Almost all chronic HBV infections in China occur during infancy and childhood, the most important of which is mother-to-child transmission. About 30% of women of childbearing age are “major triple positive” and the majority of children of mothers with “major triple positive” will be infected before the hepatitis B vaccine is applied. In Western countries, hepatitis B is a sexually transmitted disease, and the infected are adults, so it is better to treat; in Africa, it is also infected in children, but it is also better to treat than our patients, why is this? Because our women of childbearing age have more “major triplets” and more mother-to-child transmission; African mothers have more “minor triplets” and less mother-to-child transmission, and African children are naked and play in the sand, mostly spread by older children. In the 1980s, a Chinese scholar treated several Chinese patients in London with interferon, some of whom were carriers, using interferon prepared from human blood lymphocytes, which was very expensive, and the course of treatment was only 16 weeks. This conclusion had a wide negative impact in China and has been passed around to this day. Is this conclusion comprehensive? It needs to be analyzed. How does a mother transmit the hepatitis B virus to her child? In the past, there was no hepatitis B vaccine to interrupt mother-to-child transmission, and mothers with “major triplets” would almost always pass the virus to their children, and 80% of the children would become chronic hepatitis B carriers; mothers with “minor triplets” had very low serum levels of the virus and were not very contagious. If a family has several siblings infected, it may not always be transmitted by the mother. If the mother was “major triple positive” when she had her first child, the oldest child is most likely to be a mother-to-child carrier of hepatitis B. The youngest child may have been born when the mother became “minor triple positive,” and the youngest child is likely to have been infected by the oldest child when she played with him as a child. Such transmission is called horizontal transmission. Mother-to-child transmission can be either vertical or horizontal. Vertical transmission refers to infections that occur in utero, during labor, and later in life; horizontal transmission refers to infections that occur in close contact between mother and child during life. Vertical transmission accounts for about 1/3 of infections in infants and children and horizontal transmission accounts for 2/3. Would you say that vertical and horizontal infections are treated equally well? Is any hepatitis that is transmitted from mother to child difficult to treat? The younger the age of infection (vertical transmission) the stronger the immune tolerance, and the effectiveness of antiviral treatment is closely related to immune tolerance, and the stronger the immune tolerance (vertical transmission) the poorer the efficacy. (Can you please read the blog post on “immune tolerance” again?) It is difficult to determine whether the transmission is vertical or horizontal. It is difficult to determine whether it is vertical or horizontal transmission. The treatment of infection from vertical transmission is less effective and the treatment of infection from horizontal transmission is more effective, both in terms of the population. The effectiveness of individual treatment is determined by the level of immune activation, regardless of whether you are vertically or horizontally infected, the same level of immune activation will result in the same antiviral treatment. The main marker of immune activation level is the duration and magnitude of serum aminotransferase elevation. Antiviral therapy will be more effective if the serum aminotransferases are elevated for a longer period of time and at a higher magnitude, otherwise it will be less effective.