Editor's Note: July 28, 2024, marks the 14th World Hepatitis Day. Recently, the National Disease Control and Prevention Administration released a report on the national legal infectious disease situation for May 2024, revealing that viral hepatitis remains the most prevalent category B infectious disease. In light of this, Hepatology Digest interviewed Dr. Jidong Jia from Beijing Friendship Hospital, Capital Medical University, to discuss the transmission routes of hepatitis, prevention measures, and more. Below is the transcript of the interview.Hepatology Digest: Many people fear and misunderstand hepatitis B. Could you briefly explain the main transmission routes of hepatitis B and the preventive measures?
Dr. Jidong Jia: Hepatitis B, abbreviated as HBV, is a blood-borne disease primarily transmitted through skin and mucosal injuries, such as blood transfusions, use of blood products, mother-to-child transmission, and sexual contact. These routes are all forms of blood exposure. Therefore, there is no need to be overly fearful of hepatitis B because, without exposure to blood, daily activities like sharing meals, using office supplies, or cohabiting in the same office or dormitory do not transmit the hepatitis B virus (HBV).
Additionally, cultivating good personal hygiene habits is essential. Most importantly, if someone is infected with HBV, they should seek safe and standardized treatment at a reputable medical institution, which can significantly reduce the risk of HBV transmission. So, there’s no need to worry excessively about this aspect.
Hepatology Digest: Vaccination against hepatitis B is a key preventive measure. Which groups particularly need the hepatitis B vaccine, and what should be considered after vaccination?
Dr. Jidong Jia: Vaccination against hepatitis B is the most effective and cost-efficient preventive measure, often referred to as the highest cost-effectiveness ratio in professional terms. The most crucial vaccination group is all newborns, who must receive the hepatitis B vaccine within 24 hours of birth to prevent hepatitis B right from the source.
If an adult has never been vaccinated against hepatitis B, getting vaccinated now is also a good option. Adults who should be particularly considered for vaccination include: (1) Individuals with special conditions who frequently need blood transfusions or contact with blood products; (2) Those living with hepatitis B patients who may have close contact; (3) Certain professionals, such as healthcare workers, who are more frequently exposed to patients’ blood and bodily fluids.
In summary, all newborns must receive the hepatitis B vaccine, which is a mandatory requirement. High-risk adults should also get vaccinated, and the general population is encouraged to do so as well.
Hepatology Digest: How should the public correctly perceive hepatitis B screening and treatment to avoid being misled? What steps can be taken to increase the diagnosis and treatment rates of hepatitis B to meet the 2030 goal of eliminating viral hepatitis?
Dr. Jidong Jia: Many people misunderstand, fear, and even discriminate against hepatitis B due to a lack of understanding and misconceptions about its transmission routes. Therefore, we need to clarify two points: First, the state mandates that hepatitis B testing cannot be included in admission or employment medical exams to protect individuals’ rights to equal access to education and employment. Second, outside the context of school or job entry health exams, and in medical settings or personal voluntary situations, we actively encourage hepatitis B testing.
Hepatitis B testing is crucial because, during the early stages of infection, and often for a long time thereafter, HBV carriers show no clinical symptoms. Only through blood tests can it be determined if someone is infected with HBV. Thus, we advocate for hepatitis B testing in non-admission and non-employment medical exams and healthcare activities. We also encourage individuals to check their HBV status if they wish to know. Only through widespread testing can we potentially detect infections early and treat those who need it, improving patient outcomes.
To achieve the World Health Organization’s goal of eliminating viral hepatitis as a public health threat by 2030, we must increase the diagnosis and treatment rates of hepatitis B. Currently, we only treat a small number of patients who visit hospitals, resulting in low diagnosis and treatment rates. Therefore, achieving this goal requires large-scale testing and treatment.
Hepatology Digest: Hepatitis B treatment is a long-term process. What common challenges or difficulties might patients encounter during treatment? What suggestions do you have to help patients better adhere to long-term treatment?
Dr. Jidong Jia: We advocate for hepatitis B vaccination, which is an excellent preventive measure. Once infected with HBV, active antiviral treatment can also reduce HBV DNA to undetectable levels, thereby lowering the risk of related complications.
Since most chronic hepatitis B patients find it difficult to be completely cured in the short term, they need to adhere to long-term medication. On the other hand, long-term treatment requires patients to have sufficient determination and confidence to overcome various challenges during the treatment process.
