Abstract:Hepatitis B (HB) is a serious public health problem in China. Up to now, the hepatitis B virus (HBV) vaccination was the most cost-effective way to prevent HBV infection. Since 1992, when the Chinese government prioritized implementing the HBV vaccinations for newborns, China began to see a larger reduction in HBV infections. For children under 5 years, the prevalence of hepatitis B surface antigen (HBsAg) has decreased to 1.0%. However, many additional challenges for the prevention and control of HBV infectio… Show more
“…The HBV infection in children was closely related to that of their parents and surroundings, and thus, higher infection rates in adults could lead to higher rates in children. In our study, the HBsAg carrier rate in community children <12 years old was 1.56%, which was higher than the average rate in children (0.94%) identified in the 2014 national survey . In different upbringing stages, children have different possibility of HBV infection from family, kindergarten and schools.…”
Section: Discussioncontrasting
confidence: 67%
“…The national prevalence of HBV infection has markedly decreased in the general population and in children based on surveys conducted by the Chinese CDC in 2006 and 2014 . However, in some underdeveloped regions or cities, rates of HBV infection are higher than the national average.…”
Summary
Although a universal newborn hepatitis B (HB) immunization programme has been implemented in China, hepatitis B virus (HBV) breakthrough infection, including HB surface antigen (HBsAg)‐positive infection and occult HBV infection (OBI), still occurs during infancy or childhood. Obtaining the actual prevalence of HBV infection in general children is important for preventing and controlling the spread of HB. Accordingly, we investigated the prevalence of overt infection and OBI in community children and compared the serological and virological characteristics of OBI and HBsAg carrier children to clarify the mechanisms related to OBI.
In total, 6 706 community children <12 years of age were included from a population‐based HBV seroepidemiological investigation in Northwest China. The HBsAg carrier rate in community children was 1.60% (107/6706), and the anti‐HBs positive rate was 57.35% (3846/6706). Additionally, 1192 HBsAg‐negative children were examined for OBI using nested PCR. The prevalence of OBI in local children was 1.26% (15/1192), and the predominant OBI genotypes were C and D. The 15 OBI children and 29 HBsAg‐positive children from the same population did not have a statistical significant difference in age, gender, alanine aminotransferase (ALT), proportion of anti‐HBs or anti‐HBc, viral genotypes or mutations. Children with chronic overt infection had higher viral loads than OBI children (P=.004). These results suggested that HBV overt and occult infection of children was more serious in underdeveloped north‐west regions. HBV neonatal immunization and catch‐up programmes should be strengthened and supplemented. None of specific viral mutations or genotypes related to OBI were found. OBI may be a specific stage of HBV infection.
“…The HBV infection in children was closely related to that of their parents and surroundings, and thus, higher infection rates in adults could lead to higher rates in children. In our study, the HBsAg carrier rate in community children <12 years old was 1.56%, which was higher than the average rate in children (0.94%) identified in the 2014 national survey . In different upbringing stages, children have different possibility of HBV infection from family, kindergarten and schools.…”
Section: Discussioncontrasting
confidence: 67%
“…The national prevalence of HBV infection has markedly decreased in the general population and in children based on surveys conducted by the Chinese CDC in 2006 and 2014 . However, in some underdeveloped regions or cities, rates of HBV infection are higher than the national average.…”
Summary
Although a universal newborn hepatitis B (HB) immunization programme has been implemented in China, hepatitis B virus (HBV) breakthrough infection, including HB surface antigen (HBsAg)‐positive infection and occult HBV infection (OBI), still occurs during infancy or childhood. Obtaining the actual prevalence of HBV infection in general children is important for preventing and controlling the spread of HB. Accordingly, we investigated the prevalence of overt infection and OBI in community children and compared the serological and virological characteristics of OBI and HBsAg carrier children to clarify the mechanisms related to OBI.
In total, 6 706 community children <12 years of age were included from a population‐based HBV seroepidemiological investigation in Northwest China. The HBsAg carrier rate in community children was 1.60% (107/6706), and the anti‐HBs positive rate was 57.35% (3846/6706). Additionally, 1192 HBsAg‐negative children were examined for OBI using nested PCR. The prevalence of OBI in local children was 1.26% (15/1192), and the predominant OBI genotypes were C and D. The 15 OBI children and 29 HBsAg‐positive children from the same population did not have a statistical significant difference in age, gender, alanine aminotransferase (ALT), proportion of anti‐HBs or anti‐HBc, viral genotypes or mutations. Children with chronic overt infection had higher viral loads than OBI children (P=.004). These results suggested that HBV overt and occult infection of children was more serious in underdeveloped north‐west regions. HBV neonatal immunization and catch‐up programmes should be strengthened and supplemented. None of specific viral mutations or genotypes related to OBI were found. OBI may be a specific stage of HBV infection.
