The Hong Kong Government recognises the public health threat posed by viral hepatitis. To provide a comprehensive strategy for reducing the public health burden, the Steering Committee on Prevention and Control of Viral Hepatitis (SCVH) formulated the Hong Kong Viral Hepatitis Action Plan 2020 – 2024 (The Action Plan).
The Action Plan is a milestone towards significantly reducing the burden of chronic hepatitis B and hepatitis C, with the ultimate vision to render Hong Kong free of chronic viral hepatitis.


The Action Plan adopts the four strategic axes, as described in WHO framework for global action: awareness, surveillance, prevention and treatment.


Awareness: To raise public awareness and knowledge of viral hepatitis, community engagement and awareness enhancement for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections shall be tailored to the needs of different target groups, such as the general public, healthcare workers, at-risk populations, patients and their service providers.


Surveillance: The current surveillance on viral hepatitis will be continued. A set of 12 local indicators are also adopted for close monitoring of the progress towards the WHO targets and ensuring the comparability of the indicators over time.


Prevention: Mother-to-child transmission (MTCT) is a major route of HBV transmission in Hong Kong and thus preventing MTCT is the focus of prevention and control of hepatitis B.


Treatment: Access to treatment would be expanded by a series of programme, including (i) enhancement of treatment for hepatitis B, (ii) expansion of access to direct-acting antivirals (DAA) for HCV, (iii) Micro-elimination of HCV infection, and (iv) promotion of HCV testing in people who inject drugs.

Universal HBV immunization programme for newborns in HK has started since 1988. The programme consists of administration of HB immunoglobulins (Ig) to babies born to HBsAg+ve mothers together with the 1st dose of HBV vaccine upon delivery. The 2nd & 3rd doses of HBV vaccines will be given mainly in the Maternal & Child Health Centres (MCHC) at 1 and 6 months respectively. Notably, the proportion of HBsAg+ve pregnant women is decreasing from 5.2% (2016), 5.0% (2017), 4.5% (2018) to 4.0% (2019). However, despite a 99.8% HBsAg screening coverage for antenatal women, together with a 99.5% coverage with HBIg and HBV vaccinations for livebirths born to HBsAg+ve mothers, the overall MTCT rate was still 1.1% (immunoprophylaxis failure, IF) from a local study of 641 HBsAg+ve pregnant women. In order to achieve the World Health Organization (WHO) vision to eliminate viral hepatitis as a public health threat by 2030, more specific, the WHO target of 200,000 IU/ml (estimated IF rate 4.2%) will be given an early referral to the corresponding HA Hepatology Clinic to discuss starting Tenofovir by 28 weeks gestation to further reduce the risk of MTCT of HBV. This programme has started as a pilot in QMH & PWH since 1Q 2020 and extended to PYNEH, KWH, QEH, PMH, UCH & TMH since 3Q 2020. About 600 HBsAg+ve pregnant women are recruited, 17% of them having high HBV viral load > 200,000 IU/ml. After seen by Hepatologists, 81% of them have started taking Tenofovir. One important aspect for outcome assessment to be highlighted is that post-vaccination serology testing (PVST) will be performed to infants after completing the full course of vaccination.

In the past, treatment of chronic hepatitis C (HCV) infection required the combination therapy of pegylated interferon and ribavirin which was associated with many side effects and had a success rate of about 50%. As a result, the uptake of treatment was rather low. Early treatment of chronic HCV infection can halt the progression of liver damage, prevent the complications of liver disease and decrease the liver related mortality. With the advent of direct acting antiviral (DAA) agents, the success rate (sustained virological remission at week 12 or week 24) of treating chronic HCV infection is more than 95% and even approaches 100%. The pan-genotypic property of some of the DAAs coupled with a short duration of therapy has increased the uptake of treatment in the population of chronic HCV patients but this was hindered by the cost of the DAAs in the initial phase. In Hong Kong, majority of the patients with chronic HCV infection are still managed in the public sector. There is a good collection of epidemiological and drug treatment data of chronic HCV patients being managed at the Hospital Authority in The Hong Kong HCV Registry The introduction of more and more pan-genotypic DAAs into the Hospital Authority Drug Formulary and the progressive expansion of indications from cirrhosis to advanced fibrosis, to mild fibrosis and currently to all patients with chronic HCV infection will hasten the elimination of chronic hepatitis C infection in our local population. Together with other strategies to enhance the awareness, screening and diagnosis of chronic HCV, better linkage to care and treatment, we are getting closer to the World Health Organization target of HCV elimination by 2030.

The prevalence of chronic hepatitis B (CHB) has been decreasing in Hong Kong since the implementation of the universal hepatitis B vaccination in new born in 1988. However, there is still a significant proportion of patients with CHB progressing to liver cirrhosis and hepatocellular carcinoma (HCC). With the increase in the use of effective antivirals, these 2 complications have been largely reduced. In many large-scale antiviral trials on patients with CHB however, there is usually a significant number of subpopulations being excluded. They include human immunodeficiency virus or hepatitis C co-infections, patients with decompensated liver cirrhosis, solid organ transplants recipients or patients on dialysis, and pregnant ladies. Treatment in these subpopulations is of great importance as some of them are at a higher risk of cirrhosis and HCC compared with the standard patients having CHB. Entecavir and tenofovir are the 2 recommended medications therapy for most patients with CHB, including the special populations. In the current presentation, the latest scenario, management strategies and prognosis of some of these special populations will be discussed.