news

한어Русский языкEnglishFrançaisIndonesianSanskrit日本語DeutschPortuguêsΕλληνικάespañolItalianoSuomalainenLatina

(Reporters Kong Tianjiao and Wang Aibing from People's Daily Health Client/Video reporters Zhou Jingru and Yao Zhuo) July 28 this year is the 14th "World Hepatitis Day". For the first time, my country's propaganda theme is determined as "Eliminate hepatitis, take positive action."

"After I graduated from university and was assigned to the infectious disease department, the first patient I encountered was a viral hepatitis patient." Li Lanjuan, an academician of the Chinese Academy of Engineering and director of the National Key Laboratory for Diagnosis and Treatment of Severe Infectious Diseases, recalled that it was "a large number of viral hepatitis patients" that led her to "knock" on the door of the infectious disease department. In the memory of Wang Guiqiang, director of the infectious disease department of Peking University First Hospital, when he just became a doctor in the infectious disease department, "there were many cirrhosis patients with big bellies and ascites in the ward."

That was a period that Li Lanjuan and Wang Guiqiang called "the spread of hepatitis B in China was very widespread." In 1992, my country launched a nationwide hepatitis B serological epidemiological survey, and it was from this survey that China's prevention and control of hepatitis B entered a new stage.

High incidence: Almost all doctors in the infectious disease department know how to treat liver disease

"In 1973, I had just graduated from college and was assigned to work in a hospital as an infectious disease doctor. I saw a large number of patients with severe hepatitis caused by viral hepatitis. In the 1980s, the mortality rate of severe viral hepatitis (liver failure) was very high. At that time, medical equipment was insufficient and technology was backward. Many patients could not receive effective treatment, and patients' families often knelt on the ground begging for help." Li Lanjuan recalled that as a young doctor at the time, she was very helpless.

In 1984, Wang Guiqiang also became an infectious disease doctor. "At that time, there were many hepatitis B patients, as well as many patients with cirrhosis and various liver decompensations. We often encountered patients with sudden gastrointestinal bleeding or coma. The mortality rate of patients was very high at that time. There were basically no suitable drugs, and they could only relieve symptoms. In order to ensure the treatment of these patients, almost every doctor in the infectious disease department had to understand the treatment of liver disease." Wang Guiqiang also recalled.

Hepatitis plays a very important role in the prevention and control of infectious diseases in China. "Among those infected with hepatitis B virus, most are virus carriers. Some never develop the disease, some develop chronic hepatitis, some suddenly develop liver failure, and a few patients develop severe liver diseases such as liver cancer," said Li Lanjuan.

The results of a nationwide hepatitis B serum epidemiological survey launched in 1992 showed that the prevalence of hepatitis B virus carriers in China was as high as 9.75%, far higher than the 8% "high prevalence area" defined by the World Health Organization. Therefore, at that time, China was classified as a hepatitis B high prevalence area.

"In order to change this situation, I read books and searched for information, trying to find a way to change this 'high prevalence' trend," Li Lanjuan told reporters. Once, a female worker from a cotton textile factory in Hangzhou was sent to the hospital due to coma and was diagnosed with acute severe liver and kidney failure. At that time, the patient had no urine, so I used blood filtration, hemodialysis technology and activated carbon hemoperfusion to treat the patient.

After a week of rescue, the patient gradually regained consciousness. "This case may seem accidental, but it has greatly touched and inspired me. It is precisely because of this patient's treatment experience that I began to imagine using extracorporeal circulation devices, hemodialysis, activated carbon adsorption filtration and other technologies to design an 'artificial liver' support system to temporarily replace liver function." Li Lanjuan said that this was her original intention for artificial liver research and the beginning of her personal efforts to overcome hepatitis B-related diseases.

Prevention: Hepatitis B vaccine, the first medical protection measure in life

Influenced by the results of the hepatitis B serum epidemiological survey, hepatitis B vaccination was officially included in China's planned immunization management in 1992, and all newborns were vaccinated with hepatitis B vaccine. At that time, the hepatitis B vaccine and injection were all at the patient's own expense.

14 years later, in 2006, my country's second national hepatitis serological epidemiological survey found that the hepatitis B infection rate in the 1-59 age group in my country had dropped to 7.18%, a significant decrease compared with the infection rate of 9.75% in 1992.

In January 2002, my country officially included hepatitis B vaccine in its immunization program. Although the vaccine is free, people still need to pay for the vaccination. In 2005, my country began to implement a policy of free hepatitis B vaccination for newborns, ensuring that every newborn can get the hepatitis B vaccine for free.

Another 14 years later, the results of the 2020 national hepatitis B serological epidemiological survey showed that the hepatitis B virus in the general population of my countryantigenThe prevalence rate continued to decline, falling to 5.86% in 2020.

"The emergence of the hepatitis B vaccine is a major breakthrough in the medical field. Vaccination of newborns with hepatitis B vaccine can significantly reduce the risk of mother-to-child transmission, which is one of the main ways of transmission of hepatitis B virus." Li Lanjuan told reporters that the hepatitis B vaccine was included in the national Class I vaccine in 1992, which means that it has become an important part of a national public health strategy.

