Consensus and Misunderstanding of Hepatitis B (Ⅱ)

Second, how to reduce the number of hepatitis B carriers

In order to remove the label of “hepatitis B country”, it is necessary to reduce the hepatitis B carrying rate of the population. On the premise that the population base is basically stable, the hepatitis B carrying rate depends on the molecular part-the number of hepatitis B carriers.

There are four ways to reduce the number of hepatitis B carriers:

A. Reduce the number of new hepatitis B carriers in the newborn population;

B. Reduce the number of new hepatitis B carriers in other populations;

C. cure exist hepatitis B carriers;

D. Natural death of hepatitis B carriers.

Of the above four routes, route C seems impossible at present, and route D is a natural law and cannot be intervened. Only routes A and B can be realized through vaccination.

Route A can only be accomplished through strict implementation of neonatal vaccination strategy. Neonatal vaccination strategy is also the hepatitis B control method with the highest performance-price ratio. Should be the focus of public health policy. At present, There are still many areas in our country where non-hospital childbirth occurs. This situation reduces the vaccination rate of hepatitis B vaccine for newborns within 24 hours. Even newborns who give birth in hospital, It is also possible to miss the opportunity to vaccinate hepatitis B vaccine in time due to the strict control of contraindications. There are also 5ug hepatitis B vaccine for newborns provided free of charge in most areas, which is less effective than 10ug hepatitis B vaccine in blocking mother-to-child transmission. The above three problems all affect route A and need to be seriously studied and solved.

Pathway B is mainly realized through the second-fourth vaccination strategy. However, due to the consensus of the second and first points, the number of hepatitis B carriers reduced by the second-fourth vaccination strategy is limited, and its significance for individual prevention of hepatitis B is greater than that for public health.

III. Vaccination Strategy of Hepatitis B Vaccine

The following vaccination of hepatitis B vaccine, if not specifically specified, refers to 3 doses of vaccination according to procedures 0, 1 and 6, namely:

Procedure [0]: 1 dose is currently inoculated;

Procedure [1]: The second dose was inoculated after 1 month.

Procedure [6]: The third dose was inoculated after 6 months.

1. Neonatal vaccination

The main transmission route of hepatitis B in China is from the mother of hepatitis B carriers to the newborn, so it has become a consensus that the newborn should be vaccinated with hepatitis B vaccine within 24 hours after birth. At present, the selection of vaccine dose and how to use hepatitis B immunoglobulin are slightly controversial.

Recommendations for vaccine dose selection:

At present, the doses of yeast hepatitis B vaccine for infants in China are 5ug and 10ug. If possible, 10ug dose vaccine should be selected for better effect. The doses of CHO hepatitis B vaccine are 10ug and 20ug, and 10ug is enough.

Recommendations for the Use of Hepatitis B Immunoglobulin:

Only newborns whose mothers are carriers of hepatitis B need to consider vaccination with hepatitis B immunoglobulin.

Hepatitis B immunoglobulin, as a human blood product, has potential safety risks. If the benefits do not exceed the risks, it should be avoided as much as possible.

If the newborn whose mother is a carrier of hepatitis B can only choose to receive 5ug of hepatitis B vaccine, Hepatitis B immunoglobulin should be inoculated at the same time. If 5ug of hepatitis B vaccine is inoculated alone, the success rate of mother-to-child blocking of hepatitis B is about 85%-90%, and if hepatitis B immunoglobulin is inoculated at the same time, the success rate of mother-to-child blocking of hepatitis B can be increased by 5-10 percentage points, and hepatitis B immunoglobulin can no longer be inoculated when the second dose of hepatitis B vaccine is inoculated one month later; If you can choose to vaccinate 10ug of hepatitis B vaccine, you can not vaccinate hepatitis B immunoglobulin, because there is new evidence that the success rate of mother-to-child blocking is higher if you vaccinate 10ug of hepatitis B vaccine alone than if you vaccinate 5ug of hepatitis B vaccine alone, but the success rate of mother-to-child blocking cannot be further improved if you vaccinate 10ug of hepatitis B vaccine and hepatitis B immunoglobulin at the same time.

There is no evidence that vaccination of pregnant women as carriers of hepatitis B can reduce the risk of mother-to-child transmission of hepatitis B, but vaccination of hepatitis B immunoglobulin increases the financial burden of patients and has potential safety risks.

