Curing chronic hepatitis B in children transmitted vertically from mother to child is no longer a dream!

Xixi, who is over three years old, is a cute pet and the apple of her parents' eyes.

The fall semester started, and Xixi's parents wanted to send her to kindergarten. Unfortunately, Xixi's pre-school physical examination showed problems: her liver function was abnormal and her transaminase level was high.

The teacher informed Xixi's parents to take the child to a large hospital for examination, saying that Xixi's physical health condition did not meet the requirements and would not be admitted for the time being.

This news was like a bolt from the blue, leaving Xixi's parents breathless.

The mother was even more nervous and uneasy, because Xixi's mother herself had hepatitis B "big three positive", and had been to the hospital for a checkup. Because her liver function had always been normal, the doctor said that she did not need treatment for the time being, so Xixi's mother slacked off and had not been to the liver disease department since she became pregnant. After Xixi was born, she was even busier and had not had a checkup.

"Could it be that I passed the hepatitis B to my child?" Xixi's mother was anxious.

Xixi's mother herself has hepatitis B, which is also caused by Xixi's grandmother who also had hepatitis B. The grandmother had hepatitis B and died of cirrhosis and ascites. The grandmother gave birth to four children, three of whom had hepatitis B.

Xixi's mother knew that hepatitis B transmitted from generation to generation within the family was the most difficult to cure, and that curing chronic hepatitis B transmitted vertically from mother to child was simply like a dream. Otherwise, she herself would not have suffered from hepatitis B all her life.

Despite this, Xixi's mother still plans to take Xixi to the hospital for treatment.

The next day was Sunday. Xixi's mother got up early, woke up Xixi from her sleep, and went to the Liver Disease Department of the Third Hospital of the City for a check-up on an empty stomach.

The Hepatology Department of the Third Municipal Hospital is a key specialty in the city. On Sunday, the hepatology outpatient clinic was crowded. After waiting for more than two hours, it was finally Xixi and her mother's turn.

Xixi's mother told the doctor, "My child is going to kindergarten, but the examination found that her liver function is abnormal. She may have hepatitis B."

As he spoke, his eyes became wet.

The female doctor asked the mother, "Have you ever had hepatitis B?"

Xixi's mother nodded and said, "I have Hepatitis B virus (big three positive)"

"Did you take any medicine to prevent vertical transmission of hepatitis B from mother to child when you were pregnant?"

The mother shook her head in regret. "I never used it. Xixi is my second child. I gave birth to a son before. He is now 6 years old. All the examinations were fine. I thought Xixi would not have any problems either, so I did not come to the liver disease department for a follow-up check after I became pregnant. I only had a few prenatal checkups at the obstetrics and gynecology clinic."

The female doctor asked again: "Has the child been injected with hepatitis B vaccine and hepatitis B high-titer immunoglobulin after birth?"

"I have received the injection. The obstetrician and gynecologist has specifically told me about it."

"You have positive hepatitis B virus, which means that the hepatitis B virus is actively replicating in your body. In this case, if there is no intervention, the probability of mother-to-child vertical transmission is over 70%. If only the hepatitis B vaccine and hepatitis B immunoglobulin are injected after the child is born, the blocking rate can be as high as 85-90%, but there is still about 10-15% of mother-to-child vertical transmission that cannot be blocked in utero. In this case, safe antiviral drugs need to be taken in the late pregnancy to block it. If these three measures are used reasonably, the blocking rate is almost 100%."

The mother remained silent. She felt very guilty and sorry for her daughter.

The doctor comforted her, "Don't worry, we are not sure whether the child has been infected with hepatitis B. I will do some tests for you first, and we will see after the results come out."

The next afternoon, the results came out. Xixi's mother asked a colleague to help cover for her, and she hurried to the Third Hospital of the city to see a doctor to check the results.

The female doctor who had just finished reading the test results skillfully told Xixi's mother:

"The child has been infected with hepatitis B, and the virus is actively replicating, and liver function is abnormal. Other common causes have been ruled out, and antiviral treatment is needed as soon as possible. You are also in the active stage of hepatitis B, with abnormal liver function and high transaminase. You also need to start antiviral treatment as soon as possible."

Xixi's mother was puzzled. "Doctor, Xixi and I have active hepatitis B now, but we don't feel any discomfort, especially Xixi. She is in good spirits all day long, has a good appetite and is never picky about food. She jumps around and is no different from other children. She doesn't look like a child with active hepatitis B. Isn't it said that when hepatitis B is active, people will have symptoms such as fatigue, poor appetite, and aversion to greasy food?"

The female doctor pushed up her glasses, smiled and said:

"You are right, but the clinical manifestations of the disease vary greatly from person to person. Some patients have only mild abnormalities in liver function, but may experience the typical symptoms you mentioned; some patients have obvious abnormalities in liver function, but do not feel any discomfort. For children, the clinical manifestations of the disease are even more atypical, and there is basically no discomfort in the early stages. It is difficult to detect without routine physical examinations."

The doctor patiently and carefully explained to Xixi’s mother the treatment of chronic hepatitis B in children, saying that the earlier the treatment, the better the effect and the higher the chance of HBsAg turning negative.

Finally, after communication between the doctor and Xixi's mother, Xixi's mother agreed that the doctor could use interferon to treat Xixi's hepatitis B, while the mother herself chose oral antiviral drugs for treatment.

The doctor said that children will feel a little uncomfortable at the beginning of interferon treatment, such as fever, fatigue, poor appetite, etc., but these symptoms will disappear after a few injections; during the course of the disease, hair loss and decreased blood cells may also occur, but these side effects are preventable and controllable. It is recommended to cooperate closely with the doctor during the injection, and timely discover and deal with side effects when they occur. Only by following the doctor's advice can most patients complete the treatment process smoothly.

Xixi's interferon antiviral treatment went smoothly. There was almost no discomfort, except for a decrease in neutrophil count. After taking drugs to increase white blood cells under the guidance of a doctor, her blood cells have been stable within a safe range.

Xixi has monthly checkups, and the results indicate that the treatment is very effective. The hepatitis B virus DNA level, hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) titers in Xixi's blood are continuing to decrease.

After six months of treatment, a follow-up examination revealed that the HBV-DNA, HBsAg and HBeAg in Xixi's blood had all turned negative.

Xixi's mother was ecstatic. She spun around while holding her daughter and shed tears of excitement: Xixi's disease can finally be cured. When she grows up, she will no longer be like herself, who had low self-esteem, was sensitive, suspicious and unsociable since childhood because of hepatitis B.

After 7 months of treatment, hepatitis B protective antibodies HBsAb appeared in Xixi's blood, and the antibody titer gradually increased. The doctor suggested that Xixi continue to consolidate the interferon treatment. After 1 year, a check-up of Xixi's blood HBsAb had reached more than 170IU/L.

The doctor said I could stop taking the medicine and observe.

So Xixi stopped taking the medicine after one year of treatment. The doctor said that Xixi needed to be closely observed after stopping the medicine and go to the outpatient clinic for a checkup once a month for three consecutive months. If the condition remained stable, the checkup intervals could be gradually extended.

Xixi has stopped taking the medicine for half a year now, and the condition has been stable according to follow-up examinations.

A heavy stone in the mother's heart finally fell to the ground.

A reminder to parents with babies suffering from hepatitis B: as long as early detection, early diagnosis and early treatment are carried out, it is not a dream to cure children with chronic hepatitis B through vertical transmission from mother to child and block the intergenerational transmission of chronic hepatitis B within the family!

Author: Wang Fang, Department of Hepatology II, Shenzhen Third People's Hospital