- Most patients have no symptoms - Symptomatic persons experience a flu-like syndrome, anorexia, nausea, vomiting, diarrhea, dark urine, pale-appearing stools, pruritus, and abdominal pain

Hepatitis B Flashcards by nancy H

The highest concentration of the HBV is found in

Blood and serous fluid

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Primary Modes of Transmission?

blood or body fluids through

perinatal, sexual, or percutaneous exposure

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Infants born to mothers who are
infected with actively replicating HBV have a____ risk of becoming chronic
HBV carriers

90%

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Risk Factors for Acquiring HBV:

Individuals with multiple heterosexual partners
IV drug users using unsterilized needles
Recipients of blood products
Household contacts with acute hepatitis B with open cuts
Healthcare providers in contact with contaminated needles
Patients undergoing dialysis

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Hepatitis B structure?

double-stranded DNA virus with a phospholipid layer
containing hepatitis B surface antigen (HBsAg) that surrounds the
nucleocapsid.

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The ______ is detectable at the onset of clinical symptoms.

HBsAg

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Its persistence
past______ after initial detection corresponds to chronic infection and
indicates an increased risk for _______

6 months; cirrhosis, hepatic decompensation and HCC

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antibodies against hepatitis B core antigen (antiHBc) are measurable/non-measurable in blood?

measurable

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Viral replication occurs when the

hepatitis B envelope antigen (HBeAg) is

present and circulating in the blood

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Measures the viral infectivity and quantifies viral replication

Serum HBV DNA concentration

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Once Hepatitis B infection resolves, antibodies against Hepatitis

-antibodies against the hepatitis B
envelope (antiHBe)

-antibodies against hepatitis B surface antigen
(antiHBs) develop, and HBV DNA levels become undetectable.

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Approximately 90% of adults infected with the HBV develop_____, which
results in lifelong immunity

antiHBs

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In _____individuals, the disease resolves

spontaneously and does not lead to further complications.

immunocompetent

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In
____persons, the HBV is less likely to be eradicated, thus
causing persistent infection. This often leads to hepatic cell damage and
inflammation that may lead to cirrhosis and hepatocellular carcinoma

immunocompromised

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Symptoms of Disease?

Most patients have no symptoms
Symptomatic persons experience a flu-like syndrome, anorexia, nausea, vomiting, diarrhea, dark urine, pale-appearing stools, pruritus, and abdominal pain

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Signs of Disease

Jaundice- Scleral Icterus in eye
HepatoMegaly and Hepatic Encephalopathy ( Coma and Asterixis)
- Extrahepatic Symptoms: arthritis, postcervical
lymphadenopathy, palmar erythema, cryoglobulinemia, and vasculitis.

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Diagnosis of viral Hepatitis

Laboratory Serologies

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Liver function are used in ?

Extent of cholestatic and hepatocellular injury

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Why are lab serologies?

Individuals are asymptomatic & symptomatic patients cant identify a specific type of hepatitis

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The definitive test to determine the amount of damage and inflammation of hepatic cells is _____

liver biopsy

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Look at the figure .5

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Detectable in serum

HBsAg

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Undetectable in serum

HBcAg

The presence of antibodies against HBcAg to IgM indicates

active Infection

Check out figure 5 & 6

Hepatitis B Prevention?

- minimize their risk of acquiring the hepatitis B infection by avoiding contaminated blood products or participating in high-risk behavior such as IV drug use - Screening pregnant women for hepatitis B and providing universal Hepatitis B to all newborn is effective in preventing hepatitis B infections

_____ with Hepatitis B immune globulin ( HBIG) is recommended to prevent acute infection and complications associated with HBV

Post-exposure prophylaxis

HBIG- Hepatitis B Immune globulin

_____ is a sterile solution containing antibodies prepared from pooled human plasma that has a high concentration of anti-HBs

_____ provides passive immunization for post-exposure prophylaxis against HBV

HBIG

HBIG Doses?

- 0.06 ml/kg 1M= chronic | -

Side effects of HBIG?

- Erythema at injection site | - Headache, myalgia, fatigue, nausea, vomiting

Rare side effects of HBIG?

- Liver function test abnormalities, arthralgias, and anaphylactic reactions

Hepatitis B vaccine in United States?

Recombivax Hb and Engerix-B

Pre-exposure prophylaxis?

- Hepatitis B | virus should be vaccinated with the hepatitis B vaccine at months 0, 1, and 6.

The hepatitis B vaccine dose depends on the ____

person’s age

Post-exposure Prophylaxis?

the hepatitis B vaccine is indicated after exposure to prevent CHB (Chronic necroinflammatory disease).

Adults acutely exposed to blood containing HBsAg from an accidental needlestick, sexual contacts, or IV drug use should receive the hepatitis B vaccine with or without HBIG, preferably within

24 hours

What to give to a patient who has previously been vaccinated and got tested positive for HBsAg-positive

Administer HB vaccine booster dose

What to give to a patient who has not been vaccinated and got tested positive for HBsAg-positive

HBIG and initiate HB vaccine series

What to give to a patient who has not been vaccinated and got tested unknown for HBsAg-positive

No treatment

What to give to a patient who have not been vaccinated and got tested unknown for HBsAg-positive

Initiate HB vaccine series

Post-exposure prophylaxis for perinatal exposure depends on

- maternal HBsAg status and newborn Weight

Mothers with HBsAg-positive should be immunized within?

12-24 hours after birth with Hepatitis B vaccine and HBIG 0.5ml

If the mother is | HBsAg-negative, the newborn should only receive?

Hepatitis B vaccine

CHECK OUT TABLE PG9

adverse effects experienced by infants include:

local reactions at the injection site, fever, headache, dizziness and irritability

Recommendation for HBV vaccination

- Infants - Adolescents including unvaccinated children - All unvaccinated adults at risk for infection  Persons with a history of multiple sex partners  Current or recent injection-drug users  Household contacts and sex partners of persons with chronic hepatitis B infection  Healthcare workers with exposure to blood in the workplace  International travelers to regions with high or intermediate levels of endemic HBV infection  Recipients of clotting factor concentrates  Chronic dialysis

Hepatitis A and B Combination Vaccine?

Twinrix

Conditions for using Twinrix

older than 18 years old

Dosage Twinrix ?

0, 7, 21 to 31 day and the fourth dose at month | 12.

Goals of therapy?

- Suppress HBV replication - Loss of HbsAg - Prevents disease progression to cirrhosis and HCC

How is the response to therapy monitored?

- Biochemically - Histologic - Virologic response

Therapy.... - Biochemically - Histologic - Virologic response

- Normalize ALT - Decrease in Histology activity by atleast 2 points as compared with baseline biopsy - Virologic: Undetectable HBV DNA

Recommendations for treatment consider?

- Patients Age, serum HBV DNA and ALT level as well as Histologic Evidence and clinical progression of disease

How are patients monitored during drug therapy?

- ALT at 3-6 months intervals | - HBeAg should be checked every 12-6 months

Patients

HBeAg positive with HBV DNA levels >20,000 IU/mL after a 3-6 month period of elevated ALT levels between 1-2 ULN, or who remain HBeAg positive with HBV DNA levels >20,000 IU/mL and are >40 years old, should be considered for liver biopsy and treatment should be considered if biopsy shows moderate/severe inflammation or significant fibrosis.

When is liver biopsy not recommended?

- Liver biopsy is usually not necessary in young patients (below 30) who are HBeAg positive and have persistently normal ALT.