“…2d). Therefore, the age-specific death rate of non-HBV related diseases was given by μ
a ( t ) = ( d
a ( t ) N
a ( t ) − m
a
C
a ( t ))/ N
a ( t ).The other parameters except for transmission rate and HBsAg seroclearance rate were determined from published literatures 28–38 . These parameter values were summarized in Table 2.Figure 2Model input parameters.…”
Section: Methodsmentioning
confidence: 99%
“…2c
21, 29–33
d
a ( t ): age-specific total death rate in year t ;See Fig. 2d
22–26
1990 ≤ t ≤ 1995
d
a ( t ) = d
a (1990),1996 ≤ t ≤ 2002
d
a ( t ) = d
a (2000),2003 ≤ t ≤ 2007
d
a ( t ) = d
a (2005),2008 ≤ t ≤ 2014
d
a ( t ) = d
a (2010).
μ
a ( t ): age-specific death rate of non-HBV related diseases in year t ;
μ
a ( t ) = ( d
a ( t ) N
a ( t ) − m
a
C
a ( t ))/ N
a ( t )
21–26, 29–33
θ
a ( t ): catch-up vaccination coverage rate for adolescents in year t ;0.95 (For population aged 8–15 years in 2009–2011).
28
q
a : age-specific proportion of acute HBV infections that became chronic per year;
1, 34, 36
0 ≤ a < 1 year0.301 ≤ a ≤ 4 years0.255 ≤ a ≤ 15 years0.0616 ≤ a ≤ 100 years0.03
β
a (1992): age-specific transmission rate of HBV in 1992.See Fig. 2e
15, 40
The age-specific seroclearance pattern of hepatitis B surface antigen (HBsAg) in chronic hepatitis B virus (HBV) infections of China remains unclear. In this study, based on three national serosurvey data of hepatitis B in China, we propose an age- and time-dependent discrete model and use the method of non-linear least squares to estimate the age-specific annual rate of HBsAg seroclearance. We found that the HBsAg seroclearance in chronic HBV infections of China aged 1–59 years occurred at an average annual rate of 1.80% (95% CI, 1.54–2.06%) from 1993 to 2006. The HBsAg seroclearance occurred predominantly in the early childhood, 20–24 and 35–39 year age groups. Moreover, our model estimated that HBsAg seroclearance resulted in 23.38% of the decrease of total HBsAg prevalence for population aged 1–59 years in 2006. It also prevented 9.30% of new HBV infections (about 7.43 million people) and 9.95% of HBV-related deaths (about 0.25 million people) from 1993 to 2006. This study develops a new and efficient method to estimate the age-specific incidence of HBsAg seroclearance at a population-level and evaluate its effect.
“…After hepatitis B vaccine was included in the planned immunization in China in 1992, the infection rate (HBV positive) decreased from 9.75% to 7.18% in 2006, in which the HBsAg positive rate for children under 5 years of age has decreased to <1% . However, individuals infected by HBV in childhood are more likely to develop CHB than those infected in adulthood; in China, 80% of the CHB patients were initially infected in childhood.…”
Achieving ‘clinical cure’ in children with chronic hepatitis B (CHB) with safe and effective antiviral treatment is an unmet medical need. Peginterferon (PegIFN) has higher hepatitis B s antigen (HBsAg) clearance than nucleoside analogs (NUC). Currently, studies on interferon (IFN) in the treatment of Chinese children with CHB are relatively rare. This study aimed to further explore the efficacy of PegIFNα‐2a as an antiviral treatment in Chinese children and analyse the long‐term follow‐up after drug discontinuation. We enrolled 118 patients with CHB (2‐16 years old, 79 cases are males) treated with PegIFNα‐2a by the author in the Third People's Hospital of Kunming City from February 2009 to February 2015. The course of treatment was 52 weeks, with a follow‐up period of 104 weeks. All the patients completed at least 1 dose, of which 104 completed at least 36 weeks of treatment and 104 weeks of follow‐up. During treatment and follow‐up, indicators such as alanine aminotransferase (ALT), hepatitis B virus (HBV) DNA and HBV serological markers were monitored, and the efficacy and safety of PegIFNα‐2a in the treatment of CHB patients were observed. Hepatitis B e antigen (HBeAg) clearance and seroconversion rates were 53.8% and 49%, respectively, when the drug was discontinued; 72.1% and 72.1%, respectively, at the end of the follow‐up; and 98.2% and 98%, respectively, for sustained response. HBsAg clearance and seroconversion rates were 48.1% and 47.1%, respectively, when the drug was discontinued; 53.8% and 52.9%, respectively, at the end of the follow‐up; and 94% and 95.9%, respectively, for sustained response. The HBV DNA suppression rate was 89.4% when the drug was discontinued, 90.4% at the end of the follow‐up and 97.8% for sustained response. Two patients had virological relapse (2.3%) during follow‐up; however, no clinical relapse occurred. Multivariate regression analysis showed that genotype B, weight < 25 kg or between 25 and 45 kg, and reduction of HBsAg by more than 1 log following 24 weeks of treatment were independent predictors of HBsAg clearance at the end of follow‐up. Adverse events that occurred during treatment were similar to those reported in previous clinical studies on PegIFN. The results of this study showed that PegIFN was safe and effective in the treatment of children with CHB, and sustained response could be achieved after treatment. PegIFN treatment of children with CHB helps more achieve ‘clinical cure’.
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