Herpes viruses and Hep B

Question 1

Hepatitis A index case. How long to isolate?

Answer 1

7 days from symptom/jaundice ONSET.

Question 2

Fit Hep A contact, age 1-59 years old. Exposure within 14 days. PHE management?

2nd scenario: as above, exposure within 14days, age 60 and above. How to manage?

Answer 2

below 60: give Hep A vaccine

Age 60 and above: give Hep A vaccine and HNIG

Question 3

Within 14day exposure.

Close contact who has chronic liver disease/chronic Hep B/chronic Hep C/immunosuppressed/HIV cd4<200. PHE management?

Answer 3

give Hep A vaccine and HNIG

Question 4

Baby age <12 months exposed to index Hep A case within last 14 days. PHE management?

Answer 4

1. Immunise household contacts and persons involved in nappy/toileting (to prevent tertiary infection)
2. If baby age above 2 months and attends childcare, give Hep A vaccine to baby. If can’t immunise, reinforce hygiene in childcare setting

(if can’t guarantee nursery hygiene, exclude infant contact for 30days. If this may have adverse consequences (eg loss of employment),then immunise kids and staff in childcare centre.

Question 5

Hep A contact seen after 14days, but within 8weeks of exposure. More than one close contact within the household.

PHE management?

Answer 5

offer hep A vaccine

Question 6

Close Hep A contact with risk factors (chronic liver disease/chronic hep B/C) seen within 28 days of exposure.

Answer 6

Give Hep A vaccine and HNIG

Question 7

Close Hep A contact is food handler. Seen more than 14days after Hep A exposure.

PHE management?

Answer 7

Risk assess to see if need to transfer to non-food handling duties.

Question 8

traveller to India wants Hep A vaccine. How soon prior to travel should he have it?

If he is going to stay in India for prolonged periods, does he need boosters?

Answer 8

Pre-travel Hep A vaccine ideally give at least 2 weeks before departure, but can be given upto day before

(age 1 year and above)

If on-going risk, give booster at 6-12months later.

Question 9

Note

groups who need pre-exposure Hep A vaccine:

• MSM
• IVDU
• haemophilia (can’t guarantee transfusion Hep A virus has been killed)
• Chronic liver disease pts
• Occupations which must be vaccinated-lab worker, sewage workers, primate worker, residential home staff,

Answer 9

consider Hep A vaccine for occupational groups below

• food handlers
• healthcare workers
• staff in daycare facilities

Question 10

Pregnant woman with HIV & Hep B. not immune to Hep A. How to immunise?

Answer 10

Give Hep A vaccine at 0 and 6 months (on-going risk)

If CD4<300, give additional dose (0,1 and 6 months)

Question 11

Infant born to Hepatitis B positive mum.

How to manage?

Which 4 infant groups merit IVIG?

Answer 11

1. Vaccinate baby at 0.1.2.12 months
2. at least 12months, do serology to check infection/immunity.
3. also give booster dose at 5 years old due to ongoing risk from other family members.
4. in following 4, also give IVIG within 24hrs of birth

mum HbSAg pos and HBeAg pos/(HbeAg neg and anti-HBe neg)

mum had acute Hep B in preggers

mum HBSAg pos and baby<1.5kg

mum HBSAg pos and HBV DNA>10^6

Question 12

Which Hep B positive pregnant women are treated? How?

Can mum breast feed?

Answer 12

If mum HBV DNA>10^7 in third trimester, offer tenofovir.

can stop tenofovir 4-12wks post natal unless mum needs Tx.

safe to breastfeed on tenofovir&if child has been immunised.

Question 13

Which receptor does Hep B virus bind to?

Answer 13

heparin sulfate proteoglycan