2. Vaccination of high-risk population 2.1 High-risk population

The high-risk groups identified in < < Guidelines for Prevention and Treatment of Chronic Hepatitis B > > include:

1. Medical personnel (level B)

2. (Class C) Persons with regular exposure to blood

3. (Grade C) Nursery staff

4. (Grade C) Organ Transplant Patients

5. (Grade A) Regular Receiver of Blood Transfusion or Blood Products

6. People with low immune function (Grade C)

7. (Grade C) Susceptible to External Injury

8. Family members of HBsAg-positive persons (Grade B)

9. (Class A) Male homosexuality or multiple sexual partners

10. (Grade A) and Intravenous Drug Injectors A, etc.

(A, B and C are the marks I made.)

I basically agree with the division of this high-risk group, but the risk level can still be subdivided again, so as not to make anyone feel afraid after taking a corresponding seat. Among the above-mentioned groups, those with identification A have high risks, those with identification B have moderate risks, and those with identification C have lower risks. For those with A, I strongly recommend vaccination with hepatitis B vaccine. For B, I suggest to vaccinate hepatitis B vaccine. For C, I think hepatitis B vaccine can not be considered. Please note that I made the above suggestions mainly on the basis of points 2 and 1 mentioned in the consensus.

2.2 Check two and a half halves of hepatitis B before vaccination.

Before vaccination, It is strongly recommended that high-risk groups first detect two and a half halves of hepatitis B, Understand their own hepatitis B infection indicators. Two halves of hepatitis B have a total of 5 indicators, each indicator has negative or positive results, 5 indicators permutation and combination will have no less than 10 kinds of situations, clinical interpretation is also quite troublesome. In this only on whether to vaccinate against hepatitis B vaccine to make a judgment, can simplify the complex situation into two situations:

Case 1: All 5 indexes are negative; It is recommended to vaccinate hepatitis B vaccine.

Case 2: Any one or more of the five indicators are positive. Hepatitis B vaccine is not recommended.

The second situation is actually two possibilities:

Possibility 1: It is infected with hepatitis B virus and has recovered and produced protective antibodies (this is not necessary to vaccinate hepatitis B vaccine);

Possibility 2: Already a carrier of hepatitis B or a patient of hepatitis B (it is useless to vaccinate against hepatitis B in this case).

Detection of two and a half halves of hepatitis B is not necessary for vaccination against hepatitis B, Just to avoid misunderstanding and waste. For example: After vaccination still get hepatitis B, It may be considered that the vaccination is ineffective, and even that the vaccination of hepatitis B vaccine leads to hepatitis B (TA is actually the carrier of hepatitis B). It should be noted that if the two-and-a-half test results of hepatitis B are positive for any one or more of the five indicators, there will be no safety problem for hepatitis B vaccine vaccination, which is just a waste.

2.3 Inoculation Dosage

It is suggested that two-and-a-half high-risk groups with negative 5 indexes should be vaccinated with 10ug or 20ug of hepatitis B vaccine.

A. High-risk groups are generally adults, and the immune effect of hepatitis B vaccine with 10ug or higher dose is better than that of 5ug vaccine.

B. Even for children, it is recommended to replace 5ug of hepatitis B vaccine with 10ug of hepatitis B vaccine.

C. At the end of one month after the third dose of inoculation, two and a half indexes shall be detected:

If the hepatitis B surface antigen antibody turns positive (HBsAb), it is proved that hepatitis B immunity has been generated, and hepatitis B vaccine is no longer required in the future (even if the antibody turns negative in the future);

If HBsAb does not turn positive, two and a half can be tested after 3 doses of hepatitis B vaccine are vaccinated. If HBsAb turns positive, no vaccination is required thereafter. If HBsAb is still negative, re-vaccination should be abandoned. Attention should be paid to avoid high-risk behaviors at ordinary times (see point ⑤ of the consensus).

3. Vaccination of the general population

In view of the consensus on points 2 and 1, the possibility of ordinary people becoming hepatitis B carriers is very low, and hepatitis B vaccine can be vaccinated as needed. If the general population is transformed into a high-risk group, the vaccination strategy for high-risk groups will be implemented.

4. Vaccination for those with vaccination history

If HBsAb has never been detected and does not know whether HBsAb is positive, it is not recommended to vaccinate again.

If there is a record of HBsAb positive, hepatitis B vaccine will no longer be required in the future (including those who were positive before and then turned negative).

There is no HBsAb positive record, and it can only be re-vaccinated as needed if there is a clear risk of hepatitis B infection. If there is no risk of hepatitis B infection, no re-vaccination is required.