Elimination of hepatitis B virus infection in children: experience and challenge in China / 中华医学杂志(英文版)

Chronic hepatitis B virus (HBV) infection is a serious health issue because of its severe sequelae. Prevention of mother-to-child transmission (MTCT) of HBV is critical to eliminate chronic HBV infection. Here, we reviewed the progress toward the elimination of HBV infection in children in China in the recent decade. A universal hepatitis B vaccination program started from 2002 has been intensified, with the coverage of timely birth dose >95% of all newborn infants from 2012. Since 2011, China has taken a nationwide program to administer hepatitis B immunoglobulin (HBIG) with free of charge in all neonates of HBV-infected mothers, leading to a significant increment of timely use of HBIG. The prevalence of hepatitis B surface antigen (HBsAg) was declined from around 10% among children in 1980s to 2 × 105 U/mL during the third trimester is increasing, which will further reduce MTCT of HBV. However, there are some challenges in the elimination of HBV infection in children, which need to overcome by the concerted efforts. Nevertheless, it is anticipated that China will achieve the goal set by the World Health Organization that the prevalence of HBsAg in children aged <5 years is ≤0.1% by 2030.

The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: a historical cohort study

ABSTRACT Introduction: Hepatitis B virus (HBV) is responsible for one of the most common human viral infections. An estimated 257 million people are living with chronic HBV infection worldwide, and mortality has reached 900,000 deaths in recent years. In 2001, the World Health Organization reported a prevalence of chronic hepatitis B infection in Iran between 2-7%. Objective: To assess the effect of the national HBV mass vaccination program after 25 years. Methods: A retrospective cohort study was conducted in vaccinated and unvaccinated people according to the year of birth. Blood samples were obtained from each enrolled person and data about demographic variables, and medical and vaccination history were collected using a standardized questionnaire. Persons were considered uninfected if they were negative for both HBsAg and anti-HBc. Also, Vaccine effectiveness was measured by calculating the risk of disease among vaccinated and unvaccinated persons and defining the percentage risk reduction of infection in the vaccinated group. Results: A total of 2720 persons were interviewed. The rate of HBV breakthrough infection among the vaccinated group was significantly lower than in unvaccinated group. One hundred ninety-four cases with positive HBV markers of infection were identified. The risk ratio of HBV infection was 0.71, 95% CI: 0.54-0.94 (vaccinated/unvaccinated). The estimated vaccination effectiveness against Hepatitis B infection was 29% (95% CI: 6%-46%). Conclusions: Iran has successfully combined hepatitis B vaccination into regular immunization programs. The WHO goal of reducing HBsAg prevalence to an equivalent of 1% by 2020 has been reached. With respect to vaccination effectiveness and low prevalence of the disease in the country, catch-up hepatitis B vaccination programs for adolescents can guarantee the immunity of the population.

Assessment of the prevalence of vertical hepatitis B transmission in two consecutive generations / Avaliação da prevalência de transmissão vertical de hepatite B em duas gerações consecutivas

Summary Introduction: Hepatitis B is an important public health problem in the world and one of the forms of contagion would be through vertical transmission. Precose diagnosis allows the adoption of prophylaxis measures, which results in prevention in more than 90% of cases. Objective: To describe the prevalences of vertical transmission and compare two generations (mother/patient and patient/child). Method: This was a cross-sectional study, which included 101 patients. The interviews were performed through the application of the instrument of data collection and information of the physical file before the medical consultation. Results: The mean ± SD of age was 50.9 ± 13.1 years, the male gender predominated, with 56.4% of the patients, and the predominance was white, with 43.6%. Vertical transmission between mother and patient occurred in 17.8% and between patient and child, in 7.9%. In all of the eight cases of vertical transmission, the diagnosis was after the birth of children infected with HBV, and in 3/8 (37.5%), there was more than one case of infection by this mechanism per patient, totaling 13 children with the disease. Conclusion: There was a reduction in vertical transmission, showing that preventive measures were effective.

