Hepatitis B historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
While epidemics of jaundice have been observed throughout history, it wasn’t until the late 19th century that the first identifiable instance of Hepatitis B was documented during an outbreak of smallpox in Germany leading to the vaccination of shipyard workers with contaminated human lymph.[1] Throughout the 20th century, advancements in the recognition, isolation, classification, and prevention of hepatitis B were achieved. Today, the focus around HBV remains on the spread of awareness and prevention across the world, especially in endemic areas that would benefit greatly from immunization programs.
Historical Perspective
Early History
Although the first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates in the 5th century BCE,[2] the earliest identifiable occurrence of hepatitis B virus was documented in 1885 by Lurman. [1] He described a form of hepatitis that was transmitted by direct inoculation of blood or blood products during a smallpox outbreak in Bremen, Germany.[3] Thousands of shipyard employees were vaccinated against smallpox with a preparation made from human lymph. Several weeks to 8 months later, 15% of the workers became ill with jaundice while the unvaccinated workers remained healthy. Lurman's paper, now regarded as a classic example of an epidemiological study, proved that contaminated lymph was the source of the outbreak.[1]
20th Century
During the early 20th century, similar outbreaks of jaundice occurring after longer incubation periods were documented in clinics treating syphilis, diabetes, and tuberculosis.[3] Specifically, in the 1920's, reports came from German and U.S clinics treating syphilis with intravenous therapy.[4] At the time, the so-called "salvarsan icterus" was thought to be a direct effect of the treatment for syphilis and not from the use of contaminated needles and syringes. In 1926, Flaum, Malmros, and Persson published a paper implicating the role of syringes and needles in the transmission of the disease and documenting the distinctive incubation period of the infection compared to the so-called spontaneous catarrhal jaundice (now known as Hepatitis A). In their paper, they questioned the possibility of two different viruses causing hepatitis.[4]
Further evidence pointing to the existence of at least two separate etiological agents causing hepatitis came during World War II, when jaundice epidemics were clearly distinguished among US military personnel based on differences in transmission and incubation periods.[1]
In 1947, the current nomenclature of hepatitis A (so-called infectious hepatitis) and hepatitis B (so-called serum hepatitis) was proposed by MacCallum and Bauer. By this time, it was already known that in comparison with hepatitis A, hepatitis B:[3]
- Was transmitted by percutaneous exposure to blood products
- Had a longer incubation period (2-6 months)
- Occurred more often in adults
In the 1960’s and 1970’s, Krugman et al. performed studies confirming these previously observed differences as well as the occurrence of homologous immunity after infection with hepatitis B. [4]
Discovery and Prevention
The virus itself was not discovered until 1965 by Baruch Blumberg, who identified the Australia antigen(later known to be hepatitis B surface antigen or HBsAg) in blood collected from Australian aborigines.[5] In 1970, the virus particle was identified with electron microscopy by D.S. Dane et al.[6] By the early 1980's the virus' genome had been sequenced and in 1982, a vaccine against HBV was available.
In 1972, Le Bouvier et al., classified the virus into four subtypes: adr, adw, ayr, and yaw. This initial classification was based on the envelope protein of the virus. The four subtypes were noted to have different geographical distributions, thereby helping to trace the route of infections.[7][8]
Recent discoveries were able to classify hepatitis B virus, not only according to the serotype, but according to the genotype. Today HBV into ten genotypes (A-J) according to the variation of the nucleotide sequence of the genome.[9]
Treatment
On March 29, 2005, the US Food and Drug Administration (FDA) approved Entecavir for the treatment of hepatitis B.[10]
On February 25, 2005, the EU Commission approved PEGASYS for the treatment of hepatitis B making it the first pegylated interferon to be approved for hepatitis B.[11]
On October 27, 2006, telbivudine gained FDA approval for treatment of chronic hepatitis B. It is marketed under the brand name Tyzeka in the US and Sebivo outside the US. It is already approved in Switzerland.[12]
Social History
In 1992, the Global Advisory Group to the World Health Organization(WHO) recommended the incorporation of hepatitis B vaccine into national immunization programs by 1997 in all countries.
World Hepatitis Day, observed July 28, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis and treatment. It has been led by the World Hepatitis Alliance since 2007 and on May 2010, it got global endorsement from the World Health Organization.[13]
References
- ↑ 1.0 1.1 1.2 1.3 Hussey, Hugh H. (1981). "The Hepatitis B Saga". JAMA: The Journal of the American Medical Association. 245 (13): 1317. doi:10.1001/jama.1981.03310380021018. ISSN 0098-7484.
- ↑ Center for Disease Control and Prevention.Epidemiology and Prevention of Vaccine Preventable Diseases 2012. http://www.cdc.gov/vaccines/pubs/pinkbook/hepa.html
- ↑ 3.0 3.1 3.2 Mahoney FJ (1999). "Update on diagnosis, management, and prevention of hepatitis B virus infection". Clin Microbiol Rev. 12 (2): 351–66. PMC 88921. PMID 10194463.
- ↑ 4.0 4.1 4.2 "Evolution of Concepts of Hepatitis".
- ↑ Alter HJ, Blumberg BS (1966). "Further studies on a "new" human isoprecipitin system (Australia antigen)". Blood. 27 (3): 297–309. PMID 5930797. Retrieved 2012-02-08. Unknown parameter
|month=ignored (help) - ↑ Dane DS, Cameron CH, Briggs M (1970). "Virus-like particles in serum of patients with Australia-antigen-associated hepatitis". Lancet. 1 (7649): 695–8. PMID 4190997. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Mazzur S, Burgert S, Blumberg BS (1974). "Geographical distribution of Australia antigen determinants d, y and w." Nature. 247 (5435): 38–40. PMID 4128782.
- ↑ Yamanaka T, Akahane Y, Suzuki H, Okamoto H, Tsuda F, Miyakawa Y; et al. (1990). "Hepatitis B surface antigen particles with all four subtypic determinants: point mutations of hepatitis B virus DNA inducing phenotypic changes or double infection with viruses of different subtypes". Mol Immunol. 27 (5): 443–9. PMID 1694959.
- ↑ Enomoto M, Tamori A, Nishiguchi S (2006). "Hepatitis B virus genotypes and response to antiviral therapy". Clin Lab. 52 (1–2): 43–7. PMID 16506363.
- ↑ U.S. Food and Drug Administration. March 30, 2005. FDA Talk Paper: FDA Approves New Treatment for Chronic Hepatitis B. fda.gov. Retrieved on September 11, 2007.
- ↑ February 25, 2005. Pegasys approved in the European Union for the treatment of chronic hepatitis B: Only pegylated interferon approved for the treatment of chronic hepatitis B. roche.com. Retrieved on September 11, 2007.
- ↑ October 27, 2006. FDA Approves Telbivudine for Treatment of Chronic Hepatitis B. hivandhepatitis.com. Retrieved on September 11, 2007.
- ↑ http://apps.who.int/gb/ebwha/pdf_files/EB126/B126_R16-en.pdf