Prevention of hepatitis B virus infection: from the past to the future

Abstract

About 3-5 % of the world's population is chronically infected by hepatitis B virus (HBV) and is at risk of developing liver cirrhosis or hepatocellular carcinoma. The risk of dying prematurely because of chronic HBV infection is higher in younger people. The current strategies to prevent HBV infection involve immunization (active and/or passive) and antiviral chemoprophylaxis. The vaccines available for active immunization, containing hepatitis B surface antigen, are safe and confer long-term immunity in most healthy subjects. Since the vaccination is unsatisfactory in some patients, e.g., those with chronic kidney disease, human immunodeficiency virus infection, type I diabetes mellitus, and celiac disease, new strategies of vaccination are required. The neonatal, infant, and adolescent routine program vaccination in about 180 countries has greatly decreased the disease burden. Passive immunization with specific HBV immunoglobulins is recommended after single acute exposure, in infants born to infected mothers, and in HBV-infected patients undergoing liver transplantation combined with nucleoside/nucleotide analogues (chemoprophylaxis). Chemoprophylaxis is also indicated in HBV carrier candidates for immunosuppressive treatment and in patients with occult B infection undergoing immunosuppressive therapy or hematopoietic stem cell transplantation. Since HBV is not eradicable by an immune response or by antiviral drugs developed so far, the only preventive strategy remains global neonatal vaccination in all countries, firstly in HBV-endemic countries.

Durability of the hepatitis B vaccination in pediatric renal transplant recipients

“…Our data suggest pediatric kidney failure patients have a reasonable rate of seroconversion (85%). This rate, although lower than the 95% seroprotection seen in the general population of infants and children after vaccination, is consistent with the range seen in previous studies of response of 71%‐100% in pediatric chronic renal insufficiency, and higher than adult patients on hemodialysis 73%‐76% . Our data also did not show a significant difference in seroconversion when comparing patients on dialysis prior to transplant, although previous studies have shown lower response to vaccination in patients on intermittent hemodialysis compared to chronic kidney disease patients prior to dialysis .…”

A school-based intervention of screening a movie to increase hepatitis B vaccination levels among students in Uttar Pradesh, India: impact on knowledge, awareness, attitudes and vaccination levels

“…The burden of disease from HBV has declined in many countries [ 8 ], mainly due to increased public awareness and effective, broadly targeted vaccination policies. India has lagged behind in both regards.…”

Hepatitis B virus S gene therapy with 10-23 DNAzyme delivered by chitosan-g-stearic acid micelles

“…About two billion people globally have been exposed to the infection 1 and more than 250 million people are suffering from chronic HBV infection. [2][3][4] Twenty-ve percent of all chronic HBV carriers develop serious liver diseases, such as chronic hepatitis, cirrhosis and primary hepatocellular carcinoma. 5,6 HBV-related liver diseases still cause an estimated 500 000 to one million deaths per year worldwide.…”