Hepatitis B

Question 1

Hepatitis B?

Answer 1

• Hepatitis B is a double-stranded DNA hepadnavirus and is spread through exposure to infected blood or body fluids,
• including vertical transmission from mother to child.
• The incubation period is 6-20 weeks.
• The features of hepatitis B include fever, jaundice and elevated liver transaminases

Question 2

Complications of hepatitis B infection?

Answer 2

• chronic hepatitis (5-10%)
• fulminant liver failure (1%)
• hepatocellular carcinoma
• glomerulonephritis
• polyarteritis nodosa
• cryoglobulinaemia

Question 3

Immunisation against hepatitis B (please see the Greenbook link for more details)?

Answer 3

• contains HBsAg adsorbed onto aluminium hydroxide adjuvant and is prepared from yeast cells using recombinant DNA technology
• most schedules give 3 doses of the vaccine with a recommendation for a one-off booster 5 years following the initial primary vaccination
• at risk groups who should be vaccinated include: healthcare workers, intravenous drug users, sex workers, close family contacts of an individual with hepatitis B, individuals receiving blood transfusions regularly, chronic kidney disease patients who may soon require renal replacement therapy, prisoners, chronic liver disease patients
• around 10-15% of adults fail to respond or respond poorly to 3 doses of the vaccine. Risk factors include age over 40 years, obesity, smoking, alcohol excess and immunosuppression
• testing for anti-HBs is only recommended for those at risk of occupational exposure (i.e. Healthcare workers) and patients with chronic kidney disease. In these patients anti-HBs levels should be checked 1-4 months after primary immunisation

Question 4

Anti-HBs level (mIU/ml)?

Answer 4

> 100:

• Indicates adequate response, no further testing required. Should still receive booster at 5 years

Question 5

Anti-HBs level (mIU/ml)?

Answer 5

10 - 100:

• ​Suboptimal response - one additional vaccine dose should be given.
• If immunocompetent no further testing is required

Question 6

Anti-HBs level (mIU/ml)?

Answer 6

< 10:

• Non-responder.
• Test for current or past infection.
• Give further vaccine course (i.e. 3 doses again) with testing following.
• If still fails to respond then HBIG would be required for protection if exposed to the virus