A nationwide program for preventing hepatitis B virus (HBV) mother-to-child transmission (MTCT) has been in place in Japan since 1985, with obstetric guidelines outlining specific preventive measures. We investigated implementation of the preventive measures and interdepartmental collaboration with respect to 41 pregnant women positive for the HB surface antigen who delivered at our hospital between September 2010 and December 2023. We assessed testing rates for the HBe antigen, alanine transaminase (ALT), and HBV-DNA; referrals to gastroenterology; HBIG and HBV vaccination rates; and testing for the HB surface antigen/antibody in newborns. The testing rates for the HBe antigen, ALT, and HBV-DNA were high (98%, 88%, and 82% respectively), but the rate of referral to gastroenterology was just 51%. HBIG and HBV vaccination rates were 100% and 94%-100% respectively, but the rates of HB surface antigen/antibody testing after vaccination remained at 75% and 86%. One case of MTCT was attributed to inadequate collaboration between obstetrics and gastroenterology. Strengthening interdepartmental cooperation is crucial for further improvement.

Wilson's disease, a congenital copper metabolism disorder caused by ATP7B mutations, manifest with diverse clinical and histopathologic findings, which hinder diagnosis in most cases. Here, we present the challenging case of a teenage boy who was initially diagnosed with autoimmune hepatitis based on antinuclear antibody positivity and histopathologic findings. However, liver damage did not improve despite treatment with steroids and ursodeoxycholic acid. The patient did not meet the revised international diagnostic criteria (1999 edition), which considers treatment response. He had a lowserum ceruloplasmin level and high urinary copper excretion and exhibited copper deposition in the liver. Additionally, the patient developed antibody-negative hemolytic anemia and was confirmed to harbor ATP7B double mutations. Therefore, he was diagnosed with Wilson's disease and treated with zinc acetate. As illustrated in this case, Wilson's disease should be reconsidered in young patients with suspected atypical autoimmune hepatitis resistant to steroid treatment.

The HBV DNA assay system at our hospital was switched from TaqMan HBV v2.0 to Cobas HBV, increasing the assay's sensitivity from the previous lower limit of quantification of 1.3 logIU/ml to 1.0 logIU/ml. We examined the impact of this change on patients with low HBV DNA levels who were affected by the improved sensitivity. The study included 130 samples with HBV DNA levels below 1.3 logIU/ml. Among these, 19 samples (15%) were quantifiable within the range of 1.0-1.2 logIU/ml using the Cobas HBV DNA assay. This indicates that some cases of HBV DNA can be newly quantified due to the change in the assay system.

The World Health Organization aims to eliminate hepatitis C virus by 2030. However, in Japan, patients receiving direct-acting antiviral therapy are required to regularly visit hospitals, which can introduce barriers to treatment. To address this issue, we recently implemented a telephone- and video-based well-being monitoring system led by hepatitis medical care coordinators and evaluated the benefits of this remote monitoring system for patients and healthcare providers. All six patients who participated in remote monitoring achieved SVR12 without severe adverse events. Patients reported reduced psychologic and hospital visit burden, and hepatitis medical care coordinators facilitated communication and care coordination. These findings suggest that incorporating remote monitoring to hepatitis C virus treatment can improve patient access and adherence. Further studies are warranted to optimize the implementation of remote monitoring system and the patient selection criteria.