Resumo Introdução: A hepatite B é um importante problema de saúde pública no mundo e uma das formas de contágio seria através da transmissão vertical. O diagnóstico precoce possibilita a adoção de medidas de profilaxia, o que resulta na prevenção em mais de 90% dos casos. Objetivo: Descrever as prevalências de transmissão vertical e comparar duas gerações (mãe/paciente e paciente/filho). Método: Trata-se de um estudo transversal, que incluiu 101 pacientes. As entrevistas foram realizadas por meio da aplicação do instrumento de coleta de dados e informações do prontuário físico antes da consulta médica. Resultados: A média ± DP de idade foi de 50,9 ± 13,1 anos, houve predomínio do gênero masculino, com 56,4% dos pacientes, e predominou a cor branca, com 43,6%. A transmissão vertical entre mãe do paciente/paciente ocorreu em 17,8% e entre paciente/filho, em 7,9%. Em todos os oito casos de transmissão vertical, o diagnóstico foi posterior ao nascimento dos filhos infectados por HBV; em 3/8 (37,5%), houve mais de um caso de infecção por esse mecanismo por paciente, totalizando 13 filhos com a doença. Conclusão: Houve uma redução na transmissão vertical, mostrando que as medidas preventivas foram efetivas.

Las hepatitis B y C bajo la lupa La respuesta de salud pública en la Región de las Américas, 2016 / Hepatitis B and C in the Spotlight. A public health response in the Americas, 2016

El presente informe ofrece un panorama de las epidemias actuales de hepatitis B y hepatitis C, así como de la respuesta del sector de la salud en la Región de las Américas. Su finalidad es proporcionar, en el marco de un entorno en constante cambio, un conocimiento básico de los temas principales relacionados con la respuesta a estas epidemias en la Región, para lo cual presenta un panorama de los grupos de población afectados y de la carga de las infecciones por el virus de la hepatitis B (VHB) y el virus de la hepatitis C (VHC) en la Región, además de las actuales políticas y de las prácticas del sector de la salud. Este informe, el primero en su tipo que aborda el seguimiento de los progresos en la consecución de las metas establecidas en el Plan de acción para la prevención y el control de las hepatitis virales,tiene por objeto ayudar a los Estados Miembros a adaptar sus políticas y prioridades para que puedan establecer una respuesta de salud pública eficaz e integral. Se ha producido un cambio importante en la conciencia mundial sobre las epidemias de hepatitis virales: ya no se consideran silenciosas y actualmente se observa una evolución hacia la adopción de medidas a escala mundial para eliminarlas como problema de salud pública. En la Región de las Américas, la principal carga de las hepatitis virales se debe a las hepatitis B y C; unos 2,8 millones de personas (2,2 a 8,0 millones)1presentan la infección crónica por el virus de la hepatitis B (VHB), de las cuales 2,1 millones viven...

High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

Studies on the prevalence of infection with hepatitis B virus (HBV) among children are scarce in Latin American countries, especially in Mexico. This study was aimed to investigate the prevalence of HBV infection, occult hepatitis B infection (OBI) and HBV genotypes among children with clinical hepatitis. In total, 215 children with clinical hepatitis were evaluated for HBV infection. HBV serological markers and HBV DNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection was found in 11.2% of children with clinical hepatitis. Among these HBV DNA positive-infected children, OBI was identified in 87.5% (n = 21/24) of the cases and 12.5% (n = 3/24) were positive for both HBV DNA and hepatitis B surface antigen. OBI was more frequent among children who had not been vaccinated against hepatitis B (p < 0.05) than in those who had been vaccinated. HBV genotype H was prevalent in 71% of the children followed by genotype G (8%) and genotype A (4%). In conclusion, OBI is common among Mexican children with clinical hepatitis and is associated with HBV genotype H. The results show the importance of the molecular diagnosis of HBV infection in Mexican paediatric patients with clinical hepatitis and emphasise the necessity of reinforcing hepatitis B vaccination in children.