At the "2023 Hepatitis Elimination Action and World Hepatitis Day Promotion Conference", Wang Hesheng, deputy director of the National Health Commission and director of the National Disease Control and Prevention Bureau, introduced that the current vaccination rates of both hepatitis B and hepatitis A vaccines for children of appropriate age in my country have reached more than 90%, and at the same time, full coverage of prevention of mother-to-child transmission of hepatitis B has been achieved. It is particularly noteworthy that the surface prevalence of hepatitis B virus in people under 5 years old in my country is controlled below 1%, achieving the World Health Organization's (WHO) Targets for hepatitis B prevention and control in children proposed by the Western Pacific Region.

Treatment: From "finding drugs" to "selecting drugs", newer drugs and treatment methods emerge

While vaccination in my country is making great strides forward, antiviral treatment for hepatitis is also undergoing significant changes.

In the early 1990s, the only way to slow down the progression of the disease was to use liver-protecting and enzyme-lowering drugs. In 1992, although ordinary interferon was used, it was not widely used. It was not until 1999 that the first antiviral nucleoside drug was launched in China, ushering in a new era for the treatment of hepatitis B. However, this type of drug is prone to drug resistance, leading to viral rebound and/or transaminase rebound.

In 2016, WHO proposed the strategic goal of “eliminating viral hepatitis as a major public health threat globally by 2030”, requiring a 90% reduction in new infection rates and a 65% reduction in viral hepatitis-related mortality. Early diagnosis and treatment are the most important measures to reduce mortality, among which antiviral treatment is the top priority to achieve the goal.

"As more antiviral drugs come on the market, the treatment of hepatitis is constantly being optimized, and new independently developed antiviral drugs are gradually replacing old drugs." Wang Guiqiang mentioned that currently, the combination treatment of oral antiviral drugs and interferon has helped many patients achieve clinical cure.

Not long ago, Wang Guiqiang's clinic received a patient in his early 40s. "The patient has been using nucleoside drugs for more than four years, the viral load has remained negative, and the liver reserve capacity is good. We used long-acting interferon in combination with her. Three months later, the hepatitis B surface antigen disappeared." Wang Guiqiang said that it can be said that the patient achieved clinical cure through this regimen.

At the same time, the cost of hepatitis treatment has also received attention from all parties. More hepatitis treatment-related drugs have been included in the national medical insurance and centralized procurement, reducing the price of antiviral hepatitis drugs. "Take the hepatitis B antiviral drug entecavir as an example. When it was first launched, the monthly cost exceeded 1,000 yuan. With the entry into medical insurance and the emergence of domestic generic drugs, entecavir has become cheaper, costing only a few yuan a month," said Wang Guiqiang.

Conquer: my country has the technology and ability to eliminate hepatitis

In order to standardize the diagnosis and treatment of chronic hepatitis B, my country issued the first edition of the "Guidelines for the Prevention and Treatment of Chronic Hepatitis B" in 2005, and updated it in 2010, 2015, 2019, and 2022. "Through standardized antiviral treatment, the number of patients with ascites due to cirrhosis, hepatic encephalopathy, and terminal infection has been significantly reduced in clinical practice," said Wang Guiqiang, director of the Department of Infectious Diseases at Peking University First Hospital.

However, it is worth noting that there is still a large number of patients in our country who have not received treatment.

In order to eliminate the stock of hepatitis B, the China Hepatitis Prevention and Control Foundation launched the "Everest" project in April 2018. From April 2018 to June 2021, 30,000 eligible chronic hepatitis B patients were recruited and treated nationwide, helping some patients achieve clinical cure. Professor Gao Zhiliang of the Third Affiliated Hospital of Sun Yat-sen University mentioned that the Everest project has been carried out for nearly four years, 3,500 patients have been clinically cured, and the diagnosis and treatment skills of more than 1,000 trained doctors have been greatly improved.

Li Lanjuan once treated a male patient in his 50s. When he came to the clinic, his stomach was swollen like a ball. After various tests, the results showed that he had advanced liver cancer. "This patient used to be a chronic hepatitis patient. He did not have regular checkups or early antiviral treatment. When he came back for treatment, it was found that the virus had spread and the viral load was very high." Li Lanjuan described to reporters that fortunately, the patient had a liver transplant in time and was finally discharged from the hospital.

In clinic, many hepatitis B patients, like this patient, have already developed cirrhosis or liver cancer after visiting the clinic. For patients with liver disease, early antiviral treatment can control hepatitis B and cure hepatitis C virologically. Therefore, it is very necessary to achieve the "three earlys", namely early screening, early diagnosis, and early treatment.

Li Lanjuan's team has been researching liver failure, a critical illness caused by severe liver damage, since 1986. After decades of hard work, they have successfully created the new Li's artificial liver technology. From the single-mode treatment version 1.0 of artificial liver, to the personalized treatment version 2.0, to the current integrated mode treatment version 3.0, the cure rate of acute and subacute liver failure has increased from 11.9% to 78.9%, and the cure rate of chronic liver failure has increased from 15.4% to 43.4%.

Eliminating hepatitis means eliminating the harm of hepatitis. Wang Guiqiang also emphasized that hepatitis B screening should be carried out under the premise of fully protecting the privacy of patients, and the whole course of "hepatitis-cirrhosis-liver cancer" should be managed at the same time to further reduce the disease burden of liver cancer.

At present, more new drugs for the treatment of hepatitis are being developed in my country, such as direct antiviral drugs targeting the viral life cycle and indirect antiviral drugs involved in immune regulation, as well as therapeutic vaccines. Li Lanjuan and Wang Guiqiang both hope that more hepatitis patients will take the initiative to be screened and receive standardized treatment, so that there will be no more patients in my country who are harmed by hepatitis.