China is not only the country with the highest prevalence and incidence of chronic hepatitis B, but also the country where hepatitis B patients are most severely discriminated against. In response to the problem of discrimination against hepatitis B due to misunderstandings, experts in infectious diseases and hepatology in China, after years of scientific and educational efforts, as well as appeals to the government and the public, pushed the Ministry of Labor and Social Affairs to promulgate the first regulatory document against hepatitis B discrimination in 2007 – “Opinions on Safeguarding the Employment Rights of Hepatitis B Surface Antigen Carriers”. In 2007, the Ministry of Labor and Social Security promulgated the first regulatory document against hepatitis B discrimination, the Opinions on Safeguarding the Employment Rights of Hepatitis B Surface Antigen Carriers. After the introduction of this document, the implementation by employers and schools around the country has not been satisfactory. Forced entry and enrollment in schools to check for hepatitis B virus markers, and refusal to enroll or even dismiss people with positive indicators of hepatitis B still occur from time to time, causing labor disputes that have received widespread attention in the society. In view of this, the Ministry of Human Resources and Social Security, the Ministry of Education and the Ministry of Health jointly issued a notice in 2010 on further standardizing medical examination programs for schooling and employment and safeguarding the rights of hepatitis B surface antigen carriers for schooling and employment, clearly stipulating that “educational institutions and employers of all kinds at all levels shall not require hepatitis B items in the medical examination for schooling and employment of citizens Testing”, “shall not require the provision of hepatitis B project test reports, nor ask whether the hepatitis B surface antigen carriers. Medical and health institutions at all levels are not allowed to provide hepatitis B testing services during medical examinations for schooling and employment”. Since then, the problem of hepatitis B discrimination in China has not been completely solved, but the “survival situation” of slow hepatitis B patients has been greatly improved. However, there are two sides to everything, and the introduction of a good policy or regulation will inevitably bring about problems that cannot be fully covered. For example, the issue of how to effectively screen potential hepatitis B virus infected patients for early detection, evaluation and treatment has become more prominent and problematic. Clinically, we are still often saddened to find that a small number of patients with chronic hepatitis B do not go to the hospital until they develop cirrhosis, liver failure or even liver cancer due to ignorance and “unawareness” of hepatitis B. The primary factor that leads to such tragedies is the failure to test or monitor for hepatitis B. How can we avoid such tragedies that could have been avoided from happening again and again? How can hepatitis B be detected early and treated properly and effectively? To answer these two questions, we must first clarify the relationship between anti-discrimination policies and regulations of government authorities and the necessary screening for hepatitis B. The former, based on a sound understanding of scientific and academic issues such as the infectiousness and transmission routes of chronic hepatitis B, is a regulatory document with Chinese characteristics that is designed to maximize the legitimate rights of patients to employment, employment and schooling, and to protect patients and their families from infringement of their privacy rights. Such regulations are still necessary at present and for some time to come, and are necessary for social harmony, and practice so far has proven to be a great achievement. However, as subjects who are potentially infected with the hepatitis B virus – patients – must not be applied to their own health assessment or disease screening because of the government-imposed exemption from hepatitis B testing for employment and schooling. Here are a few suggestions for caution. (1) Anyone, whether they consider themselves healthy or already suffering from some disease, at any age, must have regular comprehensive health and disease indicator examinations. The idea of medical checkups is easily accepted by middle-aged people, especially those who are already sick, and young people within 30 years of age tend to be “dismissive”, which must be wrong. A special reminder: the progression of hepatitis B virus infection can be insidious, and most people do not have any symptoms until they are 30 years old. Most of the hepatitis B virus infected people in China originate from vertical mother-to-child transmission or are infected during infancy, and many of them are in an immune tolerance state until they are 30 years old, which means that they treat the hepatitis B virus as their own family and do not actively reject the virus, and do not show various symptoms of hepatitis, and the only way to