, sucking fingers, being cared for at home or at a boarding nursery, the study in the World Journal of Pediatrics found.

Rise in China's caesarean rates 'alarming'
The overuse of cesareans is rising alarmingly in China and has become a real public health problem, a review by researchers in Beijing has concluded. The current national caesarean rate is near 40%, and there has been a rapid rise of cesarean sections in recent years, say researchers from the School of Public Health at Peking University. Nonclinical factors such as financial incentives for hospitals were considered as the main drivers fueling the rise of cesareans. However the change in health services to focus on specialised care and marginalizing primary care have also played a role, they say in the International Journal of Women's Health.  

Dengue fever changes in Guangdong
The pattern of dengue fever outbreaks in Guangdong is changing, infectious disease specialists have found. The disease appears to be becoming endemic although outbreaks are caused by the milder types of dengue, researchers report. The prevalance varies between 2-5% and serotypes are now more varied, according to the study in PLOS One.

Puberty arrives earlier for Chinese girls
The age of onset of puberty is now at least a year earlier for Chinese girls compared to those of 1984, a study from the Capital Institute of Pediatrics, Beijing, has found. The research in the World Journal of Pediatrics found that the age of onset of puberty for urban girls had decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.

Fish pedicures a hepatitis risk
Aqua pedicures where tiny fish nibble away at dead skin on bathers feet may spread blood diseases such as HIV and hepatitis B, a Ningbo newspaper says. Dr Wang Jiahua, a dermatologist at a local hospital, said there were risks of infection, citing a patient whose legs became hot and swollen days after his first fish pedicure.He suggested a one month interval between fish pedicures and antibiotic ointment to protect skin where wounds are found.

China's medical news headlines for Sunday 19 January

Hepatitis B vaccine given the all clear

The Shenzhen Bio Kangtai hepatitis B vaccine that was linked to the deaths of 17 infants has now been given the all clear by the Chinese state drug authorities. After an investigation the China Food and Drug Administration and the National Health and Family Planning Commission said the vaccine could be used again as no problems have been found with the hepatitis B vaccine. Authorities tested more than 1300 vaccine samples from six batches that were under suspicion. According to the People's Daily, the CFDA said all samples met the quality standards. The NHFPC said the 17 infant deaths were due to other problems, including severe pneumonia, kidney failure and suffocation.

In Guizhou, retired doctors asked to work in rural clinics

Retired medical specialists in Guizhou are being urged to lend their expertise to rural area clinics, according to China Daily. Professor Sun Fa of Guiyang Medical University told a meeting of the Chinese People's Political Consultative Committee that there were about 600 retired doctors from the province's five top hospitals of whom half were healthy enough to work in rural clinics.
He said they could help the more than 40,000 medical staff in township clinics, many of whom have only medical qualifications from secondary colleges or no degree at all.

Guangdong plans for baby boom

The new two-child family planning policy will not pose a big challenge to public services such as medical care, a top health and family planning official from Guangdong province has said.
Zhang Feng, the former director of the Guangdong population and family planning commission, said 1.1 million to 1.2 million babies are  born in the province each year. and the new policy will see about 130,000 more babies each year. "The baby boom will bring little social impact," he said at the province's annual legislative meeting.

China's smoking ban is unrealistic, says NBC report

A report by Ed Flanagan of the American NBC News says that the recent anti-smoking measures announced by the Chinese government may be as unsuccessful as previous attempts. The article says China has 350 million smokers and the habit is deeply ingrained in society. Previous attempts to curb smoking resulted in "No Smoking' signs being put up but they were widely ignored, says Flanagan. He says the Chinese media have given no details of how the new policy will be enforced. The move also face resistance from the powerful tobacco industry in China, he adds.

 New Yorker profiles China's gene factory BGI in Shenzhen

The New Yorker has an in-depth profile of the gene factory B.G.I., (Beijing Genomics Institute), which is said to be the world’s largest genetic-research centre, located in Shenzhen. The report by Michael Specter says BGI has 178 machines to sequence DNA, and produces at least a quarter of the world’s genomic data. This could help provide new solutions to disease and other areas such as agriculture, he writes.

