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Presentation1 150512143508 Lva1 App6891
Presentation1 150512143508 Lva1 App6891
DEPARTMENT OF PUBLIC
HEALTH DENTISTRY
SEMINAR
HEPATITIS B
2
Presented by:-
Dr. Amrita Rastogi
CONTENTS
HISTORY
INTRODUCTION
PREVALENCE OF HEPATITIS B
HEPATITIS B VIRUS
MODES OF TRANSMISSION
3
PATHOLOGY & PATHOGENISIS
SIGNS AND SYMPTOMPS
CLINICAL FEATURES
DIAGNOSIS
LEVELS OF PREVENTION
CONCLUSION
REFERENCES
4
HISTORY (1)
o Its an ancient disease first described in 5th century B.C.
vaccine.
hepatitis
5
DNA viruses.
months)
months)
8
Hepatitis B is a serious and common infectious diseases
world.
Every year there are over 4 million acute causes of HBV, and
13
HEPATITIS B VIRUS (5)(6)
of hepadnavirus.
14
The virus interferes with the functions of liver while
inflamed.
17
18
HBsAg = surface (coat) protein
HBcAg = inner core protein
hepatocyte.
20
Reverse transcription: one of the mRNAs is replicated with a
particles.
carrier state
21
HOW THE VIRUS REPRODUCES ?
1.First the virus attached to a liver cell membrane
22
2. The virus is then transported into the liver cell.
23
3. The core particle then releases it’s contents of DNA and
DNA polymerase into the liver cell nucleus.
24
4.Once within the cell nucleus
the hepatitis B DNA causes
the liver cell to produce, via
messenger RNA ; HBs
protein , HBc protein , DNA
polymerase, the HBe protein
, and other undetected
protein and enzymes.
26
7.However because of the excess numbers of surface
proteins produced many of these stick together to form
small spheres and chains. These can give a characteristic “
ground glass” appearance to blood samples seen under
microscope.
27
8. The copies of the virus and excess surface antigen are
released from the liver cell membrane into blood stream
and from there can infect other liver cells
28
29
MODES OF TRANSMISSION (9)
risk.
Perinatal
• 90% of
Mother
infected
• 6% of
infants
become Host people
chronically infected over
infected the age of 5
become
chronically
infected
Infant
Recipient
Child-to-child
Contaminated needles
Sexual contacts
Healthcare worker 31
Blood transfusion
Heterosexual*
(41%)
Injecting
Drug Use
(15%) Homosexual Activity (9%)
Unknown (31%)
32
HIGH-RISK GROUPS FOR HBV INFECTION (9)
no symptoms of illness.
SECOND STAGE
In the third stage, the host can target the infected hepatocytes
reference range.
37
PATHOLOGY (11)(12)
Three antigen-antibody system
hepatitis B.
39
2) HBcAg—anti-HBc system
HBcAg in serum
41
42
43
PATHOGENISIS (11)
HBV invades into the human body by skin and mucosa, Via
blood flow enters the liver and other organs such as pancreas,
membrane.
cause cytopathy
45
SIGNS AND SYMPTOMS (12)
Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Clay-colored bowel movements
Joint pain
Jaundice
Hepatomegaly
46
Symptoms begin an average of 3 months (range: 2–
for up to 6 months.
47
CLINICAL FEATURES (12)(13)
Incubation period Average 60-90 days
Range 45-180 days
ACUTE HEPATITIS B
Phases of disease
1. Preicteric
2. Icteric
49
3. Convalescent
Preicteric
a. Tiredness
b. Anorexia
50
• Icteric
mucous membranes.
d. Hepatosplenomegaly
(<6 months)
52
Chronic Hepatitis B
54
HEPATOCELLULAR CARCINOMA
liver.
female.
4:1.
55
Appears after a mean duration of about 35 years of HBV
infection.
56
FULMINANT HEPATITIS
Usually fatal
58
DIAGNOSIS (16)(17)
infection.
integrated HBV.
60
CONCENTRATION OF HEPATITIS B VIRUS IN
VARIOUS BODY FLUIDS (16)
61
LEVELS OF PREVENTION FOR HEPATITIS B (17)(18)
Primary Prevention
Advocacy and raising awareness of all types of viral
hepatitis infections help to reduce transmission in the
community.
Safe and effective vaccines are widely available for the
prevention of HAV and HBV infections and an HEV
vaccine has recently been licensed in China.
Implementation of blood safety strategies, including
blood supplies based on voluntary non-remunerated
blood donations, effective public education on blood
donation, donor selection, and quality-assured screening
of all donated blood and blood components used for 62
transfusion can prevent transmission of HBV and HCV.
Infection control precautions in health care and community
settings can prevent transmission of viral hepatitis as well as
many other diseases.
Safe injection practices can protect against HBV and HCV
transmission.
Safer sex practices.
.
63
HEPATITIS B VACCINATION (19)
1965 Discovery of Australian antigen
65
PLASMA DERIVED VACCINE
These vaccines, derived from the plasma of HBsAg-
positive donors, consist of highly purified, formalin-
inactivated and/or heat-inactivated, alum-absorbed,
hepatitis B sub virion particles (22nm) of HBsAg that are
free to detectable nucleic acid and therefore,
noninfectious.
The first plasma derived vaccines were manufactured in
USA and France in 1981-1982.
