Universal Infant Hepatitis B Virus (HBV) Vaccination for 35 Years: Moving Toward the Eradication of HBV

Chang, Kai-Chi; Chang, Mei–Hwei; Chen, Huey‐Ling; Wu, Jia‐Feng; Chang, Chia-Hsuin; Hsu, Hong–Yuan; Ni, Yen‐Hsuan

doi:10.1093/infdis/jiab401

Cited by 25 publications

(29 citation statements)

References 15 publications

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“…Since the implementation of effective universal HBV vaccination in newborns 35 years ago, the HBsAg carrier rate in the vaccinated population has been reduced to <0.5% in Taiwan. 8 Together with spontaneous or therapy-induced HBeAg seroconversion in adult patients in the past years, HBeAg-positive patients with CHB have much decreased hence the proportion of HBeAg-negative patients in the population of CHB has increased from 25.6% with a mean age of 36.8 years in late 1980s 9 to 71.5% with a median age of 59 years in late 2010s, and >95% of the patients eligible for antiviral therapy were treated with ETV or TDF (unpublished data on file of this medical center). TDF has been mostly replaced by TAF recently.…”

Section: Current Status Of Antiviral Therapy In Chronic Hbv Infectionmentioning

confidence: 99%

Finite nucleos(t)ide analogue therapy in hepatitis B e antigen‐negative chronic hepatitis B: From an “option” to an “active recommendation”

Liaw

Chien

2022

The Kaohsiung J of Med Scie

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Nucleos(t)ide analogue (Nuc) including entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide may suppress hepatitis B virus (HBV) DNA profoundly but have no direct action on covalently closed circular DNA, which is a very stable template for HBV production. Therefore, decades of long-term Nuc therapy are required to maintain HBV suppression and to achieve hepatitis B surface antigen (HBsAg) loss in hepatitis B e antigen (HBeAg)-negative patients. However, there are concerns including financial burden, adherence, and willingness for indefinite long-term Nuc therapy. Patients lost to follow-up and hence not monitored may risk severe relapse that may deteriorate to hepatic decompensation or even hepatic failure. Cessation of Nuc therapy in HBeAgnegative patients was initially considered in early 2000s. Earlier findings in Asian patients that finite Nuc therapy over 2-3 years is feasible and safe have founded Asian-Pacific Association for the Study of Liver stopping rule since 2008. Subsequent studies have confirmed the feasibility and safety of the strategy of finite Nuc therapy, which has finally been accepted as "an option" by American and European liver associations since 2016. More recent large studies since 2018 have further confirmed the pivotal findingof greatly increased HBsAg loss rate (~5-year 39%) after stopping Nuc therapy. With the high HBsAg loss rate as the main justification, the paradigm shift from indefinite longterm therapy to finite Nuc therapy in HBeAg-negative patients has been changing from an "option" to an "active recommendation" aiming to achieve HBsAg loss. More studies are needed to fine-tuning the strategy, including research for the optimal duration of consolidation therapy, timing to stop, and to start retreatment.

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Section: Current Status Of Antiviral Therapy In Chronic Hbv Infectionmentioning

confidence: 99%

Finite nucleos(t)ide analogue therapy in hepatitis B e antigen‐negative chronic hepatitis B: From an “option” to an “active recommendation”

Liaw

Chien

2022

The Kaohsiung J of Med Scie

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“…During the past four decades, great progress has been made in the prevention and treatment of viral hepatitis [ 6 ]. Universal infant hepatitis B virus (HBV) vaccination has significantly reduced the prevalence of hepatitis B virus surface antigen (HBsAg) [ 7 ]. Nucleos(t)ide analogs suppress HBV replication and increase the rate of HBsAg seroclearance with favorable clinical outcomes, including a reduction in the incidence of hepatocellular carcinoma (HCC) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

et al. 2022

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Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.

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“…Taiwan is one of the best examples of a previously highly endemic country which benefited following mass vaccination, launched in 1984. In Taipei, the HBsAg prevalence in children decreased from 9.8% in 1984 to 0.4% in 2019 [ 62 , 63 ]. Moreover, the annual average incidence of HCC declined significantly in vaccinated children and teenagers compared to those not vaccinated [ 64 , 65 , 66 ].…”

Section: Effectiveness Of Vaccinationmentioning

confidence: 99%

Hepatitis B Vaccination: A Historical Overview with a Focus on the Italian Achievements

Romanò

Zanetti

2022

Viruses

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Vaccination is the most effective way to control and prevent acute and chronic hepatitis B, including cirrhosis and HCC, on a global scale. According to WHO recommendations, 190 countries in the world have introduced hepatitis B vaccination into their national childhood immunization programs with an excellent profile of safety, immunogenicity, and effectiveness. Following vaccination, seroprotection rates are close to 100% in healthy children and over 95% in healthy adults. Persistence of anti-HBs is related to the antibody peak achieved after vaccination. The peak is higher the longer the antibody duration is. Loss of anti-HBs does not necessarily mean loss of immunity since most vaccinated individuals retain immune memory for HBsAg and rapidly develop strong anamnestic responses when boosted. Evidence indicates that the duration of protection can persist for at least 35 years after priming. Hence, booster doses of vaccines are currently not recommended to sustain long-term immunity in healthy vaccinated individuals. In Italy, vaccination against hepatitis B is met with success. In 2020, Italy became one of the first countries in Europe to be validated for achieving the WHO regional hepatitis B control targets.

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Universal Infant Hepatitis B Virus (HBV) Vaccination for 35 Years: Moving Toward the Eradication of HBV

Cited by 25 publications

References 15 publications

Finite nucleos(t)ide analogue therapy in hepatitis B e antigen‐negative chronic hepatitis B: From an “option” to an “active recommendation”

Finite nucleos(t)ide analogue therapy in hepatitis B e antigen‐negative chronic hepatitis B: From an “option” to an “active recommendation”

MAFLD enhances clinical practice for liver disease in the Asia-Pacific region

Hepatitis B Vaccination: A Historical Overview with a Focus on the Italian Achievements

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