China medical news headlines for Friday 17 January

Monitor and treat the best way for hepatitis B

Monitoring inactive chronic hepatitis B carriers is a cost-effective strategy for China, a study shows. The findings published in Hepatology, also show that increasing treatment, monitoring and adherence to therapy are necessary to achieve significant health benefits at the population level.
Shanghai researchers compared the current strategy of not monitoring inactive chronic HBV patients to a monitor and treat strategy which included twice-yearly assessment of HBV and ALT levels. For active HBV cases the researchers suggest treatment with the antiviral entecavir, which evidence shows to be a cost-effective antiviral therapy in China.
The study found that there were 1.5 million adult HBV arriers of HBV in Shanghai, of whom 63% were hepatitis B virus e antigen (HBeAg) positive. The number of active cases of chronic HBV, were 258,139 in the eAg-positive group and 152,384 in the HBeAg-negative group. A monitor and treat strategy would reduce liver cancer by 70% and reduce mortality caused by chronic HBV by 83%, according to News Medical.

China too hard for US generic drug maker

One of the world's biggest generic drug manufacturers has quit China, saying it is too hard to do business there. The US generic maker Actavis has said it will exit China because the business climate is just 'too risky' according to its CEO.
“It is not a business friendly environment,” CEO Paul Isaro is quoted as saying by Bloomberg.

Beijing wants foreign medical city

Beijing is to set up an International Medical Service Zone in Tongzhou District in 2014, Xinhua reports. The 15 square kilometre zone is intended to be a model of medical reform that will integrate social and foreign investment. Beijing hopes the zone will attract doctors and medical experts from Beijing's top public hospitals as well as draw in international medical institutions to set up shop in a healthcare hub. The aim is to have world-class medical facilities, education institutions, medical research personnel, rehabilitation and nursing homes and health management facilities all in one place.

TCM a leading cause of liver failure

Traditional Chinese Medicine is a major cause of acute liver failure in China, according to a report in PLOS One. In a review of 177 Chinese patients with liver failure, 17% had received herbal remedies, and TCM was believed to be a more frequent cause than any other factor, the Global Times reports. Of all the patients diagnosed with acute liver failure 44% developed the condition due to drug or herbal remedy toxicity, and herbal remedies, accounted for more liver failure than paracetamol.

Hepatitis B vaccine in China: the unanswered questions

Commentary by Michael Woodhead

The deaths of 17 Chinese infants reported as having have followed hepatitis B vaccination are a tragedy that needs to be be fully investigated. When the first deaths occurred, the suspicion lay with a vaccine made by Shenzhen BioKangtai, with reports that certain batches of the vaccine were linked to the deaths of newborns in several provinces who had received vaccines with the specific batch number. Matters then became confused when reports were made of deaths of infants who had received other vaccines, including one made by a company called Beijing Tiantan. In all, 17 deaths have been officially reported in relation to hepatitis B vaccine.
When the first deaths were reported, the China Food and Drug Administration (SFDA) and the National Health and Family Planning Commission (NHFPC) ordered a halt to the use of the Biokangtai vaccine in China's newborn vaccination program and an investigation into the vaccine used.

After a rapid investigation of less than two weeks it has been announced that no problems have been found with the batches of Biokangtai's vaccine reportedly involved in the deaths and adverse reactions. The SFDA has also found no problems in the manufacturing, storage, transport or injection of the vaccine. Nevertheless, manufacturing permissions have been suspended for the three major manufacturers of hepatitis B vaccine, on the grounds that their facilities had not met the new GMP criteria for vaccine prodiction that came into effect on 1 January.
Post-mortem investigations into the infant deaths have also excluded the vaccine in nine cases, so far, and the other eight cases are waiting for autopsy results. Thus the hepatitis B infant vaccination campaign has quickly been given the all clear by the various authorities, and this verdict has been endorsed by the local branch of the WHO. The WHO representative rightly pointed out that the hepatitis B program was based on a good vaccine and prevented many cases of diseases and death every year. However, the announcement about the vaccine being safe was met with anger from some of the families of the children who died, and there has been disbelief on online forums about the "all clear" verdict from netizens who have little faith in monitoring of safety and quality of foods and medicines in China.