discover hepatitis B is to do blood tests for hepatitis B-related indicators. Accordingly, I would like to appeal to young people: what if you only do a medical checkup once before you turn 30? It should also be noted that many medical check-ups in China, including those in hospitals, have misinterpreted the national regulations on the exemption of hepatitis B indicators, and not only do they not include hepatitis B virus testing in various medical check-up packages, but they also do not remind the examinees before the check-ups, probably because they are worried about “irregularities” in their self-protective behavior. However, as a subject, since you are taking the initiative to detect unhealthy conditions, I suggest that you take the initiative to check for infectious disease indicators such as the hepatitis B virus, and the medical institution will protect your privacy. (2) If your relatives or blood-related family members are diagnosed with slow hepatitis B or slow hepatitis B-related diseases, such as cirrhosis, liver failure or liver cancer, you must immediately go to the hospital for a targeted examination, including: liver biochemical indicators (commonly known as liver function), hepatitis B virus “two-to-one” and hepatitis B virus gene (i.e. HBV DNA), preferably with a fetoprotein test, and a liver ultrasound. The cost of these tests is not very high. (3) If you experience any discomfort in the liver area, loss of appetite, generalized weakness, special sleepiness, yellowing of the face, or brownish urine that cannot be explained by other conditions or diseases, please go to the hospital as soon as possible to have the above items checked. (4) Whenever, wherever and in whatever context you find abnormal liver function (mainly referring to abnormal transaminases or bilirubin), the cause must be investigated and the hepatitis B virus must be included in the examination items in the process of finding the cause. (5) If it is found that your spouse or the person with whom you have had sexual contact is infected with the hepatitis B virus, it is also necessary to have a test for hepatitis B for yourself. Although sexual intercourse is not the primary means of transmitting hepatitis B, there is always the possibility that blood is involved in the sexual process, so it is a good idea to get tested and to get vaccinated for hepatitis B in a timely manner after the test so that you can be sure that you will not be infected by your sexual partner. (6) It is recommended to “consciously” check the hepatitis B indicators for yourself (you can not ask the other party) during the premarital examination, which is a responsible performance for your spouse and a reflection of love. In my clinical practice, I have indeed encountered many cases of wife and children separated, and “scattered” an important reason is that the other party believes that the spouse with hepatitis B “concealed” the fact. It is unfortunate, helpless and innocent to be infected by the hepatitis B virus, but once you have hepatitis B, there is not only a low probability of transmission to your spouse, but also the possibility of transmission (not necessarily genetic) to the next generation, especially mother-to-child transmission, so it is obviously a responsible act to let your spouse know and take scientific precautions in advance. What’s more, by telling the other party, not only can we obtain their understanding and comprehension, but also their cooperation and support, such as getting their spouse’s care, care, supervision, psychological comfort and financial support during the diagnosis and treatment of hepatitis B. These are all very important. Understandably, the so-called concealment of hepatitis B infection is mostly due to the fear of losing the other person. However, the “outcasts” of these two couples soon reestablished their families and accepted the fact that they had hepatitis B when they accepted their spouses. In fact, more than 90% of spouses “accept” hepatitis B. That is why I wrote an article ten years ago encouraging hepatitis B patients to be self-empowered and not self-discriminatory. Finally, I want to tell our readers that today, hepatitis B is preventable and treatable! The hepatitis B vaccine or hepatitis B immunoglobulin given to newborns at birth has successfully interrupted nearly 95 percent of mother-to-child transmission; safe and effective antiviral therapy for women of childbearing age can further reduce the rate of infection in newborns. The widespread use of antiviral drugs – interferon and nucleoside (acid) analogs – has been effective in controlling the progression of hepatitis B, even reversing cirrhosis and preventing the development of liver cancer, and a small percentage of hepatitis B patients can be cured. However, all these preventive and therapeutic achievements must be based on the timely detection of hepatitis B. To reiterate: for your own sake, and for the sake of your family, please treat refusal of employment and testing for hepatitis B indicators before enrolling in school differently than finding out if you are infected with the hepatitis B virus.