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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 ?