HEPATITIS B

LINKS:
https://www.slideshare.net/liezlejoyg/hepatitis-b-15120187

https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/hepatitis-b?
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INFECTIOUS AGENT OF HEPATITIS B

 Hepatitis B virus (HBV), a double-stranded DNA virus, is the causative agent.

MODE OF TRANSMISSION AND PORTAL OF ENTRY

Although hepatitis B surface antigen (HBsAg) has been found in virtually all body secretions and excretions, only
blood (serum or plasma), semen and vaginal fluids have been shown to be infectious.

Transmission occurs via percutaneous (intravenous, intramuscular, subcutaneous, intradermal) and permucosal
exposure to contaminated blood and body fluids. This may occur during:

 sexual contact (increased risk with anal intercourse)

 birth or perinatally (vertical transmission from mother to infant, especially if HBsAg positive)
 injecting drug use (direct injection or via contaminated drug preparation equipment)
 some household activities, such as sharing razors or toothbrushes
 invasive procedures in the community, such as tattooing or body piercing, if there is inadequate infection
control
 invasive medical (haemodialysis, acupuncture) or dental procedures if there is inadequate infection control
 •needlestick injury (risk of transmission from HBV-positive source is up to 63 per cent).

PORTAL OF EXIT
 BLOOD (BM p.203)

INCUBATION PERIOD
 The incubation period is 45–180 days, with an average of 60–90 days.

PATHOGNOMONIC SIGNS
 Jaundice, icteric mucous membranes, dark urine and clay-colored stools. Clinically, the disease closely resembles hepatitis
A, but the incubation period is much longer ( 1 to 6 months) signs and symptoms may be insidious and variable. Fever and
respiratory symptoms are rare; some patients have arthralgias and rashes. The liver may be tender and enlarged to 12 to 14
cm vertically. The spleen is enlarged and palpable in a few patients; the posterior cervical lymph nodes may be also enlarged.

OTHER SIGNS AND SYMPTOMS

DIAGNOSTIC PROCEDURES
• BLOOD TESTS 
Hepatitis B viral panels (antibody/antigen tests) – Detect antibodies to the
various viruses. 
• Alanine aminotransferase (ALT) 
– Considered best liver enzyme test for detecting hepatitis. – Elevation usually occurs before other
symptoms, such as  jaundice, are noted.
• Alkaline phosphatase (ALP) 
– Usually only slightly elevated unless severe biliary obstruction is  present. 
• Complete Blood Count 
– RBCs are decreased because of shortened life span of RBCs - liver  enzyme alterations or
hemorrhage.  
– WBCs may be abnormally low (leukopenia) or high (leukocytosis);  monocytes may be increased
(monocytosis), and lymphocytes may be  increased and atypical in appearance. 
• Serum Albumin 
Measures the main body protein manufactured by the liver. Level is
decreased.
 • Prothrombin time (PT) 
Evaluates the body’s ability to produce a clot in a  reasonable amount of time. 
May be prolonged - liver dysfunction. 
• Serum Bilirubin 
High level indicates the liver is incapable of  adequately removing bilirubin in a timely manner  due to blockage of bile ducts
or liver disease, such as  acute hepatitis. 
• LIVER SCAN 
May be indicated for differential diagnosis, to identify underlying chronic  liver disease, or for evaluating organ
function. 
Helps estimate the severity of parenchymal damage. 
• LIVER BIOPSY 
Considered if diagnosis is uncertain or if clinical course is atypical or  unduly prolonged. 
Provides initial assessment of disease severity in client 
• URINALYSIS 
Checks the urine for bilirubin for the nonjaundiced client. 
Elevated bilirubin levels and proteinuria and hematuria may occur. 
• STOOL ANALYISIS 
Clay-colored stools indicate lack of normal bile excretion into the intestine.

