Professor Wu Jian: Raise the awareness of hepatitis E prevention and treatment among the whole people, and promote the further improvement of the level of hepatitis E diagnosis and treatment

Editor's note: July 28, 2024 is the 14th World Hepatitis Day, and this year's theme is "Eliminate Hepatitis, Take Action". At present, viral hepatitis is still the most common Class B infectious disease in mainland China. Hepatitis E (hepatitis E) is highly endemic in mainland China, and it still faces great challenges in diagnosis and treatment. In order to further standardize the in-hospital screening and management process of hepatitis E in mainland China, accurately assess hepatitis E, and reduce the disease burden, the China Hepatitis E Research Assistance Group (CCSHE), the Infectious Diseases Branch of the Chinese Medical Doctor Association, and the National Clinical Research Center for Infectious Diseases jointly formulated the Expert Consensus on the Management Process of In-hospital Screening for Viral Hepatitis E in China (2023 Edition) (hereinafter referred to as the "Consensus"). At the recent academic exchange meeting on the prevention and control of hepatitis E, Professor Wu Jian, chairman of the Laboratory Medicine Center of Suzhou Hospital Affiliated to Nanjing Medical University and CCSHE, interpreted the consensus. Professor Wu Jian was specially invited to share his insights and experience on the prevention and treatment of hepatitis E, diagnosis and treatment, etc., aiming to further enhance the awareness of viral hepatitis prevention and treatment among the whole people, and call on the whole society to take active actions to curb new infections to the greatest extent.

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Liver Disease International: Can you briefly describe the background to the consensus? What are the current challenges faced by mainland China in in-hospital screening for hepatitis E?

Prof. Wu Jian: With the goal of eliminating viral hepatitis as a public health hazard by 2030 put forward by the WHO, the mainland has made remarkable achievements in the prevention and treatment of hepatitis B (hepatitis B) and hepatitis C (hepatitis C), and is in a leading position in the world. In terms of hepatitis B, the incidence of hepatitis B has decreased significantly, from 2699.35 per 100,000 in 1990 to 1384.26 per 100,000 in 2019, a decrease of 48.7%, and the prevalence of HBsAg in children under 5 years of age has also decreased significantly, close to the 2030 target. In terms of hepatitis C, thanks to the application of pan-genotype antiviral drugs, the cure rate after 8~12 weeks of treatment is more than 95%.

However, in the field of hepatitis E, the mainland still faces serious challenges, and its incidence has been on the rise in recent years and has been neglected for a long time. According to statistics, there are about 20 million cases of hepatitis E virus (HEV) infection worldwide every year, of which about 3.3 million cases of hepatitis E and 70,000 infection-related deaths. Over the past decade, although we have made significant progress in understanding hepatitis E, the situation is still not optimistic. A large number of HEV patients are underdiagnosed or misdiagnosed due to insufficient screening, especially the screening of HEV infection for key and special populations has been neglected clinically, which is very likely to increase the risk of chronic disease development and acute liver failure. In view of this, a consensus came into being, which brings together the wisdom of experts in infectious diseases, hepatology, laboratory medicine and hospital infection control, aiming to enhance the attention of medical institutions to hepatitis E, and provide a solid theoretical basis and practical guidance for accurate diagnosis, effective treatment, scientific prevention and control, and comprehensive health management of hepatitis E.

At present, the challenges faced by mainland China in the field of in-hospital screening of hepatitis E mainly include the following aspects:

01

Limited screening coverage: Current screening strategies have relatively narrow coverage and fail to fully cover all potential high-risk groups, which directly leads to the omission of a large number of HEV infection cases and affects the early detection and intervention of the disease.

02

Limitations of diagnostic technology: The actual disease burden of hepatitis E is significantly underestimated, and there are many shortcomings in existing laboratory diagnostic technologies, such as insufficient sensitivity of detection methods, the singleness of HEV IgM antibody detection limiting its detection efficiency, and significant differences in accuracy and consistency among various detection reagents on the market, all of which limit the accuracy and efficiency of hepatitis E diagnosis.