66
RECOMMENDATION FOR PRE EXPOSURE
IMMUNIZATION WITH HEPATITIS B
68
COMBINATION VACCINES
The HBsAg vaccines can be combined with other
vaccines such as Calmetta-Guerin Bacillus(BCG),
measles, mumps, and rubella, Haemophilus influenzae b,
diptheria, tetanus and petussis combined with polio.
Neonates born to mother who are HBsAg positive should
be given a combination of passive and active
immunization to provide immediate protection in the first
6 hours after delivery, followed by long term immunity
with the vaccine.
69
The vaccine is administered by intramuscular injection in
the antrolateral aspect of the thigh of the new born and
infants or deltoid (arm) muscle of children and adults in
order to achieve optimal protection.
It is particular effective within 48 hours of the incident. It
may also be given to neonates who are at increased risk
of contracting hepatitis B i.e. whose mothers are HBsAg
and HBeAg positive.
Hepatitis B Immunoglobulin - HBIG may be used to
protect persons who are exposed to hepatitis B.
70
HEPATITIS B VACCINE
ADOLESCENT AND ADULT SCHEDULE
Usual Minimum
Dose Interval Interval
Primary 1 --- ---
Primary 2 1 month 4 weeks
Primary 3 5 months 8 weeks*
Recombivax HB Engerix-B
Dose (mcg) Dose (mcg)
Infants and children 0.5 mL (5) 0.5 mL (10)
<11 years of age
73
DENTAL CONSIDERATION
o lichen planus
o Mucosal Ecchymosis
74
Management for dentists:
Pre – Exposure vaccination : Engerix. Which is available
commonly.
Maintaining proper sterilization and infection control
measures.
More use of disposable products like disposable gloves,
mouth mask, syringes, etc.
Proper disposal of used needles.
75
ROLE OF A PUBLIC HEALTH DENTIST
A public health dentist can play an important role in preventing the
hepatitis B by:
Telling about healthy lifestyle and habits to prevent any kind of liver
related diseases.
76
SECONDARY PREVENTION (20)
Early diagnosis provides the best opportunity for effective
medical support and prevention of further spread. It also
allows the infected persons to take steps to prevent
transmission of the disease to others. Early diagnosis of
those with chronic infection also allows people to take
precautions to protect the liver from additional harm,
specifically by abstaining from alcohol and tobacco
consumption and avoiding certain drugs that are known
to be toxic to the liver.
77
Treatment of acute HBV infection is primarily supportive.
also necessary.
78
Possible adverse effects to interferon include fever and
79
In acute hepatitis B the treatment is basically
symptomatic
Rest
Hepatotropic agents
80
Chronic Hepatitis B (20)(21)
83
CONCLUSION
hepatitisB.
85
REFERENCES
1. Hepatitis B Epidemiology and Prevention of Vaccine-
Preventable Diseases The Pink Book: Course Textbook - 12th
Edition Second Printing (May 2012) Center Of Diseases
Control
2. Fauci ,Braunwald, Isselbacher Harrison’s Principle of internal
mediciene vol-2 14th edition.
3. Haslett, Chivers, Boon Davidson’s Principles and Practice of
Mediciene. 2004 19th edition.
4. Churchill’s Illustrated Medical Dictionary, New York ,
Churchill Livingstone, 1989.
5. Harmanjit Singh Hira Text book of General Medicine for
Dental Students.
6. Manual of Clinical Microbiology, Patrick R Murray 9th
edition.
7. Topely and Wilson’s, Virology volume-1 ,9th edition. 86
8. Mandell’s, Principle and Practice of Infectious Diseases,
5th edition
9. Documents on Hepatitis A-E published by WHO,
Department of Communicable Diseases Surveillance
and Response
10. Textbook of Microbiology, Ananthanarayan and
Paniker,7th edition
11. European Association for the Study of the Liver. EASL
clinical practice guidelines: management of chronic
hepatitis B. J Hepatol 2009;50:227–242.
87
12. Ganem D, Schneider RJ. Hepadnaviridae: The Viruses and
Their Replication. In : Knipe DM et al., eds. Fields Virology,
4th edition, Philadelphia, Lippincott Willams& Wikins,
2001:2923-2969.
13. Ganem D, Prince AM. Hepatitis B virus infection – natural
history and clinical consequences. N Engl J Med
2004;350:1118–1129.
14. Hepatitis B ; World Health Organization, Department of
Communicable Diseases Surveillance and Response;
WHO/CDC/LYO/2002.2: Hepatitis B.
15. Center for Disease Control and prevention. Hepatitis B
vaccine. 1998
(http://www.cdc.gov/ncidod/diseases/b/hebqafn.htm)
16. Gitlin N. Hepatitis B: diagnosis, prevention, and treatment.
Clinical Chemistry, 1997, 43:1500-1506.
17. Prevention and Control of Viral Hepatitis; Frame Work for
global action;WHO/HSP/PED/HIP/GHP/2012.1
88
18. Jacobsen KH, Wiersma ST. Hepatitis A virus
seroprevalence by age and world region, 1990 and 2005
Vaccine, 2010, 28: 6653–6657.
19. Perz JF et al. The contributions of hepatitis B virus and
hepatitis C virus infections to cirrhosis and primary
liver cancer worldwide. Journal of Hepatology,
2006,45: 529–538.
20. World Health Organization. Hepatitis B vaccines.
Weekly Epidemiological Record, 2004.79:255-263.
21.Hepatitis B Department of Health and Human Services
Center Of disease conrol and prevention ; Division of
viral hepatitis.June 2010 (WWW.CDC.gov/hepatitis)
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