Hepatitis Flashcards
What is % response to ultra rapid Hep B vaccination course?
HebBsab response in 80% at 4-12 weeks post course
Can offer 3 further doses to other 20% but most would eventually respond
Response increases to 95% with booster
What is the ultra rapid Hepatitis B vaccine schedule?
0, 7 days, 21 days
Booster at 12 months
What is the rapid (post exposure) Hepatitis B vaccine schedule?
0, 1 m, 2m
Booster at 12 m
What is the standard Hepatitis B vaccine schedule?
0, 1m, 6m
Booster 12m
What are some of the associated factors for increased risk of hepatitis C?
Presence of other STIs (particularly syphilis and LGV
Traumatic anal sex
Fisting
shared sex toys
group sex, serosorting
Concomitant use of recreational drugs (including injected recreational drugs such as crystal methamphetamine in ‘chem-sex’ party settings).
How often should hepatitis C be tested for in MSM
Hepatitis C testing should be offered at least annually to men eligible for three-monthly HIV testing and those taking or eligible for PrEP
HIV-positive MSM should be routinely screened for HCV at least annually
Causes of raised bilirubin?
Normal levels are 3-17
Jaundice- levels over 40
Obstructive liver disease (usually also raised ALP and GGT)
Gilbert’s disease
Haemolysis
Atazanavir
What is the risk of vertical transmission in Hepatitis B?
90% of pregnancies where the mother is hepatitis B e antigen positive
10% of surface antigen positive, e antigen negative mothers.
Most (>90%) infected infants become chronic carriers
What can be done to prevent hep b infection to babies born to Hep B positive mums?
Infants born to infectious mothers are vaccinated from birth.
Hepatitis B specific Immunoglobulin 200 i.u. IM is also given in certain situations where the mother is highly infectious
This reduces vertical transmission by 90%.
Can Hep B positive Mum be treated in pregnancy to reduce the risk of transmission?
Tenofovir monotherapy can be considered for pregnant women with HBV DNA >107 IU/ml in the third trimester
Can Hep B positive Mum breastfeed?
Yes
% of MSM needed to vaccinate against Hepatitis A to prevent an outbreak?
70%
Diagnosis? HBsAg + HBeAg + Anti HBc IgM + Anti HBc IgG + HBV DNA + HBeAb - HBsAb -
Acute Hepatitis B
Diagnosis? HBsAg + HBeAg - Anti HBc IgM + Anti HBc IgG + HBV DNA - HBeAb + HBsAb -
Resolving Hepatitis B infection
Diagnosis? HBsAg + HBeAg + Anti HBc IgM - Anti HBc IgG + HBV DNA + HBeAb - HBsAb -
Chronic
Highly infectious Hepatitis B
Diagnosis? HBsAg + HBeAg - Anti HBc IgM - Anti HBc IgG + HBV DNA + HBeAb + HBsAb -
Chronic Hepatitis B
Low infectivity
Diagnosis? HBsAg - HBeAg - Anti HBc IgM - Anti HBc IgG + HBV DNA - HBeAb + HBsAb +
Resolved immune Hepatitis B
Diagnosis? HBsAg - HBeAg - Anti HBc IgM - Anti HBc IgG - HBV DNA - HBeAb - HBsAb +
Hepatitis B vaccination
How is Hepatitis C transmitted in pregnancy?
It is thought that hepatitis C is transmitted via the placenta rather than through the birth canal.
Risk of vertical transmission of hepatitis C
LOW RATE
~5% (7% if HIV coinfection)
Incubation of hepatitis c?
4-20 weeks (1-5 months)
What % of people with hepatitis C infection become chronically infected?
80%
How many with acute hepatitis C have symptoms?
20%
How many people with hepatitis C go on to develop cirrhosis?
10-20% after 20- 30 years