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-An estimated 240 million people are chronically infected with hepatitis B (defined as . hepatitis B surface antigen positive for at least 6 months) . More than 686 000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer.Hepatitis B is an important occupational hazard for health workers. However, it can be prevented by currently available safe and effective vaccine A vaccine against hepatitis B has been available since 1982. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to .hepatitis B Symptoms Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small subset of persons with acute hepatitis can develop acute liver failure which can .lead to death In some people, the hepatitis B virus can also cause a chronic liver infection that can later .develop into cirrhosis of the liver or liver cancer ?Who is at risk for chronic disease The likelihood that infection becomes chronic depends upon the age at which a person becomes infected. Children less than 6 years of age who become infected with the hepatitis .B virus are the most likely to develop chronic infections In infants and children:80-9-% of infants infected during the first year of life develop chronic infections; and 30-50% of children infected before the age of 6 years develop chronic infections In adults:less than 5% of otherwise healthy persons who are infected as adults will develop chronic infection; and20-30%of adults who are chronically infected will develop cirrhosis and/or liver cancer Diagnosis : It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is .essential Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also seropositive for hepatitis B e antigen (HBeAg). HBeAg is usually a marker of high levels of replication of the virus. The presence of HBeAg indicates that the blood and body fluids of the infected individual are highly contagious Chronic infection is characterized by the persistence of HBsAg for at least 6 months (with or without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for .developing chronic liver disease and liver cancer (hepatocellular carcinoma) later in life SO Case definition of hepatitis B: An acute illness that includes malaise, extreme fatigue, fever, nausea and sometimes vomiting and upper right quadrant abdominal tenderness, then dark urine followed by jaundice :Case classification Suspected case: A case compatible with clinical description * Probable case: A Suspected Case + Positive Bile pigment in urine and elevated serum * )bilirubin and liver enzymes (ALT, SGPT and Serum Alkaline Phosphatase Confirmed case: Probable/suspected case with positive specific serological tests. This can * be done by different methods and the most famous one is ELISA method. In addition great increase of liver enzymes like alanine transaminase (ALT), serum alkaline phosphatase and .SGOT etc Occurrence In countries where HBV is highly endemic (HBs Ag prevalence 8% or higher), most infection .occur during infancy & early childhood in countries where HBV is intermediately endemic (HBs Ag prevalence 2-7%) & occur in all .age group In countries with low endemicity (HBs Ag prevalence less than 2%), most infection occur in young adult especially high risk group Iraq is considered with low endemic with HBsAg prevalence was 1.6% in 2006