Hepatitis B

Question 1

How is Hep B transferred?

Answer 1

Vertical (mouthed to child)
Sexual contact
Injections (drugs/needle stick injuries)
Close household objects- significant blood exposure

Question 2

What are the symptoms of acute Hep B?

Answer 2

Jaundice
Fatigue
Abdominal pain
Anorexia/nausea/vomiting 
Arthralgia (pain in a joint)

Question 3

What is the incubation time for acute Hep B?

Answer 3

6wks to 6 months

Question 4

What sort of numbers would you get for ALT/AST levels in someone who has acute Hep B?

Answer 4

In the 1000s

Question 5

Is it possible to get chronic Hep B?

Answer 5

Yes (happens in about 10% of cases- adults , 90% if infected in infancy)

Question 6

What are the antigens associated with Hep B?

Answer 6

HBsAg (surface antigen)
HBeAg (e antigen)
HBcAg (core antigen)- not detectable in blood

Question 7

What the antibodies associated with Hep B?

Answer 7

HBsAb (surface antibody)
HBeAb (e antibody)
HBcAb (IgM or IgG; core antibody)

Question 8

In whatordwr would you expect to see the appearance of the various antigens and antibodies in the blood of someone with Hep B?

Answer 8

1. HBsAg first
2. HBeAg next (at the point when someone is most infectious)
3. HBcAb (IgM) - wouldn’t see the HBcAg because it isn’t detectable in the blood. IgM because because it is early infection
4. HBeAb - to fight e antigen
5. HBsAb - to fight surface antigen, at this stage the person is recovering and likely to successfully rid themselves of the virus
6. HBcAb (IgG- persists for life)

Question 9

When does acute Hep B become chronic HepB?

Answer 9

If HBsAg persists after 6 months

*25% chronic infections will lead to cirrhosis and ~5% will develop hepatocellular carcinoma

Question 10

What is the treatment for chronic Hep B?

Answer 10

NO CURE (because it integrates into the hosts genome)

• we can give life long antivirals to suppress viral replication

** can be an inactive carrier not requiring treatment though. They have low viral load/normal LFTs/ no liver damage

Question 11

How can we prevent people getting Hep B?

Answer 11

Vaccinated ( 3 doses and boosters if required): give genetically engineered surface antigen, causing a surface antibody production response

Question 12

What antibody/antigen associated with Hep B will tell you if someone currently has Hep B (be that chronic or acute)?

Answer 12

HBsAg

Surface antigen

Question 13

What antibody/antigen associated with Hep B will tell you whether someone has ever had Hep B?

Answer 13

HBcAb -core antibody

In acute they will have IgM, in chronic and recovered patients they will have IgG

Question 14

What antibody/antigen associated with Hep B will tell you whether someone has immunity/ is protected?

Answer 14

HBsAb - surface antibody

Possible to have this even without ever having hep B- present in those who have been vaccinated