Hepatitis B Flashcards by Rebecca Macinnes

Acute clinical hepatitis can occur any time between

A few weeks and 6 months after infection with hepatitis B virus

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State the symptoms of acute clinical hepatitis

Anorexia, lethargy, nausea, fever, abdominal discomfort, arthralgia and urticarial skin lesions, then dark coloured urine and jaundice

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State the mechanism of acute hepatitis

Immune-mediated, the greater the antigen/antibody reaction the more severe clinical and biochemical hepatitis

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State the percentage of patients hospitalised with acute infection of hepatitis B and fulminant hepatitis with dissemninated intravascular coagulation and encephalopathy

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State the possible outcomes of acute hepatitis B virus

Recovery (90-95%) or HBsAg positive chronic infection (5-10%)

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What type of virus is hepatitis B

Hepadnavirus

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State the three forms of the virus seen in blood

Infectious viral particles and non-infectious spheres and tubules

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What do the non-infectious spheres and tubules consist of

HBsAg

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The core of the hepatitis B virus contains what

HBcAg

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What is HBeAg

Split from HBcAg in the liver cell during new virus formation and released in a free soluble form in the serum

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State the markers of viral replication in hepatitis B

Serum HBeAg and HBV-DNA

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What is HBsAg used for

To detect both acute and chronic HBC infection

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Patients positive with HBeAg are

High infectious and at risk of developing chronic liver disease and hepatoma

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Describe patients who are HBsAg positive but HBeAg negative

Highly infectious with high serum HBV DNA as a result of chronic HBV infection with a virus with a mutant genome

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Statte the routes of transmission of hepatitis B

Vertical (perinatal) and horizontal (sexual, parenteral, needle stick injury)

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State what makes hepatitis B so infectious

May be 100million infectious particles per mL of blood, it is also stable and may survive outside of the body for weeks

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State the number of people worldwide effected by HBV

350million

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State the countries with the highest rates of hepatitis B infection (HBsAg 5-10%)

South-East Asia, China, Africa, Oceania and South America

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State the countries with intermediate rates of hepatitis B infection (2-5%)

Eastern Europe, Mediterranean, south Ameria and the Middle East

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State the countries with the lowest rates of hepatitis B infection (<2%)

Western Europe, North America and Australia

List the factors with increased risk of infection in the UK

IVDU, MSM, Immigration from areas of high endemicity, patients with learning disability who live in residential care, patients in haemodialysis units, babies born to mothers who are at risk, tattooing or body piercing with non-sterile equipment

State the number of women in areas of high endemicity who may be infection with HBeAg

10-15%

State the risk of transmission of infection from HBeAg positive blood

30%

State the risk of infection from Anti-HBe positive blood

0.1%

State how acute hepatitis B infection is usually diagnosed

HBsAg can be detected in serum, if not present, confirmed if high levels of anti HBc IgM antibodies are present

What is seroconversion

Development of significant levels of specific antibody following the infection or vaccination

Describe seroconversion in terms of hepatitis B

Anti-HBs from AntiHBc occurs some weeks after the disappearance of HBaAg

Define chronic hepatitis B infection

Persistence of HBsAg in the serum for more than 6 months

When is chronic hepatitis B more common

90% of infants, children, males and immunodeficiency

Patients with chronic hepatitis B are more at risk of

Chronic liver disease, membranous glomerulonephritis and polyarteritis nodosa

Whos more at risk of developing chronic disease

Patients who have asymptomatic or mild acute infection

State the symptoms of chronic hepatitis B

Fatigue, anorexia, depression, jaundice

What results in raised Serum AST and ALT levels

Immune system may begin to respond to the foreign viral proteins and attack the infected liver resulting in symptoms

State the percentage of individuals with chronic hepatitis B who can progress to cirrhosis or hepatoma

25%

State those who should be considered for antiviral treatement aimed at inhibition of HBV replication

Asymptomatic chronic HBV infection with raised ALT who are HBeAg positive and those with progressive liver disease

State the indications of use of antiviral therapy in the treatment of hepatitis B

Cirrhosis with evidence of ongoing viral replication in the form of circulating HBV DNA, or the presence of 2 of: HBV DNA>2,000 IU/ml Raised ALT Significant liver inflammation or fibrosis

State the go to antiviral treatment for hepatitis B

A long acting preperation of pegylated alpha interferon given subcutaneously once per week for 12 months or nucelotide analogues (especially in chronic hepatiits B patients)

State the two nucelotide analogues used in the treatment of hepatitis B

Entecavir and tenofovir

When should liver transplantation be considered in hepatitis B

Advanced cirrhosis or hepatoma

State the most important means of preventing HBV infection

Immunisation, infection control procedures, screening of blood donors and transplant donors

Active hepatitis B vaccine contains what

HBsAg produced by recombinant DNA technology

State the conditions with are associated with poor responses to the vaccine

Age over 40, obesity, smoking, wrong site of injection and immunocompromised

A person with post-vaccine antiHBs level of >100

Good responder, no further antibody check, booster given in 5 years

A person with post-vaccine antiHBs level of 10-<100

Poor responder, booster now and in 5 years

A person with post-vaccine antiHBs level of <10

No response to vaccine, repeat course of vaccine and recheck antibody level, 3 months after the last dose

List the people recommended to have active vaccination against hepatitis B

direct contact with blood or body fluids, those travelling to endemic areas for prolonged stay (>1yr), renal dialysis patients, those who change sexual partners frequently (particularly MSM and both male and female commercial sex workers), PWID, selected police and emergency services personnel, and close contacts of those with acute or chronic HBV infection.

How can passive immunisation against HBV be given

Hepatitis B specific immunoglobulin

When is a combination of passive and active immunisation used

Infants born to mothers with chronic HBV infection or who are HBsAg positive after acute infection Healthcare workers not known to have adequate antiHBs Previously unprotected sexual contacts and family contacts of individuals who have acute or chronic HBV infection