Despite the endorsement of WHO, there are still areas of doubt and unanswered questions in relation to the safety of China's hepatitis B vaccine and other child vaccine programs. First of all, if a vaccine was not responsible for the infant deaths, what was or were the real causes? With millions of newborns being vaccinated it is statistically probable that some natural infant deaths will co-incide with the time of vaccination. But the reports of 17 deaths in association with hepatitis B vaccination require in-depth investigation. Another question is whether it is possible to confidently rule out the vaccine as a possible factor in the cause of death. The investigations into the child deaths and into the vaccine quality and usage were done very quickly, raising questions about how thorough and comprehensive they were. There was also little transparancy about the process.
By comparison, when a similar series of vaccine-linked adverse events was seen in Australian infants given flu vaccine in 2010, authorities followed this up with several major inquiries. One inquiry was overseen by an independent clinician who examined the timeliness and appropriateness of the responses to the events. A second inquiry looked at the systems in place to monitor vaccine adverse events. A third inquiry looked into the vaccine manufacturing and quality issues. These separate inquires continued for months and in one case extended for more than a year. They concluded that a manufacturing anomaly had caused the vaccine batch for that year to be more 'reactive' than usual and to provoke more adverse effects. As a result, flu vaccine made by this manufacturer was banned from use in children, while products from other manufacturers continued to be allowed to be used. The other inquiries found that vaccine event monitoring and responses could have been better, and that information sharing had been poor and could be improved.

The recommendations from these inquiries were accepted by the Australian government, which has started to implement new vaccine monitoring and oversight systems. China could learn much from the Australian response to a series of vaccine related adverse events, to improve vaccine safety monitoring and response systems and to improve transparency in the whole process.
A clear and open response on the issue is needed from the Chinese authorities to maintain confidence in the safety of vaccination programs for children. It is not enough to point out that 15 million children receive the hepatitis B vaccine each year with the vast majority showing no ill effects and that the vaccine program prevents millions of cases of severe illness and death. Given the previous food and drug quality safety scandals seen in China - and the lack of public faith in the responses from the authorities - it is not surprising that there is now a crisis of confidence in the quality of China's food and drug products. Let us hope that vaccines do not become like milk powder, with parents only having faith in imported foreign brands for their newborns.

Relatives and netizens sceptical of hepatitis B vaccine verdict

The father of one of the infants who died after receiving hepatitis B vaccine has rejected the findings of an official investigation that found no link between vaccine and the deaths.
According to Radio Free Asia, Yang Wenlong of Shanxi  said the official account clearing the vaccine of any role in the babies' deaths was groundless.
"They are talking absolute rubbish, and no one in China will believe it unless they are idiots," Yang said.
"I for one don't believe their results."
Mr Yang said the official verdict had been criticized by Chinese netizens on social media sites such as QQ. Many citizens were sceptical of the government following a series of product safety and public health scandals in recent years."I think they are afraid of affecting people's uptake of the vaccine."
"But I think that what they've done here will have the opposite effect to the one they intended."

Medical news from China's media

In the China Daily, womens' hospitals says they are being inundated with inquiries from women about having a second child following the amendment to the family planning policy in early November. One hospital, the Women's Hospital of Zhejiang University's School of Medicine has opened a consultation clinic for women considering a second child.

Xinhua reports that two more babies have died after receiving hepatitis B vaccinations, this time in Shandong province. However, the report does not say which brand of vaccine the cases are related to, even though the Shenzhen Bio Kangtai vaccine has been withdrawn.
According to the provincial Centre for Disease Control and Prevention they have also received a report of a baby that died in October after a hepatitis B vaccination.
At least twelve infants are reported to have died in China after receiving vaccines against Hepatitis B.

The People's Daily has a report on gay college students being targeted for HIV prevention measures, as the number of cases in young gay men in China is increasing dramatically. The article says that in
Guangzhou there have been 117 cases of HIV in 48 colleges or universities, according to  the Guangzhou Disease Prevention and Control Center. Ninety percent were infected via homosexual behavior, with high risk sexual activities being common. Students are being targeted for safe sex behaviour campaigns and also for HIV testing.

CRI reports that a tourist from mainland China has brought H7N9 influenza into Taiwan.
Disease control authorities said an 86-year old  tourist from Jiangsu was confirmed with H7N9 avian influenza. The man showed first symptoms on December 19 and has been hospitalized since Dec 24.
This is Taiwan's second case of H7N9, the first imported case  occurred in April this year.

Tiantan hepatitis B vaccine maker bosses resign

The makers of one of China's hepatitis B vaccines has seen several of its top executives resign in the wake of the recent spate of deaths of babies who received hepatitis vaccinations. However, the resignations are from the Tiantan Biological company, whose vaccine has been linked to few if any of the recent reports of deaths of newborns after receiving hepatitis B vaccine. The 12 deaths reported so far have mostly been linked to the rival Shenzehn Bio-Kangtai vaccine.
Caixin reports that several board members of Tiantan have offered their resignations, apparebtly becaus the recent investigations into manufacturing processes at vaccine makers have exposed sub-standard practices, especially in relation to meeting GMP requirements. The board members of Tiantan include the financial manager and auditors. The lack of GMP certification meant the company was unable to expand its production and thus has been unable to meet the shortfall created by the ban on use of BioKangtai vaccine, which  accounted for about a quarter of the market.