PREVENTION AND TREATMENT

PREVENTION • Active Immunization: Hepatitis B Vaccine 
• Hepatitis B vaccine provides long-term protection against  HBV infection. Hepatitis immune globulin may be
effective  for unvaccinated persons who are exposed to the infection  if given within 7 days of exposure.
Hepatitis vaccination is  recommended for preexposure and postexposure  prophylaxis. 
• The vaccine also is recommended for all persons who are at  high risk for exposure to the virus. The vaccines
are  administered intramuscularly in three doses; the second  and third doses are given 1 and 6 months
respectively,  after the first dose. The third dose is very important in  producing prolonged immunity. Hepatitis
B vaccination  should be administered to adults in the deltoid muscle.

Prevention of Hepatitis 
❑Encourage proper community and home  sanitation. 
❑Encourage conscientious individual hygiene.
❑Instruct patients regarding safe practices for  preparing and dispensing food. 
❑Support effective health supervision of  schools, dormitories, extended care  facilities, barracks, and camps. 
❑Promote community health education programs.
❑Facilitate mandatory reporting of viral hepatitis to local  health departments. 
❑Recommend vaccination for all children 1 year of age  and older. 
❑Recommend vaccination for travelers to developing  countries, illegal drug users (injection and
noninjection.  drug users), men who have sex with men, and people  with chronic liver disease, and recipients
(eg,  hemophiliacs) of pooled plasma products. 
❑Promote vaccination to interrupt community-wide  outbreaks.

From PDF BURTONS MICROBIOLOGY

Hepatitis B virus - Antiviral Agent (BM p.163)
Adefovir, entecavir, peginterferon α-2a, lamivudine, telbivudine, tenofovir

Route of exit- BLOOD (BM p.203)

Route of Transmission or Entry- Transfusion or needlestick injury (BM p.203)
Bloodborne illnesses hepatitis B virus (HBV) (BM p.224)

Type of vaccine (BM p.296)

Subunit vaccines-. A subunit vaccine (or acellular vaccine) is one that uses antigenic (antibody-stimulating) portions of a
pathogen, rather than using the whole pathogen.

The material that is used to protect healthcare workers and others from hepatitis caused by hepatitis B virus (HBV) is being
produced by genetically engineered yeasts. The genes that code for hepatitis B surface protein were introduced into yeast cells,
which then produced large quantities of that protein. The proteins are then injected into people. Antibodies against the protein are
produced in their bodies, and these antibodies serve to protect the people from HBV hepatitis.

Hyperimmune serum globulin (or specific immune globulin) has been prepared from the serum of persons with high antibody
levels (titer) against certain diseases. For example, hepatitis B immune globulin (HBIG) is given to protect those who have been,
or are apt to be, exposed to hepatitis B virus. (BM p.298)

Hepatitis, or inflammation of the liver, can have many causes, including alcohol, drugs, and viruses. Viral hepatitis refers to
hepatitis caused by any one of about a dozen different viruses, including hepatitis A virus (HAV), hepatitis B virus (HBV),
hepatitis C virus (HCV), hepatitis D virus (HDV), hepatitis E virus (HEV), hepatitis G virus (HGV), hepatitis GB virus A
(HGBV-A), hepatitis GB virus B (HGBV-B), and hepatitis GB virus C (HGBV-C). Hepatitis can also occur as a result of viral
diseases such as infectious mononucleosis, yellow fever, and cytomegalovirus infection. (BM p.245)

The World Health Organization (WHO) estimates that ∼240 million people are chronically infected with HBV worldwide, that
about 600,000 people die each year as a result of HBV infections, and that more than 2 million new acute clinical cases occur
annually. (BM p.346)

The HBV vaccine is a subunit vaccine, produced by genetically engineered Saccharomyces cere
visiae (common baker’s yeast). At first, HBV vaccine was only recommended for persons at high risk of acquiring HBV infection
(such as infants born to HBV antigen–positive mothers, household contacts of HBV carriers, homosexual and bisexual men, and
users of illicit drugs), but now it is routinely administered to U.S. children. It is required for healthcare workers exposed to blood.
In addition to vaccination against HBV, healthcare personnel practice Standard Precautions (described in Chapter 12). Hepatitis B
immune globulin can be given to unvaccinated people who have been exposed to HBV,
perhaps by accidental needlestick injury. (BM p.346)