Ray Gautam
Gastroenterology Unit, Department of Medicine, B.R.Singh Hospital, Kolkata, India.
J Clin Transl Hepatol. 2017 Sep 28;5(3):277-296. doi: 10.14218/JCTH.2017.00024. Epub 2017 Jul 8.
Hepatitis B is a significant public health problem in India, yet disease awareness is very low among the general population. The disease is mostly acquired horizontally, but the role of vertical transmission should not be underestimated. In spite of the fact that the majority of cases are e negative disease, most patients present in the advanced stage and even with hepatocellular carcinoma, the leading cause of which is hepatitis B. High-risk groups (especially tribals) also harbour significant disease burden and have a high prevalence of occult infection, supporting the potential of unknowingly spreading the disease. Findings on the relation of genotypes with disease severity or drug action have been conflicting. Though recently, oral antivirals with high genetic barrier to resistance have shown good viral suppression in the long term, e and s seroconversion is poor and relapse is universal upon therapy discontinuation. As no cure is possible with the currently available therapy, the target is long-term viral suppression by prolonged administration of oral antivirals; unfortunately, this leads to poor treatment adherence, which along with the high cost of therapy results in disease progression and spread of infection. At present, therefore, emphasis should be put on health education of the general and high-risk populations, along with health care workers to increase knowledge on such preventive measures as avoiding unsafe injection practices, high-risk sex, performing unnecessary injection and blood transfusion and providing proper screening of blood products; these efforts should be combined with intensive screening and aggressive vaccination programs, especially in high-risk groups and areas of high endemicity. Vaccination strategies are still below par and logistics should be developed for wider coverage; in addition, further research should be carried out on the efficacy and mode of usage for different types of vaccine.
在印度，乙型肝炎是一个重大的公共卫生问题，但普通人群对该疾病的认知度非常低。这种疾病大多通过水平传播获得，但垂直传播的作用也不应被低估。尽管大多数病例为e抗原阴性疾病，但大多数患者就诊时已处于晚期，甚至患有肝细胞癌，而其主要病因就是乙型肝炎。高危人群（尤其是部落人群）也承受着巨大的疾病负担，隐匿感染的患病率很高，这表明该疾病有可能在不知不觉中传播。关于基因型与疾病严重程度或药物作用之间关系的研究结果一直存在矛盾。尽管最近，对耐药具有高基因屏障的口服抗病毒药物长期显示出良好的病毒抑制效果，但e抗原和s抗原血清转换较差，停药后复发普遍。由于目前可用的治疗方法无法治愈，目标是通过长期服用口服抗病毒药物实现长期病毒抑制；不幸的是，这导致治疗依从性差，再加上治疗费用高昂，从而导致疾病进展和感染传播。因此，目前应重视对普通人群和高危人群以及医护人员的健康教育，以增加对诸如避免不安全注射行为、高危性行为、进行不必要的注射和输血以及对血液制品进行适当筛查等预防措施的认识；这些努力应与强化筛查和积极的疫苗接种计划相结合，特别是在高危人群和高流行地区。疫苗接种策略仍不尽人意，应制定物流方案以扩大覆盖范围；此外，应进一步研究不同类型疫苗的疗效和使用方式。