China reports 12th hepatitis B vaccine-related death

An infant in south China's Hainan Province died on Friday after receiving hepatitis B vaccine, local authorities said, bringing the total of such cases to 12 in the country.
Medical specialists are on their way to look into the cause of death in Lin'gao County in Hainan.
This is the third infant death linked to hepatitis B vaccines produced by the Beijing Tiantan Biological Products Co. Ltd.
Source: Peoples Daily

WHO defends China's hepatitis B vaccination programme

China's vaccines are produced and regulated in accordance with international standards, and the hepatitis B vaccination program is vital in safeguarding children against the illness, according to the World Health Organization.
Bernhard Schwartlander, China representative for the international health body, made these points during an interview with China Daily on Thursday.
"Given that the hepatitis B virus is still around, it's important for babies to get vaccinated," he said.
The WHO Beijing office met with the National Health and Family Planning Commission on Thursday to discuss the latest developments surrounding incidents in which 11 newborns have died after being inoculated against hepatitis B.
According to Schwartlander, it's difficult to establish a causal link between the vaccines and the babies' deaths since nearly all infants in China receive the vaccine as part of a very successful vaccination program.

Experts defend hepatitis B immunisation programme after deaths

The hepatitis B vaccination program for newborns should stay in place despite the recent deaths of eight babies, medical experts said.
But expectant mothers are worried about the quality of vaccines as authorities investigate the cause of the deaths.
Jia Jidong, who leads the Liver Research Center at the Beijing Friendship Hospital, cited China's relatively high prevalence of the viral infection as a major reason for keeping the immunization program.
China reported a hepatitis B prevalence of more than 7 percent.
"We would have seen a relapse of the epidemic if the program was not well implemented,” he warned.

Hepatitis B vaccine death toll rises to seven, questions asked about slow recall

Seven children have now died in China since November following hepatitis B vaccination, raising questions of the effectiveness of the emergency response.
To date, four infants have died in south China's Guangdong Province after hepatitis B vaccinations with products made by Biokangtai,a Shenzhen drug manufacturer, the Provincial Disease Control and Prevention Center said on Monday. The four deaths in Guangdong occurred in Zhongshan, Jiangmen, Shenzhen and Meizhou, but the Zhongshan case was not related to the vaccine. The baby in that case died of pneumonia, according to the center. Autopsy results have not yet been released for the other three cases. Cause of the death can only be confirmed after autopsies which normally take 30 working days. Two babies in neighboring Hunan Province and another in the southwestern province of Sichuan died in similar circumstances, according to the National Health and Family Planning Commission. A circular on Friday ordered suspension of Biokangtai vaccinations,two weeks after the first Biokangtai link was established on Dec. 6. Babies died in Hunan on Dec. 9 and in Shenzhen on Dec. 17.

Guangdong buys extra hepatitis B vaccine to replace suspect batches

Guangdong has purchased 1.45 million doses of hepatitis B vaccine for the province after health authorities halted the use of a vaccine suspected in the deaths of four babies.
A baby boy in Shenzhen died on Tuesday after being inoculated with hepatitis B vaccine produced by Biokangtai, a local pharmaceutical company.
His death was the fourth such recently after babies were inoculated with the hepatitis B vaccine produced by the company, according to China Food and Drug Administration.
Two babies in Hunan province and another in Sichuan province died recently after being injected with the Biokangtai vaccine.
On Friday, the administration and the National Health and Family Planning Commission asked all hospitals to stop using the vaccine produced by Biokangtai, and said it will investigate the cause of the deaths and examine the company's products.

More details released on hepatitis B vaccine deaths and recall

An infant who became sick just minutes after a hepatitis B vaccination and died an hour later may be the fourth victim of vaccines produced by China’s largest hepatitis B vaccine supplier in the southern city of Shenzhen.
The deaths have triggered a nationwide suspension.
An official investigation is underway, while Biokangtai has not said where vaccines from the same batch as the Shenzhen baby received may have been sold.
Last Tuesday, the boy, born at 10:31am and apparently healthy, was given a vaccination six minutes later. At 10:39am, his face turned blue, his cries became faint and his breathing became rapid due to a lack of oxygen, Dr Yang Jinmin at the Nanwan People’s Hospital in Shenzhen, Guangdong Province, said.