Download Hepatitis B

Hepatitis B
By Patty Dahl, PHN
What is Hepatitis B?
Hepatitis means inflammation of the liver.
Toxins, certain drugs, some diseases,
heavy alcohol use, and bacterial and viral
infections can all cause hepatitis.
Hepatitis B is a contagious liver disease
that ranges in severity from a mild illness
lasting a few weeks to a serious, lifelong
illness. It results from infection with the
Hepatitis B virus and can be either “acute”
or “chronic”.
Acute and Chronic Hepatitis B
Acute Hepatitis B virus infection is a short term
illness that occurs within the first 6 months after
someone is exposed to the Hepatitis B virus.
Acute infection can, but does not always, lead to
chronic infection.
Chronic Hepatitis B infection is a long term
illness that occurs when the hepatitis B virus
remains in a person’s body. Chronic infection
can result in cirrhosis, liver failure and liver
cancer.
Statistics
Estimated 46,000 new infections in 2006.
Estimated 800,000-1.4 million people with
chronic HBV infection. Estimated 2,000-4,000
persons in the U.S. die from HBV related illness
per year. 15-25% of chronically infected
persons develop chronic liver disease. Rates of
acute hepatitis B in the U.S. have declined by ~
80% since 1991. At that time, routine hepatitis B
vaccination of children was implemented. This
resulted in a 94% decrease in rates of disease in
children.
Hepatitis Global Prevalence
Chronic hepatitis B affects ~ 350 million people
and contributes to ~ 620,000 deaths each year.
Laboratory Diagnosis
HBsAg most common test for diagnosing acute infection or detecting
carriers, it can be detected as early as 1-2 weeks and as late as 1112 weeks. Presence of HBsAg indicates that a person is infectious
(acute or chronic).
Anti-HBc (core antibody) develops in all HBV infections, indicates
infection at some undefined time in the past, persists for life, not a
serologic marker for acute infection.
IgM anti-HBc indicates recent infection with acute disease, appears
at illness onset, present for 4-6 months, best marker of acute
infection.
Anti-HBs (surface antibody) indicates recovery and immunity against
re-infection; also can be acquired as immune response to Hepatitis
B vaccine.
HBeAg presence is associated with relatively high infectivity.
Transmission
The virus is transmitted by parenteral or mucosal
exposure to HBsAg positive body fluids from persons
who have acute or chronic HBV infection. Transmission
occurs primarily through :
Birth (spread from infected mother to baby)
Sex with infected partner
Sharing needles/drug injection equipment
Sharing razors, toothbrushes, other items with infected
persons
Direct contact with blood or open sores of infected
person
Exposure to blood from needlesticks or other sharp
instruments
Persons at Risk
Sex with infected person
Multiple sex partners
MSM (men who have sex with men)
Persons with a STD (sexually transmitted disease)
Injection drug users
Household contacts of infected persons
Exposure on the job (HCW’s, safety workers)
Infants born to infected mothers
Travel to Hepatitis B endemic countries
Hemodialysis patients
Symptoms
Symptoms of acute Hepatitis B include:
Fever, fatigue
Anorexia, nausea, vomiting
Dark urine, clay colored stools
Abdominal pain
Jaundice
Joint pain
Communicability
Incubation period is 45-160 days (average 120
days)
Persons with either acute or chronic HBV
infection should be considered infectious any
time that HBsAg is present in the blood. When
symptoms are present in persons with acute
HBV infection, HBsAg can be found in blood
and body fluids for 1-2 months before and after
onset of symptoms.
Vaccine recommendations
Hepatitis B vaccine is recommended for:
All children should get first dose at birth and complete
series by 6-18 months of age
Sex partners of infected persons; persons with multiple
partners
MSM
Injection drug users
Persons with HIV or seeking STD treatment
Persons with chronic liver disease and end stage renal
disease
HCW’s and public safety workers exposed to blood on
the job
Vaccine Schedule
Infants and children: 3-4 doses given over
a 6-18 month period depending on vaccine
type and schedule
Adults: 3 doses given over a 6 month
period
Store at 35-46 degrees F. Do not freeze.
Immunogenicity and Vaccine
Efficacy
After 3 IM doses of Hepatitis B vaccine, >
90% of healthy adults and > 95% of
infants and children develop adequate
antibody response
The vaccine is 80-100% effective in
preventing infection or clinical hepatitis in
those who receive the complete course of
vaccine.
Adult Hepatitis Vaccine Project
2009
Who qualifies for Hepatitis B vaccine?
Persons seeking treatment for HIV or STD
Illicit drug users, MSM
Chronic liver disease, alcoholic liver
disease
Hepatitis A or C
Born in Asia or Pacific Islands (API)
TEST
What is Hepatitis B?
How is Hepatitis B spread?
What are the symptoms?
Who should be vaccinated?
What is the incubation period?
What is the route and site of adult vaccine
administration?
How should it be stored and handled?
What are some contraindications to vaccination?
Who qualifies for the free vaccine from the AHVP ?