https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/jhep.2001.29401

Chronic hepatitis B

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.23190

Chronic hepatitis B: Update 2009

Cancer burden in the year 2000. The global picture.

DNA recombinant technology has radically changed hepatitis B virus (HBV) virology. The genetic organization, transcription and replication of the virus are basically understood, structures of integrated HBV sequences in hepatocellular carcinoma have been characterized, and new vaccines produced by recombinant DNA technique are being developed.

The hepatitis B virus

Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection. This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005;54[No. RR-16]:1-33). In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, health-care settings targeting services to IDUs, health-care settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, health-care providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, health-care providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination.

A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults.

Prevention of perinatally transmitted hepatitis b virus infections with hepatitis b immune globulin and hepatitis b vaccine

A randomised blind controlled trial of hepatitis B immune globulin (HBIG) plus hepatitis B vaccine for the prevention of the perinatally transmitted HBsAg carrier state was conducted in Taipei. Infants of e-antigen-positive HBsAg carrier mothers were given HBIG immediately after birth, and then one of three schedules of vaccination. There was no difference in efficacy between the three schedules; the combined efficacy was 94%, compared with that of HBIG alone (71%) or of vaccination alone (75%). Persistent HBs antigenaemia developed in only 9 (6%) of the 159 infants receiving prophylaxis, but in 88% of the controls. Antibodies developed in all those who did not become antigenaemic and presumably will provide long-term protection from hepatitis B virus infection. HBIG should be given as soon as possible after birth and need not be given again if the infant is subsequently vaccinated. With HBIG coverage from birth, the timing of the start of vaccination does not seem to be of importance within the first month of life, but to maximise compliance and minimise costs hepatitis B vaccination should be initiated during the confinement.

Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine

The immunogenicity of hepatitis B virus vaccine was studied in 38 Chinese neonates, 23 of whom were healthy and susceptible and 15 of whom had passive serum antibody to hepatitis B surface antigen (anti-HBs). Initially, each infant received two 20-11g doses of vaccine by the intramuscular route, with a one-month interval between doses. No adverse reactions occurred, and all susceptible neonates had a brisk antibody response that was comparable to that in older infants and children and superior to that in adults. The first dose of vaccine stimulated the production of anti-HBs within one month in 48% of the neonates. Anti-HBs was detectable in the serum of 91% of the vaccinees at the age of three months -that is, two months after the second dose. By the age of six months, 96% of vaccinees had detectable anti-HBs in their serum. All vaccinees developed anti-HBs after a third dose was administered at the age of seven months. High levels of anti-HBs were sustained after vaccination in infants who initially had passive antibodies.

George Chin-Yun Lee

Papers

Prevention of perinatally transmitted hepatitis b virus infections with hepatitis b immune globulin and hepatitis b vaccine

Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine

Immunogenicity of Hepatitis B Virus Vaccine in Healthy Chinese Neonates

Growth of Japanese encephalitis virus in cell culture