Guía de práctica clínica para el diagnóstico y tratamiento de la hepatitis crónica por el virus de la hepatitis B / Practice guideline for diagnosis and treatment of chronic hepatitis virus hepatitis B

La presente guía establece los criterios técnicos para el diagnóstico y tratamiento de la hepatitis crónica secundaria a hepatitis viral B con la finalidad de contribuir a reducir la morbimortalidad de esta enfermedad. Da las definiciones para comprender las recomendaciones aquí dadas. Descripción de aspectos epidemiológicos, factores de riesgo asociados; aspectos clínicos y de diagnóstico de la hepatitis crónica por virus B. Se dan las recomendaciones de manejo incluyendo circunstancias especiales tales como el paciente con cirrosis, el paciente con coinfección VIH ó con coinfección con hepatitis C. Las recomendaciones aquí mencionadas se convierten en la guía nacional para el manejo de la Hepatitis crónica por hepatitis B.

This guide sets out the technical criteria for the diagnosis and treatment of chronic hepatitis secondary to viral hepatitis B. The guide intend to reduce the morbidity and mortality of this disease. The Guide give practical definitions to help understand the terminology, describe epidemiology, risk factors, and clinical aspects and the diagnosis of chronic hepatitis B. Finally the guide give recommendations for the management including special circumstances such as patients with cirrhosis, patients coinfected with HIV or coinfected with hepatitis C. The recommendations of the guide become the national guide for the management of chronic hepatitis B.

Chronic hepatitis B in pregnancy: unique challenges and opportunities / 대한간학회지

Chronic hepatitis B (CHB) affects 350 million individuals worldwide. Perinatal transmission leads to high rates of chronic infection and complications, including cirrhosis and hepatocellular carcinoma. It is important to recognize and appropriately treat CHB in pregnancy, thereby reducing the risk of neonatal transmission and HBV-associated morbidity and mortality. Screening for CHB is recommended in all pregnant mothers as is universal vaccination of infants with hepatitis B virus (HBV) vaccine with or without hepatitis B immunoglobulin (HBIG). This has resulted in a lower incidence of HBsAg seropositivity and HCC in regions where universal infant vaccination has been endorsed. Mode of delivery and breastfeeding do not appear to affect HBV transmission rates based on available data. Overall, CHB does not increase perinatal maternal-fetal mortality. Administration of oral antiviral therapy during the third trimester to HBsAg-positive mothers with HBV DNA> or =7 log IU/mL may be useful in preventing breakthrough infection. Treatment may be considered earlier in pregnancy for persistently active liver disease shown by high ALT, HBV DNA levels and/or significant hepatic fibrosis. Lamivudine, tenofovir and telbivudine are safe and effective and are the agents of choice in pregnancy. However, further clinical studies are necessary to elucidate the role of antiviral therapy in the pregnant HBV carrier.

Chronic liver disease prevention strategies and liver transplantation / Estratégias de prevenção da doença hepática crônica e transplante de fígado

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80 percent of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.

As doenças hepáticas crônicas estão entre as três principais causas de morte na Africa e Asia.O transplante de fígado é o único tratamento curativo para esta doença hepática de caráter terminal.O presente artigo tem como objetivo apresentar as causas passíveis de prevenção de cirrose e as estratégias que podem ser utilizadas no sentido de preveni-las. Com pequenas variações ao redor do mundo, 70 a 80 por cento das doenças hepáticas terminais são causadas por consumo excessivo de álcool e por hepatites virais que são doenças passíveis de prevenção.O consumo excessivo de álcool é importante problema de saúde pública, pois envolve violência doméstica, acidentes de trânsito, além da possível evolução para cirrose e suas conseqüências. Entre as causas virais as hepatites pelo vírus B e C têm o maior impacto na saúde pública. Para a hepatite B já há vacinas disponíveis. Enquanto a vacina para a hepatite C é ainda aguardada, estratégias efetivas de prevenção devem ser efetuadas com o objetivo precípuo de se evitar, por conseqüência, casos de hepatopatias crônicas desta natureza.

