Hepatitis B

Report by: Desiree C. Escobido BSN 2-C

What is Hepatitis B?
It is a contagious, life-threatening, viral liver infection caused by hepatitis B virus (HBV) that
could be either chronic or acute. HBV is a bloodborne virus that is transmitted primarily via
sexual contact and needle use.

Mode of Transmission
HBV is contracted when blood, semen, or other bodily fluids from an individual with the virus
enters to someone via sexual contact, sharing of syringes or other drug-injection equipment, or
from mother to baby at birth.

Risk Factors
 Direct contact with an infected person
 Sexual exposure
 Sharing of needles
 Percutaneous or mucosal exposure to blood and other bodily fluids
 Diabetes, liver disease, and HIV/AIDS

Who are commonly affected (at-risk population)?

 Newborns of an infected mother
 A person engaging in sexual intercourse with an infected individual.
 Men who are in sexual activity with men
 Anyone who shares needles, syringes, or works for injecting drugs, body piercing, and/or
tattooing
 Any household contact of known individual with HBV
 Anyone who is exposed and works with blood and other bodily fluids
 Anyone who has undergone hemodialysis
 Anyone who travels to countries with moderate to high rates of HBV

Pathophysiology
The hepatitis B virus is constructed of an outer capsule containing HBsAg (hepatitis B surface
antigen), an inner core containing HBcAg (HBV core antigen), and the HBeAg (hepatitis
Beantigen).
The body mounts a cell-mediated immune response, as the blood is exposed to HBV, in which
cytotoxic T cells and natural killer cells are sent to the virus and release inflammatory cytokines.
The greater the immune response, the greater the chance of fighting the virus.
The virus is constantly dispersed into the blood due to the continual proliferation of hepatocytes,
contributing to the development of chronic infection.

Incubation Period
The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus
can still cause infection if it enters the body of a person who is not protected by the vaccine. The
incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected
within 30 to 60 days after infection and can persist and develop into chronic hepatitis B,
especially when transmitted in infancy or childhood.

Symptoms
 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea and vomiting
 Weakness and fatigue
 Yellowing of the skin and the whites of the eyes, also called jaundice

Acute vs. Chronic Hepatitis B

Hepatitis B infection may be short-lived, also called acute. Or it might last a long time, also
known as chronic.
 Acute hepatitis B infection lasts less than six months. Your immune system likely can
clear acute hepatitis B from your body, and you should recover completely within a few
months. Most people who get hepatitis B as adults have an acute infection, but it can lead
to chronic infection.
 Chronic hepatitis B infection lasts six months or longer. It lingers because your immune
system can't fight off the infection. Chronic hepatitis B infection may last a lifetime,
possibly leading to serious illnesses such as cirrhosis and liver cancer. Some people with
chronic hepatitis B may have no symptoms at all. Some may have ongoing fatigue and
mild symptoms of acute hepatitis.
The younger you are when you get hepatitis B — particularly newborns or children younger
than 5 — the higher your risk of the infection becoming chronic. Chronic infection may go
undetected for decades until a person becomes seriously ill from liver disease.

Complications
 Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B
infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's
ability to function.
  Liver cancer. People with chronic hepatitis B infection have an increased risk of liver
cancer.
 Liver failure. Acute liver failure is a condition in which the vital functions of the liver
shut down. When that occurs, a liver transplant is necessary to stay alive.
 Reactivation of the hepatitis B virus. People with chronic hepatitis B who have
suppression of their immune system are prone to reactivation of the hepatitis B virus.
This can lead to significant liver damage or even liver failure. This includes people on
immunosuppressive medications, such as high-dose corticosteroids or chemotherapy.
Before taking these medications, you should be tested for hepatitis B. If you test positive
for hepatitis B, you should be seen by a liver specialist (hepatologist) before starting
these therapies.
 Other conditions. People with chronic hepatitis B may develop kidney disease or
inflammation of blood vessels.
Hepatitis B – Details
Size / Type of Virus 47 nm DNA virus
Incubation Period 60-180 days
Transmission Parenteral, sexual
Onset Insidious
Chronic Progression Yes, 15-30% chance of cirrhosis and hepatocellular
carcinoma
Carrier State Positive
Prophylaxis Hygiene, HBV vaccine

Diagnostic Procedures / Laboratory Tests

It is not possible on clinical grounds to differentiate hepatitis B from hepatitis caused by other
viral agents; hence laboratory confirmation of the diagnosis is essential. Several blood tests are
available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute
and chronic infections. WHO recommends that all blood donations be tested for hepatitis B to
ensure blood safety and avoid accidental transmission.
 Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell
your provider whether it's acute or chronic. A simple blood test can also determine if
you're immune to the condition.
 Liver ultrasound. A special ultrasound called transient elastography can show the
amount of liver damage.
 Liver biopsy. Your provider might remove a small sample of your liver for testing to
check for liver damage. This is called a liver biopsy. During this test, your provider
 inserts a thin needle through your skin and into your liver and removes a tissue sample
for laboratory analysis.

Treatment
Hepatitis B can be prevented, but there’s no cure once you have the condition. Certain
precautions and prevention are taken to aid in preventing further spread of infection. On the
bright side, there are several prescription medications to treat chronic hepatitis B such as
antiviral medications that could help fight the virus and slow its damaging effect on the liver,
improving long-term survival and delaying the progression of liver failure/impairment. That said,
one should also be monitored regularly for signs of liver disease. However, they should not be
complacent if their condition is recovering as there is a possibility of infection reoccurrence.

