[MUSIC] [MUSIC] Hello, everybody. This is Yen-Hsuan Ni. I'm a professor of pediatric gastroenterology and hepatology. I'm also the Dean of College of Medicine in National Taiwan University. >> Hello, I'm Kai-chi Chang. I am from National University Children's Hospital. I'm a clinician of pediatric gastroenterology and hepatology. [MUSIC] Although the HPV immunization program in Taiwan is well designed and no coverage rate is high. But HPV infection still cannot be completely eradicated. Professor knew what his opinion about the current immunization policy. >> Okay. I think the current policy, current vaccination policy, especially universal vaccination in infants. It's extremely important to eradicate the hepatitis B. In Taiwan, the temporary speed in reversal bus nation has been implemented for more than 30 years. So we have already achieved a very, very good result. So, for in Taiwan, if we want to eradicate. Every, single HPV infection. I think we need to do, the first one, is to minimize the carrier rate of the mother. That's the first thing. So once, we have to extensively screen the mother. Once we detect the mother, I think we should proceed to give them a especially for those with high viremia which would give them some antiviral agent in the last trimester to minimize the viral load, which has been proven to reduce the infection load to a minimum extent. After that, we have to do the postpartum nation screening for the newborn infants. Those who are born to the search engine positive mothers, actually they are high risk infants to develop the chronic HBV infection. So roughly at the age of about one year we have to screen their surface functioning and antibody status. If they don't develop the service the antibody. I think we need to give them a booster. But if we really are detect someone who became here carriers, they we have to recruit them to a chronicle follow-up status and carefully to take care of them and give them in appropriate treatment. So that's the Taiwan spatial condition because we have already done this for more than 30 years. But for those who are just starting to implement the universal Hepatitis B vaccination in other countries, I think the most important thing is to push your coverage rate up to 97 or even 99, or even 100%. That's the most important because if the the babies the newborn babies cannot receive an adequate vaccination, there will be impossible for them to achieve a good coverage rate and of course, you cannot eradicate chronic hepatitis B infection. So for different regions in the world, I think we need to implement different strategy to eradicate hepatitis B. From the WHO I think we have a goal in the year of 2030 and try to minimize the hepatitis B I think we should all follow this goal and aim for that. And in different countries we need to implement different strategies to achieve that goal. Yeah, that's it. That's my opinion. Yes. >> Chronic HPV infection, my brain a risk of liver cirrhosis and HCC. Do you recommend that HPV infected children to receive antiviral agent as early as possible to prevent long term complications. >> Yes, this is I think this is a very, very interesting and important question. Theoretically we need to treat the patients as early as possible. However we need to balance the the pros and cons of the treatment. Because right now we don't have a very, very effective treatment to eradicate HIV and chronic hepatitis B so the current guideline or indication for the treatment of chronic disability in children, actually, I think only the follow up. Of course, for those who have never ever developed abnormal arity with higher with abnormal liver functions yeah, we can seriously consider to treat them, however, because those treatments for example, for the those so-called nucleoside the animal, you don't know how to stop the treatment. So in that case, like, if we treat patients like the Ad age about three, and you are going to tell tell the parents in the patient that's perhaps you may be, you need to take the medicines for the rest of your life. I think that's kind of impossible. At this moment, I think we should, I think we need to follow the guidelines. And only for very, very selective patients, we start to treat them with our current medications. But in the future, if we can develop something that's very, very, very minimal side effect. Then I would agree that we should treat patients as early as possible. Because from our study, we know that even those who were really young, they still can have the flare up of the hepatitis. That means there will be some damage, maybe even minimal but there is still a chance for the liver to be damaged. And we don't want that happen. So, theoretically, I think I would like to agree that we should treat the patients as early as possible, but only if we have a very, very effective medicines with minimal side effects. Otherwise, I think we should follow the current guidelines and the indications to give the medication only when they are really indicated [MUSIC]