03

Lack of clinical awareness: Clinicians in non-infectious disease and non-hepatology departments have insufficient understanding of the dangers of hepatitis E and often ignore its potential as a potential etiology, especially when considering extrahepatic diseases, and rarely include HEV infection in the differential diagnosis, which further reduces the overall prevalence of hepatitis E testing.

04

Lack of treatment: There is still a lack of specific treatment drugs for HEV infection, and it is extremely difficult to treat patients with hepatitis E who have developed chronic or severe disease, and it is urgent to develop new treatment methods to improve the prognosis of patients.

In summary, in view of the problems and challenges existing in in-hospital screening of hepatitis E in mainland China, it is urgent to strengthen multidisciplinary cooperation, expand the scope of screening, optimize diagnostic technology, improve clinical understanding, and actively explore effective treatment strategies to comprehensively promote the in-depth development of hepatitis E prevention and control.

Liver Disease International: In your interpretation of the consensus, you mentioned the optimization of the in-hospital screening management process, which is important for healthcare facilities to more effectively identify and manage patients with hepatitis E. What are the highlights of the consensus that reflect this optimization?

Prof. Wu Jian: The highlight of the consensus lies in its deep integration of systematization and practicability, which is embodied in the following aspects, which together form the core framework for the optimization of the hepatitis E screening management process in the hospital:

01

Screening process: The consensus clarifies the standardized path of the screening process, specifies the specific steps and methods of screening, and ensures the consistency and standardization of the screening work. This standardized process has significantly improved the accuracy and efficiency of screening results, laying a solid foundation for the early detection of hepatitis E.

02

Diagnostic criteria: The consensus clearly defines the diagnostic criteria and provides detailed diagnostic evidence and procedures, aiming to help medical staff accurately identify patients with hepatitis E and effectively reduce the occurrence of misdiagnosis and missed diagnosis.

03

Treatment and isolation measures: The consensus emphasizes the timely isolation and standardized treatment of patients diagnosed with hepatitis E, and clarifies the specific implementation requirements of isolation measures and the principles of scientific formulation of treatment plans. This not only helps to reduce the risk of transmission of the virus in medical institutions and ensures the safety of patients and medical staff, but also promotes the standardization and individualization of the treatment process and improves the treatment effect.

04

Information sharing mechanism: The consensus advocates the construction of an information sharing mechanism between medical institutions, aiming to improve the coordination and efficiency of screening and prevention and control by strengthening information exchange and collaboration.

05

Patient education and communication: In addition, the consensus emphasizes the importance of patient education and communication, and points out that health education and communication should be strengthened to help patients have a comprehensive understanding of their condition and prevention and treatment measures, and improve their treatment compliance and self-management capabilities.

International Liver Disease: What important progress has been made in the field of hepatitis E diagnosis and treatment in mainland China?

Professor Wu Jian: In recent years, under the leadership of Academician Zhuang Hui, Academician Li Lanjuan and Academician Xia Ningshao, many remarkable progress has been made in the field of hepatitis E diagnosis and treatment in mainland China.

01

Screening and diagnosis

In terms of the scope of screening, more specific and targeted screening suggestions are put forward for susceptible groups and high-risk groups, such as the elderly, individuals with underlying liver diseases, and women of childbearing age, to ensure comprehensive coverage and efficient implementation of screening.

In terms of detection technology, on the basis of the combination of serological detection and viral nucleic acid detection, new methods such as antigen detection have been introduced, which have significantly improved the accuracy and sensitivity of hepatitis E diagnosis.

In terms of diagnostic criteria, with the deepening of the understanding of hepatitis E, the diagnostic criteria have been updated to clarify the different conditions of acute infection, chronic infection and previous infection, providing clinicians with a clearer basis for diagnosis.

02

Treatment algorithm

In terms of treatment strategies, a comprehensive treatment strategy has been formulated for different stages of hepatitis E, from ordinary infected patients to acute severe and chronic patients, including antiviral therapy, artificial liver supportive therapy, and microecological regulation therapy, so as to achieve personalized and precise treatment.