How to prevent?
HBV is prevented by immunization of hepatitis B vaccine. This vaccine is usually given in two
doses with a month interval or 3-4 doses within six months, depending on which brand of
vaccine (Hepliv, Euvax B, Engerix B). It is recommended for infants, children, and adults aged
19-59 years. It is also given to those who belong in at-risk population.

Precautions
To further reduce the risk of contracting HBV, one should;
 Know the HBV status of any sexual partner.
 Always engage in a protected sex.
 Avoid usage of illicit drugs.
 Be mindful of body piercing and tattooing.
 Ensure acquiring hepatitis B vaccine.

Medical Management
 Antiviral medications
 HBV vaccine
 Interferon injections
 Liver transplant

Nursing Management
 Compromise and implement precautions for droplet infection to control infection
proliferation.
 Assess for symptoms, medical history with HBV exposure, and status of vaccine
immunization.
 Run diagnostic tests to confirm disease presence.
 Take vital signs and conduct independent nursing interventions to alleviate specific
symptoms.
 Administer and teach patient on how to take the prescribed medications.
 Conduct health teaching with regards to Hepatitis B and how to manage it by providing
insights of precautionary measures, prevention, and treatment.
What is Hepatitis B Vaccine?
It is used to protect against hepatitis B infection. The vaccine is monovalent (contains only one
antigen), but is also available in combination. Only the monovalent type is given as birth dose
within 24 hours after delivery, while the combination type is used in subsequent doses and
should not be given at birth. The HepB vaccine should never be frozen and must be shaken
before use (since the vaccine may separate from the liquid and will submerge at the bottom of
the vial).
Vaccine Disease Type of Formulatio Usual no. of Common Damaged
Vaccine n (of doses in vial size by
vaccine) primary series freezing?
and route of
administration
HepaB Hepatitis Liquid Monovalent 1st dose – 1 dose Yes
Vaccine B intramuscular 10 doses
(IM)
Forms & Presentation of HepB Vaccine
HepB vaccine is a cloudy liquid provided in single or multi-dose vials or in prefilled autodisable
(AD) injection devices. Hepatitis B vaccines are available in single-dose and multidose glass
vials. Multi-dose vials contain 2, 6, 10, or 20 doses.
How effective is HepB Vaccine?
Hep B is one of the safest and most effective of vaccines. Studies show that it is 95% effective in
preventing chronic infection. For infants exposed through the mother at birth, monovalent Hep B
vaccine is 90% effective in preventing transmission if the first dose is administered within 24
hours and the series completed at the recommended intervals using the combination vaccines.
Potential adverse effects?
Mild, temporary local reactions are common after an injection of HepB vaccine. Reactions and
complications due to the vaccine are rare, and no fatal allergic reaction has been reported. Mild
reactions include: soreness (mild swelling, tenderness, and redness at the injection site) and fever
(lasts one or two days after vaccination).
Administration Summary
HepB Vaccine Newborn Children/Adult
Mode of Action Induces specific humoral antibodies against HBV
Type of Vaccine Recombinant DNA
Form Cloudy liquid
Injection Site Intramuscular Intramuscular
Vastus Lateralis Deltoid
Number of Doses 1 dose 3 doses
Schedule “Birth Dose” 0, 1, 2-month interval
Within 24 hours (ideally 90 (Updated: 0,1,6 interval)
minutes) after birth. Can still be
given within 7 days
Dosage 0.5 mL Children: 0.5 mL
 Adults (< 20yo): 1 mL
Contraindications No contraindications, except if a very rare anaphylactic reaction to a
previous dose has occurred.
Hypersensitivity. Acute febrile illness.
Side Effects / Adverse Mild soreness and fever. Rare anaphylactic reaction.
Reactions
Special Precautions Patient with bleeding disorders including thrombocytopaenia, altered
immunocompetence (e.g., patient receiving chemotherapy or
immunosuppressants). Concomitant use with anticoagulant. Renal
impairment. Children. Pregnancy and lactation.
Storage Store between +2°C to +8°C.
Do not freeze. Protect from light. Any unused portions should be
disposed of in accordance with local requirements.

References:
Centers for Disease Control and Prevention. (n.d.). Hepatitis B Vaccination of Adults. Retrieved
December 11, 2022, from https://www.cdc.gov/hepatitis/hbv/vaccadults.htm
Fletcher, J. (2022, January 13). What is the incubation period for hepatitis B? Medical News
Today. https://www.medicalnewstoday.com/articles/what-is-the-incubation-period-for-
hepatitis-b
Mayo Clinic. (2022, September 4). Hepatitis B. https://www.mayoclinic.org/diseases-
conditions/hepatitis-b/symptoms-causes/syc-20366802
MIMS. (n.d.). Vaccine, Hepatitis B. Retrieved December 11, 2022, from
https://www.mims.com/philippines/drug/info/vaccine,%20hepatitis%20b?mtype=generic
Republic of the Philippines Department of Health. (2021). National Immunization Program:
Manual of Operations (Booklet 3). DOH.
https://doh.gov.ph/sites/default/files/publications/NIP-MOP-Booklet%203.pdf
South Dakota Department of Health. (n.d.). Hepatitis B. Retrieved December 11, 2022, from
https://doh.sd.gov/diseases/infectious/diseasefacts/hepatitis-b.aspx
State of Rhode Island Department of Health. (n.d.). Hep B (Hepatitis B). Retrieved December 11,
2022, from https://health.ri.gov/diseases/hep/?parm=4
World Health Organization. (2022, June 24). Hepatitis B. https://www.who.int/news-room/fact-
sheets/detail/hepatitis-b