Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7264-7274
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7264
Current hepatitis B virus infection situation in Indonesia and its genetic diversity
Maria Inge Lusida, Juniastuti, Yoshihiko Yano
Maria Inge Lusida, Juniastuti, Institute of Tropical Disease, Airlangga Health Science Institute, Airlangga University, Surabaya 60115, East Java, Indonesia
Maria Inge Lusida, Juniastuti, Department of Microbiology Faculty of Medicine, Airlangga University, Surabaya 60131, East Java, Indonesia
Yoshihiko Yano, Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: All authors made substantial contributions to the conception and design of the study, data acquisition, and drafting and critically revising the manuscript; the authors approved the final version.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Maria Inge Lusida, MD, PhD, Clinical Microbiologist, Professor of Virology, Head, Institute of Tropical Disease, Airlangga Health Science Institute, Airlangga University, Campus C UNAIR Mulyorejo, Surabaya 60115, East Java, Indonesia.
Telephone: +62-31-5992446 Fax: +62-31-5992445
Received: March 28, 2016
Peer-review started: March 28, 2016
First decision: May 30, 2016
Revised: June 27, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016

Indonesia has a moderate to high endemicity of hepatitis B virus (HBV) infection. The risk for chronic HBV infection is highest among those infected during infancy. Since 1997, hepatitis B (HepB) vaccination of newborns has been fully integrated into the National Immunization Program. Although HBV infection has been reduced by the universal newborn HepB immunization program, it continues to occur in Indonesia. The low birth dose coverage and the presence of vaccine escape mutants might contribute to this endemicity among children. Although limited information is available for an analysis of occult HBV infection (OBI), several variations and substitutions in the pre-S/S region have been detected in Indonesian HBV strains. Additionally, persistent infection and disease progression of chronic hepatitis B are related to not only viral factors but also the host genome. Indonesia is one of the most ethnically heterogeneous nations, with Javanese and Sundanese as the two highest ethnic groups. This multi-ethnicity makes genomic research in Indonesia difficult. In this article, we focused on and reviewed the following aspects: the current hepatitis B immunization program and its efficacy, OBI, HBV infection among high-risk patients, such as hemodialysis patients, and research regarding the host genome in Indonesia.

Keywords: Hepatitis B virus, Immunization, Occult infection, Hemodialysis, Indonesia

Core tip: Hepatitis B virus (HBV) infection is still an important health problem in Indonesia. Although HBV infection has been reduced by the universal newborn hepatitis B immunization program, it continues to occur in Indonesia. The high prevalence of occult hepatitis B infection and HBV infection among hemodialysis patients also contributes to its endemicity. The association between human genetic variations and HBV infection in several Asian countries, including in Indonesia was also identified. We reviewed these important aspects of the current HBV infection situation in Indonesia.