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1.
2. Overview
Discussion Hepatitis B
Definition
Epidemiology
Clinical course and symptoms
Prevention
Treatment options
3. Hepatitis
Hepatitis is an injury to liver characterised by
presence of inflammatory cells in the liver tissue.
It can be self limiting, or It can progress to scarring
of the liver.
Hepatitis viruses cause most cases of liver
damage worldwide
4. Hepatitis B
HBV is a Hepadna virus.
An extremely resistant strain
capable of withstanding extreme
temperatures and humidity.
It can survive when stored for 15 years at -
20°C, for 24 months at -80°C, for 6 months at
room temperatures, and for 7 days at 44°C.
5. Hepatitis B
The hepatitis B virus is transmitted through
contact with the blood and body fluids of
someone who is infected.
The same way as human immunodeficiency
virus (HIV).
Hepatitis B is nearly 100 times as infectious as
HIV.
6. HEPATITIS B (SERUM HEPATITIS)
• Transmitted by:
1. Contaminated blood products or article
2. Body secretions
3. Introduction of infectious material into eye, oral
cavity, lacerations or vagina
4. Contaminated needles
during administration of medications
shared by drug users
8. Hep B epidemiology
• 1/3 of world’s
population has been
infected
• 350 million with
chronic disease
• 15-25% of these die
due to liver related
diseases
– 1 million deaths
annually
9. Hepatitis B primary infection
• Symptoms
– Malaise, fatigue, anorexia,
nausea, low grade fever after
45-160 day incubation
• Can be asymptomatic
– More common in children
10. Secondary prevention :Diagnosis
• A battery of serological tests are used for the diagnosis of acute and
chronic hepatitis B infection.
• HBsAg - used as a general marker of infection.
• HBsAb - used to document recovery and/or immunity to HBV
infection.
• anti-HBc IgM - marker of acute infection.
• anti-HBcIgG - past or chronic infection.
• HBeAg - indicates active replication of virus and therefore
infectiveness.
• Anti-Hbe - virus no longer replicating. However, the patient can still
be positive for HBsAg which is made by integrated HBV.
• HBV-DNA - indicates active replication of virus, more accurate than
HBeAg especially in cases of escape mutants. Used mainly for
monitoring response to therapy.
11. Secondary prevention :Treatment
• Interferon - for HBeAg +ve carriers with chronic active hepatitis.
Response rate is 30 to 40%.
– alpha-interferon 2b (original)
– alpha-interferon 2a (newer, claims to be more efficacious and
efficient)
• Lamivudine - a nucleoside analogue reverse transcriptase inhibitor.
Well tolerated, most patients will respond favorably. However,
tendency to relapse on cessation of treatment. Another problem is the
rapid emergence of drug resistance.
• Adefovir – less likely to develop resistance than Lamivudine and may
be used to treat Lamivudine resistance HBV. However more expensive
and toxic
• Entecavir – most powerful antiviral known, similar to Adefovir
• Successful response to treatment will result in the disappearance of
HBsAg, HBV-DNA, and seroconversion to HBeAg.
12. Secondary prevention :Treatment
• Who to treat
– Chronic active hepatitis > 6 months duration
– S Ag+, E Ag +/-, DNA+, ALT > 2 x normal
– Active hepatitis, advanced fibrosis on biopsy
• Goal of treatment
– Stop viral replication: HBV DNA becomes Neg
– Convert E Ag+ to E Ag--; E Ab becomes pos
– Improve histology, prevent progression to cirrhosis
– Prevent hepatoma
– With successful treatment 1-2% per year will loose
S Ag
14. Prevention
• Vaccination - highly effective recombinant vaccines are now
available. Vaccine can be given to those who are at increased
risk of HBV infection such as health care workers. It is also
given routinely to neonates as universal vaccination in many
countries.
• Hepatitis B Immunoglobulin - HBIG may be used to protect
persons who are exposed to hepatitis B. It is particular
efficacious within 48 hours of the incident. It may also be given
to neonates who are at increased risk of contracting hepatitis B
i.e. whose mothers are HBsAg and HBeAg positive.
• Other measures - screening of blood donors, blood and body
fluid precautions.
15. Prophylaxis
• Hepatitis B immune globulin (HBIG) and vaccine
• Indications
– Patients with no history of vaccine and
• Percutaneous exposure (needle sticks)
• Household contacts exposed to blood
– Perinatal exposure – prevents transmission in 95% of
mothers HBsAg positive when given within 12 hours of
birth
• Breast feeding ok if baby received prophylaxis
16. Hepatitis B
Prevention
• Behavior modification
– Eliminate high risk behavior; use condoms
– Acute infection has declined for 20 years
• Screen pregnant mothers
– HBIG and HBV vaccination at birth prevents 95% of perinatal infections
• HBV Vaccination
– Perinatal exposure
– Persons with sexual, mucosal, percutaneous exposures
– Persons with HCV or IV drug abuse
– Homosexuals
– Health care workers
– Hemodialysis patients
– Universal vaccination for children
• Hepatitis B Immune Globulin
– Perinatal exposure
– Needle stick exposure
– Persons with recent sexual, mucosal, percutaneous exposures
17. Prevention of Perinatal Hepatitis
B Virus Infection
• Begin treatment within 12 hours of birth
• Hepatitis B vaccine (first dose) and
HBIG at different sites
• Complete vaccination series at 6 months
of age
• Test for response after completion of at
least 3 doses of the HepB series at 9
through 18 months of age (generally at
the next well-child visit)
18. Six Responsibilities of Perinatal
Hepatitis B Prevention Program
Assure identification Assure all exposed
of ALL HBsAg infants receive HBIG
positive women and and 1st dose of hep.
their infants Prevention B vaccine w/in 12
hours of birth
of
Perinatal
Hepatitis B
Transmission
Assure that all Assure
susceptible completion of 3
household and doses of hepatitis
sexual contacts B vaccine and post
are vaccinated vaccination testing
of exposed infants
Conduct active
surveillance, quality
assurance, and outreach to
improve program