To help patients better adhere to long-term treatment, I have the following suggestions. First, patients should build confidence and understand that long-term oral antiviral medication can control HBV, reduce complications, extend life expectancy, and improve quality of life. This understanding is the fundamental motivation to persist with treatment.
Second, patients need to have the determination to take their medication on time daily and not stop it randomly. Irregular medication intake or sudden discontinuation can lead to drug resistance or disease relapse, worsening the patient’s condition and treatment outcome.
Lastly, patients need to undergo regular check-ups to monitor HBV control and liver function. Regular check-ups also help detect early liver cancer, allowing for timely treatment and improved outcomes.
In summary, building confidence, adhering to medication, and undergoing regular check-ups are key to successfully managing long-term hepatitis B treatment. By following these steps, most patients can lead normal lives.
Hepatology Digest: Hepatitis C is a viral hepatitis that is often overlooked. Who are the high-risk groups for hepatitis C infection? Could you briefly introduce the main transmission routes and preventive measures for hepatitis C?
Dr. Jidong Jia: Hepatitis C, like hepatitis B, is also a blood-borne disease, with similar transmission routes, including blood transfusions, the use of blood products, unsafe medical procedures, sexual transmission, and mother-to-child transmission. Although the intensity of mother-to-child and sexual transmission of hepatitis C is relatively low, it still requires caution.
High-risk groups for hepatitis C include those who were exposed to blood products before the 1990s, those who underwent invasive procedures, and those who require long-term dialysis or other special procedures due to specific conditions. For these individuals, we recommend proactive testing, starting with hepatitis C antibody testing. If the antibody test is positive, further nucleic acid testing should be conducted.
Currently, many treatment options are available for hepatitis C. If detected early, hepatitis C can be cured within a short period.
Hepatology Digest: Hepatitis C is a disease that can be completely cured. Could you outline the main treatment strategies? What areas of hepatitis C prevention and treatment in China still need improvement?
Dr. Jidong Jia: There is currently no vaccine for hepatitis C, so prevention relies mainly on safe blood transfusions, injections, and strict sterilization protocols in medical procedures. In terms of treatment, most patients can clear the virus within three months through oral direct-acting antiviral (DAA) drugs, achieving virological cure. Even patients with cirrhosis or special conditions can achieve virological cure after six months of treatment.
However, in terms of prevention and treatment, there are still some areas that need attention. First, hepatitis C treatment drugs are now relatively affordable and covered by health insurance, so it’s essential to increase public awareness of hepatitis C, encouraging more people to get tested and treated. Second, for patients who have been cured of hepatitis C but have cirrhosis, it is still necessary to regularly check liver function, alpha-fetoprotein levels, and undergo ultrasound scans to monitor any changes in their condition. Overall, China has made significant progress in the prevention and treatment of hepatitis C.
Hepatology Digest: In your opinion, how can society, including the government, medical institutions, media, and the public, work together to achieve the goal of “Eliminate Hepatitis: Act Now”?
Dr. Jidong Jia: Regarding hepatitis B, the situation in China can be summarized in two sentences: the increase in new cases is minimal, but the existing burden remains substantial.
Since 1992, China has gradually strengthened hepatitis B vaccination for newborns and implemented special mother-to-child transmission prevention measures, such as administering hepatitis B immunoglobulin to newborns and antiviral treatment for pregnant women with high HBV DNA levels. Now, the mother-to-child transmission rate is very low, and the HBsAg positivity rate in children under five has dropped to about 0.3%, while the overall population positivity rate has decreased from 9.75% in the past to around 6%.
Despite the small increase in new cases, given China’s large population, even a 6% positivity rate still means that 70 to 80 million people are HBsAg positive. If untreated, some of these individuals may develop cirrhosis and liver cancer. Therefore, we should encourage hepatitis B testing while respecting patient wishes and protecting privacy, and include these tests in regular health check-ups. Positive individuals should be guided to seek standardized treatment at reputable hospitals and undergo long-term follow-up.
Achieving the goal of “Eliminate Hepatitis: Act Now” requires collective efforts from all sectors of society. We need to eliminate public fear, prejudice, and discrimination against the disease, encouraging patients to face it courageously and seek active treatment, as it is entirely preventable and treatable. The government, medical institutions, media, and the public should all participate in advancing the progress of hepatitis prevention and treatment efforts.
