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Prevention of hepatitis B virus infection: from the past to the future

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Abstract

About 3–5 % of the world’s population is chronically infected by hepatitis B virus (HBV) and is at risk of developing liver cirrhosis or hepatocellular carcinoma. The risk of dying prematurely because of chronic HBV infection is higher in younger people. The current strategies to prevent HBV infection involve immunization (active and/or passive) and antiviral chemoprophylaxis. The vaccines available for active immunization, containing hepatitis B surface antigen, are safe and confer long-term immunity in most healthy subjects. Since the vaccination is unsatisfactory in some patients, e.g., those with chronic kidney disease, human immunodeficiency virus infection, type I diabetes mellitus, and celiac disease, new strategies of vaccination are required. The neonatal, infant, and adolescent routine program vaccination in about 180 countries has greatly decreased the disease burden. Passive immunization with specific HBV immunoglobulins is recommended after single acute exposure, in infants born to infected mothers, and in HBV-infected patients undergoing liver transplantation combined with nucleoside/nucleotide analogues (chemoprophylaxis). Chemoprophylaxis is also indicated in HBV carrier candidates for immunosuppressive treatment and in patients with occult B infection undergoing immunosuppressive therapy or hematopoietic stem cell transplantation. Since HBV is not eradicable by an immune response or by antiviral drugs developed so far, the only preventive strategy remains global neonatal vaccination in all countries, firstly in HBV-endemic countries.

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Notes

  1. The plasmid DNA vaccines rely on a small part of circular DNA capable of reproducing itself in bacteria; the desired gene can be inserted into plasmid and, so, injected in the host’s tissue; they can bypass the several problems linked to the other systems of gene transfer, in which DNA is packaged into recombinant viral vectors or attached to cationically charged molecules, such as the immune responses against the delivery vector [92].

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Acknowledgments

We are indebted to Jean Ann Gilder, Scientific Communication Srl (Naples, Italy), for editing the manuscript.

Author contributions

Tosone G and Orlando R designed the study and overviewed the manuscript; Foggia M and Mascolo S carried out the systematic review of data on chemoprophylaxis with antiviral drugs; Palmiero G and Tambaro O carried out the systematic review of data on vaccines against hepatitis B; Maraolo AE carried out the systematic review of data on occult B infection. All authors contributed to interpreting the data and writing the manuscript, and read and approved the final manuscript.

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The authors declare that they have no conflicts of interest.

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  1. Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy

    R. Orlando, M. Foggia, A. E. Maraolo, S. Mascolo, G. Palmiero, O. Tambaro & G. Tosone

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  1. R. Orlando
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  2. M. Foggia
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Orlando, R., Foggia, M., Maraolo, A.E. et al. Prevention of hepatitis B virus infection: from the past to the future. Eur J Clin Microbiol Infect Dis 34, 1059–1070 (2015). https://doi.org/10.1007/s10096-015-2341-x

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