It is very important to eliminate high risk screening of hepatitis and block mother to child transmission
Director / Chen Jinjun, deputy director of Department of infection, Nanfang Hospital, Southern Medical University,
Peng Jie, deputy director of Department of infection, Nanfang Hospital, Southern Medical University
Liu Zhihua, deputy chief physician, Department of infection, Nanfang Hospital, Southern Medical University,
Jinyang network reporter Wang Nan correspondent Li Xiaoshan reported: hepatitis is a kind of liver inflammation, virus infection is the most common cause. Among them, hepatitis B and C lead to hundreds of millions of people suffering from chronic liver disease, and are the most common causes of liver cirrhosis and liver cancer.
Timely screening for hepatitis C in high risk population
It is understood that China has more than 9.8 million people with chronic hepatitis C infection, which is the largest country with hepatitis C infection in the world. Professor Chen Jinjun, Department of infection, Nanfang Hospital, Southern Medical University, pointed out that compared with the well-known hepatitis B, hepatitis C may also evolve into cirrhosis and liver cancer. Studies have shown that 20 years after HCV infection, the incidence of liver cirrhosis is about 20%, the annual incidence of decompensated liver cirrhosis is 3-4%, and the annual incidence of hepatocellular carcinoma is 2-4%, which is very harmful to the health and life of patients and the public.
“The routes of transmission of hepatitis C include blood transmission, sexual transmission and mother to child transmission, among which blood transmission is the most important route.” Professor Chen Jinjun said that the main reason for the spread of hepatitis C is “unsafe injection”. In daily life, tattoos, ear holes, sharing razors and toothbrushes will also increase the risks. In China, the infection rate of hepatitis C among intravenous drug users is the highest, about 70-90%, while that among hemodialysis patients is 20-50%.
Therefore, according to the national health industry standard “hepatitis C screening and management”, in the past long-term injecting drug users should be regularly screened for hepatitis C. At present, maintenance hemodialysis patients should be regularly screened every six months. For those who have iatrogenic exposure, or need emergency invasive examination and invasive operation (including operation), corresponding screening should also be carried out. In addition, infants born to mothers with chronic hepatitis C infection should be tested for anti HCV (hepatitis C virus antibody) after 18 months of birth, or HCV RNA (hepatitis C virus quantification) after 1 month of birth.
Cure is the only way to block the spread of HCV
Peng Jie, chief physician of infection department in Nanfang Hospital of Southern Medical University, pointed out that the risk of chronic hepatitis C virus infection after acute infection is very high, about 55% ~ 80%. About 5-15% of the patients with chronic hepatitis C develop liver cirrhosis every year, followed by decompensation of liver cirrhosis, hepatocellular carcinoma and other serious adverse consequences. In this regard, he reminded that hepatitis C genotype III, higher age, longer duration of infection, higher alcohol consumption, male and HIV (HIV), HBV (hepatitis B virus) mixed infection are risk factors for the progress of liver fibrosis. For people with the above characteristics, treatment should be sought as soon as possible.
Hepatitis C virus belongs to RNA (ribonucleic acid) virus, which has a very high mutation rate. Therefore, there is still no vaccine that can be used for prevention, and the hepatitis C antibody produced by the body after infection does not have a protective effect, so reinfection will occur. Peng Jie said that through antiviral treatment, if HCV RNA (HCV quantitative) is still not detected 12 weeks after drug withdrawal, it can be regarded as a cure for hepatitis C. The cure of hepatitis C is the best way to block the spread of hepatitis C.
As for the new strategy for the treatment of hepatitis C, Peng Jie said that it has entered a new era of direct antiviral drugs (DAA) treatment from interferon treatment. DAA has achieved a cure rate of more than 95% for all genotypes, and also has the characteristics of less adverse reactions, short treatment cycle and convenient oral use. In order to maximize the efficacy of antiviral drugs, he pointed out that standardized treatment plans should be implemented as far as possible, including but not limited to strict management of drug resistance risk, drug quality, course of treatment and combination of drugs. At the same time, a new generation of hepatitis C DAA, which covers the whole genotype, has a shorter course of treatment and is not affected by drug resistance, will be on the market soon, which is the key to eliminate viral hepatitis in the future.
