Hepatitis A and B Flashcards by Alixandria Keller

Hepatitis A: treatment

supportive care

immune globulin
handwashing hygiene

** NO role for antiviral agents in tx

infection confers lifeline immunity

prevention w/ vaccination preferred

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Hepatitis A: HAVRIX vaccine (number of doses, schedule, age)

2 doses (0, 6-12mo)
1-18yo and 19+yo

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Hepatitis A: VAQTA vaccine (number of doses, schedule, age)

2 doses (0, 6-18mo)
1-18yo and 19+yo

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Hepatitis A: TWINRIX vaccine (number of doses, schedule, age)

3 doses (0, 1, 6mo)
18+yo - ADULTS ONLY

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Hepatitis A: vaccine: accelerated schedule (vaccines included, age, doses, schedule)

combination of HepA and HepB vaccine + 20mcg of HepB surface antigen

4 doses (0, 7d, 21-30d, 12+mo)
18+yo - ADULTS ONLY

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Hepatitis A Vaccine: ADEs

soreness and warmth at injection site
HA
malaise
pain (arthralgias, myalgias)

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In which patient population is efficacy of the HepA vaccine decreased?

HIV pts w/ CD4 <200

coinfected HIV/HCV pts

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HepA: When can you administer PREEXPOSURE prophylaxis?

What is the exception?

vaccine can be given regardless of departure dates to endemic areas

Exception:
give both Ig and vaccine if traveling w/in 2 weeks
-older pts
-IM
-hx of chronic liver dz
-hx of other chronic medical condition

**Ig gives passive coverage while we wait for the active coverage of the vaccine

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HepA: What are the options for POSTEXPOSURE prophylaxis?

either the vaccine or Ig

vaccine preferred w/ recent HAV exposure

vaccine brands are interchangeable for booster shots

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What is an advantage and disadvantage of POSTEXPOSURE prophylaxis with the hepatitis A vaccine?

advantage: active immunity

disadvantage: uncertain efficacy in patients:
>40yo
w/ underlying conditions

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HepA: When do patients not need Ig prophylaxis (pre or post exposure)?

pts who have received at least 1 dose of HAV vaccine at least 1 mo prior to exposure

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HepA: When is Ig treatment indicated?

when the vaccine is not an option:

<12mo or >40yrs
IM
chronic liver dz
underlying medical conditions
vaccine contraindicated

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Does immunoglobulin confer active or passive immunity?

passive

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What is an ADE reported w/ HepA Ig treatment?

anaphylaxis in pts w/ IgA deficiency

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What are the 2 categories of dosing for HepA Ig therapy?

postexposure prophylaxis, short term preexposure (<3mo)

- long term preexposure (=5mo)

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Where is HepA Ig administered?

24+mo: deltoid, gluteal muscle

<24mo: anterolateral thigh muscle

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What does a loss of HBsAg confer?

loss of HBsAg –> development of HBsAG antibody –> confers immunity and clearance

What does a loss of HBeAg confer?

loss of HBeAg –> development of HBeAg antibody –> confers infection resolved

What is the sign of chronic HBV?

detectable HBsAg for more than 6mo

Is Hepatitis B curable?

infections can be controlled

cure is not possible bc HBV template is integrated into the host genome

Hepatitis B: Treatment: Acute Supportive

immune globulin (IVIG) - acute exposure

Hepatitis B: Treatment: Prevention

vaccine (0, 1, 6mo)

Engerix-B®
Recombivax HB®

serology markers anti-HBsAg only

Hepatitis B: Treatment: Chronic Management

interferons

antivirals

When can you administer a combination vaccine for HepB?

combo vaccine should NOT be used for birth (0) dose for HepB

may be used to complete the course after 6+ weeks of age (1, 6)

eg: HepB w/ DTaP,HIB

What determines the newborn first dose?

the HBsAg status of the mother

When is the first dose for an infant with an HBsAg NEGATIVE mother?

first dose: at birth/before discharge

When is the first dose for an infant with an HBsAg POSITIVE mother?

first dose: w/in first 12hrs of life (even if premature, regardless of birth weight) administer Ig at the same time (different site)

When is the first dose for an infant with an HBsAg UNKNOWN mother?

first dose: w/in 12hrs of birth

What condition requires serologic testing and potential revaccination for HepB?

renal impairment (vaccine dialyzes off) serologic testing: 1-2mo after final dose, annually **no hepatic adjustment needed for hepatic impairment

When should patients be revaccinated for HepB?

antiHBs concentrations <10mIU/mL revaccinated w/ 3 doses of vaccine

Hepatitis B Vaccine: contraindications, ADEs, interactions

hypersensitivity (yeast, HepB vaccine, component of formulation) syncope (maybe w/ visual disturbances, weakness, tonic clonic movements) dermatologic (ANGIOEDEMA, petechiae, pruritus, rash, urticaria) IM: may diminish therapeutic effect of vaccines

What is the POSTEXPOSURE treatment for HepB? What is the timespan for action?

post exposure w/in 7d HepB immune globulin (HBIG) follow w/ HBV

What is the treatment for chronic HepB?

PEG-INF alpha (immunomodulating agent) antivirals (Entecovir, Tenofovir) HAV vaccination

Long term therapy for HepB can develop resistance. Resistance develops to which agents most common and least common?

MC: lamivudine, telbivudine LC: tenofovir

What additional recommendations would you give to a patient w/ HepB?

vaccinate sexual and household contacts avoid alcohol milk thistle (not with antivirals) (can protect/restore liver hepatocytes)

What diagnostic information is used to determine if a patient can be observed/monitored or needs pharmacologic intervention for HepB?

ALT =2: observe/monitor >2: pharmacologic tx for pts w/ cirrhosis: also look at HBV DNA

HepB: Entecavir: ADEs

HA fatigue upper abdominal pain lactic acidosis

HepB: Tenofovir disoproxil: ADEs

``` nausea diarrhea abdominal pain dizziness fatigue nephropathy lactic acidosis ```

HepB: Pegylated Interferon alfa 2a: ADEs

``` flu like sx fatigue mood disturbances (DEPRESSION) cytopenias autoimmune disorders ```

What indicates a positive response to HBV therapy? (biochemical, histologic, virologic)

biochemical: normalization of ALT histologic: dec histology activity virologic: undetectable HBV DNA, loss of HBeAg