Professional Documents
Culture Documents
Huamin Wang
Statistics on HBV
Most healthy adults (90%) who are
infected will recover and develop
protective antibodies against future
hepatitis B infections
90% of infants and up to 50% of young
children infected with hepatitis B will
develop chronic infections.
Hepatitis B in China
1.3 billion people
the world's largest population of hepatitis
B patients, with nearly half a million people
dieing of the liver disease every year
120 million Chinese have tested positive
for hepatitis B, which has become a
severe public health problem in the
country
General Concepts
Hepatitis = 'inflammation of the liver'.
six medically important viruses are commonly
described as hepatitis viruses:
HAV,HBV,HCV,HDV,HEV,HGV.
Enterically
E
transmitted
A
NANB
B D
Parenterally
C transmitted
F, G, TTV
? other
Table 24.12
Hepatitis B Virus
1 Properties of HBV
a member of the hepadnavirus group
Circular partially double-stranded DNA
viruses
Replication involves a reverse transcriptase.
endemic in the human population and
hyperendemic in many parts of the world.
a number of variants
It has not yet been possible to propogate the
virus in cell culture
HBV : Structure
HBV : Structure
Virion also referred to as Dane particle (ds-tranded DNA)
42nm enveloped virus
Core antigens located in the center (nucleocapsid)
* Core antigen (HBcAg)
* e antigen (HBeAg)- an indicator of transmissibility
(minor component of the core- antigenically distinct from
HBcAg)
22nm spheres and filaments other forms- no DNA in
these forms so they are not infectious (composed of
surface antigen)- these forms outnumber the actual
virions
decoy particles
HBsAg-containing
particles are released into
the serum of infected
people and outnumber the
actual virions.
Spherical or filamentous
They are immunogenic and
were processed into the
first commercial vaccine
against HBV.
GENOME
2 HBV: Replication
Reverse transcription: one of the mRNAs is
replicated with a reverse transcriptase making the
DNA that will eventually be the core of the
progeny virion
RNA intermediate: HBV replicates through an
RNA intermediate and produces and release
antigenic decoy particles.
Integration: Some DNA integrates into host
genome causing carrier state
Replication of HBV
mother(HBeAg+)
4 Epidemiology
350,000,000 carriers worldwide
120,000,000 carriers in China
- the carrier rate can exceed 10%
-15 to 25% of chronically infected patients will die
from chronic liver disease
500,000 deaths/year in China
982,297 liver disease in China 2005
50% of children born to mothers with chronic HBV in
the US are Asian American
Moderate
Low/Not
Detectable
semen
urine
vaginal fluid feces
saliva
sweat
tears
breastmilk
80
80
60
40
100
Chronic Infection
60
40
20
20
Symptomatic Infection
0
Birth
1-6 months
7-12 months
Age at Infection
1-4 years
0
Older Children
and Adults
6 Clinical Features
Incubation period:
Average 60-90 days
Range 45-180 days
Insidious onset of symptoms.
Tends to cause a more severe disease than Hepatitis A.
Clinical illness (jaundice):
<5 yrs, <10%
5 yrs, 30%-50%
1/3 adults-no symptoms
Clinical Illness at presentation
10 - 15%
Acute case-fatality rate:
Chronic infection:
5 yrs, 2%-10%
0.5%-1%
< 5 yrs, 30%-90%
infections
Premature mortality from
chronic liver disease: 15%-25%
Chronic hepatitis
12-25% in 5 years
6-15% in 5 years
Cirrhosis
Hepatocellular
carcinoma
Death
20-23% in 5 years
Liver failure
Liver transplant
Death
HBeAg
Total anti-HBc
Titre
anti-HBs
IgM anti-HBc
HBsAg
12
16
20
24
28
Weeks after
32
36
52
100
Chronic
(6 months)
(Years)
HBeAg
Anti-HBe
HBsAg
Titer
Total anti-HBc
IgM anti-HBc
0 4
8 12 16 20 24 28 32 36
52
Years
7 Laboratory Diagnosis
8-2 Prevention
Vaccination
Hepatitis B Vaccine
Infants: several options that depend on status of
the mother
If mother HBsAg negative: birth, 1-2m,6-18m
If mother HBsAg positive: vaccine and Hep B immune
globulin within 12 hours of birth, 1-2m, <6m
Adults
* 0,1, 6 months
Vaccine recommended in
All those aged 0-18
Those at high risk
summary
Questions
What is hepatitis B?
What are the properties of HBV?
How many ORFs of HBV?
How is HBV spread?
How does the HBV curse the liver diseases?
How do you interpret serological lab results
for HBV?
How to treat and prevent hepatitis B?
Review Quiz
Following transmission of HBV from mother to
infant, which of the following is the most
common medical problem for the infant?
A. Liver failure.
B. Chronic HBV carrier state
C. Development of lymphoma.
D. Opportunistic infections.
E. Development of CNS disease.
Asians and Westerners can both get hepatitis B through contact with
blood, unprotected sex, shared needles, and from an infected
mother to newborn baby during delivery.
Jobs and lifestyle choices can create an equal risk for both groups.
However, hepatitis B is often spread differently among Asians.
Asians are most commonly infected as newborns - from a mother
who unknowingly passes the virus on during delivery.
Young children are also at risk if they live in close daily contact with
an infected family member.
Babies and children are more likely to develop a chronic hepatitis B
infection because their young immune systems have trouble getting
rid of the virus.
Westerners are most commonly infected as young adults through
unprotected sex. As adults, their immune systems can usually get
rid of the virus and they "recover" from an infection.