Although the efficacy of hepatitis C DAA is reliable, it is still difficult for some poor families to afford. It is understood that the project of “search up and down, cure hepatitis C” initiated by China primary health care foundation has been popularized in China. As the first project in Guangdong Province, Nanfang Hospital will provide free DAA drugs for patients who have received the minimum living allowance for more than one year and half a course of medicine for low-income people. At the same time, in order to solve the problem of difficulty in seeing a doctor for patients with hepatitis C, the infection department of Nanfang Hospital has opened a fast medical channel for patients with hepatitis C, which is convenient for patients with hepatitis C to diagnose and improve relevant examinations as soon as possible, and to obtain expert treatment guidance.
Breastfeeding does not increase the incidence of mother to child transmission
Mother to child transmission is one of the most important transmission routes of hepatitis B virus (HBV). Mother to child transmission of hepatitis B refers to the transmission of hepatitis B virus from mother to fetus or infant, including prenatal transmission, intrapartum transmission and postpartum transmission. According to Liu Zhihua, deputy chief physician of infection department in Nanfang Hospital of Southern Medical University, more than 90% of newborns infected with hepatitis B virus will become chronic infection, and about 15% – 40% of them will eventually develop into liver cirrhosis or even liver cancer. Blocking mother to child transmission is the most important link to reduce the infection rate of hepatitis B virus.
He introduced that there are two main measures to block the mother to child transmission of hepatitis B: one is the active and passive combined immunization of newborns: after the birth of newborns, it is better to inject the first dose of vaccine and hepatitis B immunoglobulin in 12 hours, which is the most important measure to block the mother to child transmission of hepatitis B. Second, antiviral intervention during pregnancy: for pregnant women with high viral load (i.e. HBV DNA & gt; 106 IU / ml), due to the strong infectivity, the possibility of mother to child transmission is high. Taking antiviral drugs can reduce the viral load and reduce mother to child transmission. Liu Zhihua pointed out that the detection of hepatitis B surface antigen (HBsAg) and surface antibody (anti HBS) in children’s blood after vaccination is the judgment standard. If HBsAg is positive, its titer is more than 10 ml U / ml, it means that the immunization is successful; if HBsAg is positive, it means that mother to child transmission has occurred and blocking is failed.
In addition, many hepatitis B mothers also worry about whether hepatitis B virus will be transmitted through milk. Liu Zhihua explains that breast feeding does not increase the incidence of mother to child transmission. There are three reasons: first, the detection rate of hepatitis B virus in milk is very low; the content is also very small; second, hepatitis B virus is a blood infectious disease, and hepatitis B virus cannot be transmitted through the digestive tract; third, the baby is vaccinated with hepatitis B vaccine And hepatitis B immunoglobulin immunity, the body has a protective antibody. As long as the baby immune success, even “big three yang” carrier mother can also breastfeed. On whether cesarean section can reduce the rate of mother to child transmission, he said, cesarean section will not reduce the rate of mother to child transmission. As long as the natural birth process is normal and the active and passive combined immunization is implemented in time after birth, there is no significant difference between the mother to child transmission rate and natural birth.
Free clinic notice:
July 28 is the World Hepatitis Day. In order to further arouse the public’s awareness of hepatitis B and hepatitis C, especially the high-risk groups, popularize the mother infant blocking strategy of chronic hepatitis B and expand the detection rate of chronic hepatitis C, establish the public’s correct understanding of viral hepatitis and eliminate hepatitis discrimination and misunderstanding, the liver disease center of southern hospital held the World Hepatitis Day on July 25 Free clinic and education activities.