I. The Infectious Nature of Hepatitis B

I. The Infectious Nature of Hepatitis B

Traditionally, people believed that hepatitis B was an infectious disease with strong transmissibility—especially for patients who tested positive for the E antigen (commonly known as "big three positives"), whose HBV-DNA levels consistently exceeded 10^3. Some also believed that the higher the level of HBsAg, the greater the infectivity. However, through more than 20 years of clinical observation, I found that individuals negative for the E antigen were virtually non-infectious; they could marry normally and have healthy children, with over 90% of their offspring being healthy and free from infection. Those positive for the E antigen did exhibit some degree of infectivity, though not as "highly contagious" as commonly perceived. We observed the following patterns: ① Among mothers who were infected, many of their children became ill, while fathers who were infected had few or no children who developed the disease; ② In families where multiple members were infected—whether they were big three positives or small three positives—there was always at least one person who ate and lived with them and remained healthy throughout their lives; ③ In families where only one member was infected, while the rest of the family remained healthy, treatment tended to be smoother, and most cases could achieve complete recovery with medication. These patterns were based on long-term clinical experience and were not based on large-scale statistical data, but rather serve as reference for readers. Literature suggests that there are horizontal infections, vertical infections, blood-to-fetal infections, and perinatal infections. Horizontal infections occur through social contact and are often self-healing or easier to treat, with the virus being relatively easy to eliminate. Vertical infections, on the other hand, refer to infections transmitted from mother to fetus. These infections are closely linked to blood-to-fetal transmission and perinatal factors, but even more importantly, they involve the expression of genetic traits passed down from both parents, making such infections more difficult to treat and harder to eradicate. It was once believed that fetuses born to parents who were positive for the E antigen were more likely to develop hepatitis B; however, this view should now be completely abandoned. In recent years, when one or both parents of a child with hepatitis B receive preventive treatment during pregnancy, up to 98.5% of the fetuses remain healthy. The prevention treatment involves: ① Administering high-dose hepatitis B immunoglobulin injections at 28, 32, and 36 weeks; ② Administering high-dose immunoglobulin injections at 24 hours and on day 15 after the baby's birth; ③ Administering one dose of inactivated hepatitis B vaccine at 1 month, 2 months, and 6 months after the baby's birth. With these three interventions, the health rate of the fetus can reach ideal levels, greatly alleviating the anxiety of hepatitis B families. As early as the late 20th century, China began widely implementing preventive vaccinations for perinatal fetuses, and it has since been proven that the incidence of hepatitis B among children in China has decreased significantly compared to previous years.

In summary, the infectious nature of hepatitis B should be understood as follows: hepatitis B is indeed contagious, but only a small proportion of those infected with the hepatitis B virus go on to develop hepatitis B. Most people in the population have the ability to clear the hepatitis B virus from their bodies. So why do people react differently to the hepatitis B virus? This is a matter of genetic factors. Therefore, the onset of hepatitis B involves both internal and external factors—just like philosophical principles, where internal factors are the underlying causes and external factors are the conditions. The former are the primary factors, while the latter are secondary factors. Based on this reasoning, the spread of hepatitis B in the population is not simply determined by its high infectivity; some foreign scholars have even proposed that hepatitis B should be classified as an autoimmune disease rather than continuing to be regarded as an infectious disease. Of course, this is just one perspective, and it is not yet sufficient to draw definitive conclusions.