1. Research on HBV in SCDC Xi Zhang, Ye Lu Shanghai Municipal Center for Disease Control and Prevention May, 2008

2. Content Situation of Chronic HBV Infection Immunology of HBV Infection Immunization of HBV Research on HBV Related Fibrosis in SCDC

3. Content Situation of Chronic HBV Infection Immunology of HBV Infection Immunization of HBV Research on HBV Related Fibrosis in SCDC

5. Ratio of HBsAg carrier ---7.18% Population of HBsAg carrier --- 93 million (by the year of 2006)

6. Percentage of different types of virus in virus hepatitis in China from 1990-2004

7. Percentage of different types of virus in virus hepatitis in Shanghai in 2007

8. Content Situation of Chronic HBV Infection Immunology of HBV Infection Immunization of HBV Research on HBV Related Fibrosis in SCDC

9. 1. Electron Microscope Photo of HBV Dane Particle Globular Particle Tubal Particle

10. 2. Dane Particle  Complete particle, infective HBV  Spherical, double capsid outer capsid HBsAg inner capsid HBcAg, HBeAg internal DNA ---circular, double stranded DNA polymerase

11. 3. Genome of HBV pre-s1 pre-s2 S P C pre-c X HBV DNA 3.2 kb 编码 pre-S1 pre-S2 S HBsAg pre-C HBeAg C HBcAg P DNAP X HBxAg Gene Gene production (protein)

12. 4. Clinical Significance of HBV Related Antigen and Antibody  HBsAg Time of Appearance --- 2 to 6 months after HBV infection Time of Lasting --- less than 6 months for acute infection or life time for chronic infection

13. Persisted Express HBsAg HBV S Gene Integrate Hepatic Cell DNA Subtype of HBsAg adr adw ayr ayw North of Yangzhi River South of Yangzhi River West area of China Produce of HBsAg

14.  Anti-HBs Time of Appearance --- late stage of acute infection or after clearance of HBsAg The appearance of anti-HBs implies the recovery from HBV infection.

15. HBcAg is expressed ---in the HBV infected hepatitis cells or on inner capsid of Dane particle  HBcAg HBcAg cannot be detected in serum.

16.  Anti-HBc Time of Lasting --- 6 -18 months Type of antibody ---IgM: indicate the recent infection or activity of chronic infection IgG: indicate previous infection

17.  HBeAg: the degradation product of HBcAg HBV C gene Pre C C preC / C protein HBeAg HBcAg Gene Expression split 、 process Secreted outside cell HBeAg can be detected in serum, implies strong virus replicate and infectivity.

18.  Anti-HBe Time of Appearance --- after clearance of HBeAg The appearance of anti-HBs implies the reduction of virus replicate and infectivity.

19. Clinical Implication of Antigen & Antibody of HBV

20. Content Situation of Chronic HBV Infection Immunology of HBV Infection Immunization of HBV Research on HBV Related Fibrosis in SCDC

21. Progression from HBV infection to cancer Exposure to HBV No infection Chronic infection Cirrhosis Asymptomatic carriers Slowly Progressive HCC ?%?% ?%?% 10% Years Infection Acute infection (HBV clearance) 90% Death ~25%

22. Iatrogenic Sexual Maternal-neonatal Transmission of HBV Infection

24. The younger the infection age, The worse the prognosis  Infected at birth, almost all will develop into chronic hepatitis  Infected at 1-2 year old, 80% will develop into chronic hepatitis  Infected at 3-6year old, 50% will develop into chronic hepatitis  Infected at adult, only 2-6% will develop into chronic hepatitis

25. HBV Vaccine Immunization in China Immunized object  New born  Juvenile  High risk population

26. HBV Vaccine Immunization in China Immunized object  New born  Juvenile  High risk population

27. 1992.01.01 2002.01.012005.06.01 Immunization of new born was administered under immunization program. Immunization of new born was free, with only ￥ 10 fee. Immunization of new born was totally free.

28. 1~5~10~15~20~30~40~50~60~ 0 2 4 6 8 10 12 Percentage of HBsAg Carrier (%) 2002 1992 3.1 4.8 7.1 9.7 10.2 11.3 Effect of HBV Immunization in China In 2006, the data are 0.96% and 2.42% Age

30. Content Situation of Chronic HBV Infection Immunology of HBV Infection Distribution and Immunization of HBV Research on HBV Related Fibrosis in SCDC

31. Healthy CLD HCC (Disease process) Exposure to HBV Metastasis Chronic inflammation Chronic infection CirrhosisHCC Fibrosis  Liver fibrosis is the middle stage in the course of chronic hepatitis B virus infection.  Liver fibrosis is reversible.  Liver fibrosis will develop into cirrhosis and eventually HCC if not treated at early stage.

32. Reversible of liver fibrosis Ramón Bataller and David A. Brenner, J. Clin. Invest,2005, 115:209–218

33. Research on early diagnosis of HBV related liver fibrosis DIGE SELDI Clinical feature of subjects Table 1 Table 2

34. DIGE Result 12 up-regulated 18 down-regulated SELDI Result 7 up-regulated 13 down-regulated Peptide identification in process Data analysis in process

35. Conclusion HBV infection is the most important pathogen of virus hepatitis in China. Antigen and antibody against HBV infection are useful in clinical diagnosis. Immunization of HBV vaccine can prevent HBV infection in children. Research on HBV related disease is highly interested in China.

36. Acknowledgement Laboratory of Microbiology, SCDC Department of Molecular Biology for Public Health, SCDC Department of Immunization, SCDC Department of Acute Infectious Disease Prevention, SCDC China CDC

37. Thank you for your attention !