Hepatitis B

Question 1

Is the initial hepatitis B infection asymptomatic?

Answer 1

Initial hepatitis B infection may be asymptomatic in up to 50% of adults and 90% of children. This can develop into chronic infection and patients are often unaware of it until the development of end-stage liver disease

Question 2

What % of adults with Hep B will progress to a chronic infection? What will progress to liver diseas?

Answer 2

About 5-10% of adults will progress to chronic infection, and 15-40% of them will develop liver disease.

Question 3

How is Hep B transmitted?

Answer 3

Hepatitis B virus is substantially more infective than HIV. It is primarily transmitted through blood or other bodily fluids by sharing contaminated needles or other drug paraphernalia or through sexual contact. It can also be transmitted from mother to child during pregnancy or birth, and 90% of these babies have high risk of developing chronic hepatitis B infection later in life leading to liver cirrhosis and hepatocellular carcinoma.

Question 4

What are the complications of liver disease from Hep B?

Answer 4

Complications of liver disease will include hepatic encephalopathy, ascites, portal hypertension, esophageal varices, impaired liver synthetic function, and hepatorenal syndrome.

Question 5

What is the clinical presentation of Hepatitis B infection?

Answer 5

Often asymptomatic
Fever
Fatigue
Loss of appetite
Myalgia, arthralgia
Right upper quadrant pain
Diarrhea
Nausea and vomiting
Jaundice
Laboratory finding: elevation of serum transaminase with alanine transaminase (ALT) > aspartate transaminase (AST), total and direct bilirubin, and alkaline phosphatase (ALP)

Question 6

Describe each of the following serologic markers and what they mean?
a. HBSAg (Hep B surface antigen)
b. HBeAg (Hep B envelop antigen)
c. Anti-HBc (Antibody to HB core antigen)
d.Anti-HBs (Antibody to HBsAg)

Answer 6

HBsAg (hep B surface antigen) – present in acute or chronic infection. Detected in serum 30-60 days after exposure and persists until infection resolves.

HBeAg (hep B envelope antigen) – associated with higher viral loads, increased infectivity and more actively replicating virus.

Anti-HBs (antibody to HBsAg) – usually appears when the infection has resolved and confers long-term immunity. This can be a result of vaccination or resolved infection.

Anti-HBc (antibody to HB core antigen) – indicates exposure to the virus, includes those who have chronic infection and those infected in the past but have cleared the virus.

Question 7

List the antigens and antibiotics that make up the serologic markers for Hepatitis b virus exposure or immunity?

Answer 7

Question 9

What kind of immunity or infection does the patient have if:
1. HBS Ag - Positive
2. Anti-HBc - Positive
3. Igm antiHBC - Positive
4. Anti-HBS - Negative?

Answer 9

Acutely infected

Question 10

Interpret what it means if:
HBsAg - negative
Anti-HBc - negative
Anti-HBs - negative?

Answer 10

SUSCEPTABLE to HEP B

Question 11

HBsAg - negative
Anti-HBc - positive
Anti-HBs - positive

Answer 11

Means immune to natural infection

Question 12

HBsAg - negative
Anti- HBc - negative
Anti-HBs - positive

Answer 12

Immune through vaccination

Question 13

HBsAg - positive
Anti-HBc - positive
IGM - AntiHBc - negative
Anti-HBs - Negative

Answer 13

Chronically infected

Question 15

What are ways to prevent HB infection?

Answer 15

Always practice safe sex.
Never share needles or any other drug equipment.
Wear gloves when in contact with or handling blood specimens.
Avoid sharing personal items that are likely to become infected with blood, eg. Toothbrushes, razors.
Make sure all equipment is sterile when getting a tattoo, body piercing, or acupuncture treatments.

Vaccination: 95% - 100% effective pre-exposure for at least 30 years following immunization.

Question 16

What are considered protective antibodies after

Answer 16

Protective antibody levels: > 10 IU/mL
Check titres to ensure response
ADR: injection site reactions, fever, h/a, dizziness, irritability, hypersensitivity and rarely serum sickness reactions

Question 17

Which groups should receive the Hep B vaccine?

Answer 17

Universal neonatal vaccination program + catch-up program for adolescents who did not receive childhood vaccine
Healthcare works or others with risk of occupational exposure (eg. Child care workers)
Travellers to endemic areas
All adults and children who have immigrated to Canada from areas of high prevalence (even if child born in Canada)
Children in child care settings where a child or worker is a carrier or has acute hep B
Household and sexual contacts
Populations in communities in which Hep B is endemic
Residents/staff of institutions
Persons who have lifestyle risk factors
Chronic liver disease
Hemophiliacs and others receiving repeated infusions of blood or blood products
Chronic renal disease on dialysis
Congenital immunodeficiency, transplant, HIV

Question 18

What does the WHO recommend regarding Hepatitis vaccination and age?

Answer 18

There is currently no cure for chronic hepatitis infection, therefore vaccination is highly recommended for those at risk. Since the risk of chronic infection is so high for newborns, both the World Health Organization and US Centre for Disease Control and Prevention recommend that all infants receive first dose of hepatitis B vaccine within 12-24 hours after birth. However, this should be balanced with risk of hepatitis in mothers and seroprotection rates achieved by hepatitis B immunization at the age of vaccination.

Question 19

Which ages have the best response rate to Hep B vaccination?

Answer 19

While children less than 2 years old have 95% response rate, the best immune response (99% seroprotection rate) is observed in children between the age of 5 to 15 years old. Generally, the response rate for adults decreases with age and depends on the health status of the individual.

Question 20

Which groups should receive post-exposure prophylaxis for HB?

Answer 20

Post-exposure immunization with Hep B vaccine +/- immunoglobulin (HBIG) is recommended to:

Infants born to a mother with acute or chronic Hep B infection (vaccination initiated within 12 hours of birth + HBIG)
Sexual or household contacts of an acute case or chronic carrier of Hep B - sexual contacts may receive HBIG up to 14 days after exposure, while household contacts should be vaccinated (no HBIG indicated).
Percutaneous or mucosal exposure to blood or bodily fluids potentially containing Hep B virus – see further details below.