Electiveness of hepatitis B vaccination in children of chronic hepatitis B mothers

Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained. The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen [HBsAg] and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993. Chronic infection [HBsAg positivity] was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group [relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02]. Previous infection of hepatitis B [HBcAb positivity] was found in 29 [29.9%] children in the exposed group, but only one [1.2%] in the unexposed group [RR=26.01, 95% CI: 3.61-186.95]. Immunity [HBsAb positivity] in the exposed group measured 48 [49.5%] and unexposed group measured 56 [64.4%] [R.R=0.76, 95% CI: 0.59-0.99]. Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth

Infección por hepatitis viral tipo B y prevención de carcinoma hepatocelular / Viral hepatitis

La etiología de la hepatitis es multicausal, tanto agentes infecciosos como trastornos metabólicos y agentes físicos la pueden ocasionar. Los virus identificados en la patología hepática y capaces de producir hepatitis son siete, que suelen transmitirse por inoculación de sangre o productos hematológicos infectados. Esta infección es muy frecuente en homosexuales y toxicómanos de drogas intravenosas; otros grupos de riesgo son los pacientes y personal de centros para hemodiálisis, médicos, odontólogos, enfermeras y personal que trabaja en laboratorios y bancos de sangre. Tres son las principales formas de transmisión: percutánea, sexual y de madres infectadas en el momento del trabajo de parto. La distribución varía en todo el mundo, países con alta y baja prevalencia. Pueden existir portadores sanos, reservorios de la infección. El virus pertenece a la familia de los hepadnavirus, tiene dos componentes importantes: uno externo y otro interno al cual se le han identificado tres sistemas antígeno-anticuerpo que se relacionan con la infección del virus. Se encuentra presente con títulos elevados en sangre y en exudados de los pacientes con infección aguda o crónica, con títulos moderados en semen, secreción vaginal y saliva, la materia fecal y la orina no son fuentes de HBV. De acuerdo con las manifestaciones clínicas se identifican dos, la hepatitis B aguda y la hepatitis B crónica. Los pacientes con hepatitis B crónica pueden desarrollar cirrosis hepática y de éstos algunos pueden progresar a carcinoma hepatocelular, la cual varía de acuerdo con el estado inmunológico, edad, el estado serológico de la infección, factores genéticos y geográficos.

Curso terapêutica em gastroenterologia, aula 10: hepatite crônica por vírus B / Couse gastroenterology therapeutic: lesson 10th: chronic hepatitis by virus B

A infecção pelo vírus B da hepatite (VHB) é um problema de saúde mundial. De acordo com a Organização Mundial de Saúde, estima-se que até o ano 2000 cerca de 400 milhões de indivíduos tenham sido infectados, o que corresponde a aproximadamente 5 por cento da população mundial. Tem sido observado que, apesar de permanecer elevada, a incidência da infecção pelo VHB vem diminuindo progressivamente, seja pela utilização das vacinas seja principalmente pela introdução de programas de orientação populacional estimulando modificações comportamentais. No presente artigo discute-se as opções disponíveis para tratamento da hepatite B, em especial o interferon-alfa e a lamivudina. Veremos que os achados sorológicos, o quadro clínico e a evolução da infecção são variáveis, dependendo de fatores como tempo de doença (se aguda ou crônica), presença ou ausência de co-morbidades, como a co-infecção pelo vírus C da hepatite (VHC) e(ou) delta (VHD), e também existência de comprometimento do sistema imunológico, como indivíduos pós-transplante, em tratamento quimioterápico ou na existência do vírus HIV associado

Tratamento de hepatites crônicas virais: uma atualização / Chronic viral hepatitis: an update

O autor realiza uma revisão da literatura sobre o tratamento atual das hepatites virais. Salienta, no caso da hepatite crônica pelo vírus B, a importância da vacinação, já que essa é uma doença que pode ser evitada. No seu tratamento, a droga mais aceita é o Interferon, a despeito da baixa eficácia. O papel dos análogos nucleosídios (lamivudina) ainda não está definido, restringindo-se o seu uso a protocolos, salvo em pacientes em programa de transplante hepático. No que tange ao tratamento da hepatite crônica pelo vírus C, a droga a ser ofertada também é o Inteferon. No entanto, pela baixa resposta terapêutica alcançada, abre-se uma perspectiva em sua associação com a Ribavirina