In terms of monitoring and management, the indicators and time points that need to be monitored during the treatment period, as well as the comprehensive management of untreated or failed patients and the adjustment principles of treatment plans are clarified to ensure the continuity and effectiveness of treatment.

In addition, we have strengthened the management of follow-up and follow-up visits, and standardized the follow-up process, which helps doctors to continuously track the changes in patients' conditions, adjust treatment plans in a timely manner, and improve treatment outcomes.

03

Patient education and self-management

The importance of popular science education in the hospital was further emphasized, and the awareness of patients about hepatitis E was improved by strengthening patient education, and the self-management ability and treatment cooperation of patients were enhanced, which was helpful to promote the recovery of patients.

04

Emphasis is placed on extrahepatic manifestations

In addition, the extrahepatic manifestations of hepatitis E have received increasing attention. HEV infection not only affects the liver, but may also affect multiple organs such as the nervous system, blood system, and renal system, suggesting that hepatitis E is a systemic disease. Future research directions will be more diversified, including in-depth investigation of the distribution of HEV infection rate, genotype and subtype, exploring the pathogenesis and prevention strategies of HEV infection in women with severe hepatitis and pregnancy, and developing new HEV antiviral drugs.

International Liver Disease: Under the theme of this year's World Hepatitis Day, "Eliminate Hepatitis, Take Action", what is the significance of consensus in promoting the prevention and control of hepatitis E?

Prof. Wu Jian: In the context of the theme of this year's World Hepatitis Day, the consensus has undoubtedly injected new impetus into the prevention and control of hepatitis E, and its significance is reflected in the following aspects:

01

Strengthening awareness and vigilance: The consensus first strengthened the awareness of all sectors of society about the severity of hepatitis E, raised the awareness of medical professionals and the general public about hepatitis E, and laid a solid foundation for subsequent prevention and control work.

02

Standardized screening process: The consensus clarifies the standardized screening process for hepatitis E and ensures the standardization and accuracy of screening. This helps to detect and diagnose hepatitis E patients in a timely manner, especially those with severe and chronic infection, and effectively reduces the number of missed diagnoses and misdiagnoses.

03

Promoting multidisciplinary cooperation: The consensus emphasizes the synergy and cooperation between multiple disciplines and departments within medical institutions, promotes the application of cross-field and interdisciplinary cooperation models in the prevention and control of hepatitis E, helps to achieve comprehensive and systematic management and control, provides clear guidance for patient consultation, referral, treatment and follow-up, and helps to optimize the diagnosis and treatment experience, improve treatment effects and improve quality of life.

04

Expanding the scope and depth of screening: The consensus also increased the awareness and understanding of hepatitis E among non-infectious disease and non-hepatologists, which helped to expand the scope and depth of screening.

05

Provide data support and policy guidance: The consensus includes quality control indicators and specific requirements for data collection, which provides a scientific basis for monitoring and evaluating the effectiveness of prevention and control measures. These data can not only reflect the effectiveness of prevention and control efforts, but also provide valuable data support for policymakers to promote the effective allocation and rational use of public resources.

06

Promoting global prevention and control: Consensus is undoubtedly an important milestone in achieving the 2030 target set by the World Health Organization. It not only provides a concrete action plan for the prevention and control of hepatitis E in China and the world, but also emphasizes the central role of systematic management and interdisciplinary cooperation in the control of hepatitis E. The implementation of these comprehensive measures will help reduce the incidence and mortality of hepatitis E, protect people's health, and promote the continuous development of global hepatitis E prevention and control.

Professor Wu Jian's message on "World Hepatitis Day".

In the prevention and treatment of hepatitis B, hepatitis C and hepatitis E, the key lies in "early screening, early prevention and early treatment". Advances in testing technology have made it possible to diagnose early, which is the key to achieving the best possible treatment outcomes. Therefore, we call on all sectors of society to pay attention to the screening of key populations and specific populations, move the prevention and treatment threshold forward, and carry out diagnosis and treatment as soon as possible. This can not only effectively reduce the severe disease rate and mortality rate of patients, but also an important step towards the goal of eliminating viral hepatitis. We call on the whole society to work together to contribute to the prevention and control of hepatitis.