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Hepatitis B Virus

Hepatitis B - Clinical Features


• Incubation period: Average 60-90 days
Range 45-180 days
• Clinical illness (jaundice): <5 yrs, <10%
≥5 yrs, 30%-50%
• Acute case-fatality rate: 0.5%-1%
• Chronic infection: <5 yrs, 30%-90%
≥5 yrs, 2%-10%
• Premature mortality from
chronic liver disease: 15%-25%
Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Symptoms
HBeAg anti-HBe

Total anti-HBc
Titer

HBsAg IgM anti-HBc anti-HBs

0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure
Progression to Chronic Hepatitis B Virus Infection
Typical Serologic Course
Acute Chronic
(6 months) (Years)
HBeAg anti-HBe
HBsAg
Total anti-HBc

Titer

IgM anti-HBc

0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
Rate of Reported Hepatitis B by Age Group
25 United States, 1990
100,000)

20
(per 100,000)

15
Rate (per
Rate

10

0
0-14 15-19 20-29 30-39 40+
Age Group (Years)
Source: CDC Viral Hepatitis Surveillance Program
Age at Aquisition of Acute and Chronic HBV Infection
United States, 1989 Estimates

(4% ) Perinatal (24%)


(4%) Children (12%)
(1-10 yrs) Adult
Adult
(8%) Adolescent (6%) (59%)
(83%)

Acute HBV Infections Chronic HBV Infections


Outcome of Hepatitis B Virus Infection
100 by Age at Infection 100

Symptomatic Infection (%)


80 80
Chronic Infection

60 60
Chronic Infection

40 40
(%)

20 20

Symptomatic Infection
0 0
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
Age at Infection
Global Patterns of Chronic HBV Infection

• High (≥8%): 45% of global population


– lifetime risk of infection >60%
– early childhood infections common
• Intermediate (2%-7%): 43% of global population
– lifetime risk of infection 20%-60%
– infections occur in all age groups
• Low (<2%): 12% of global population
– lifetime risk of infection <20%
– most infections occur in adult risk groups
Geographic Distribution of Chronic HBV Infection

HBsAg Prevalence
≥8% - High
2-7% - Intermediate
<2% - Low
Concentration of Hepatitis B Virus
in Various Body Fluids

Low/Not
High Moderate Detectable

blood semen urine


serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
Hepatitis B Virus
Modes of Transmission

• Sexual
• Parenteral
• Perinatal
Risk Factors for Acute Hepatitis B
United States, 1992-1993
Heterosexual*
(41%)

Injecting
Drug Use
(15%)

Homosexual Activity (9%)


Household Contact (2%)
Health Care Employment (1%)

Unknown (31%)
Other (1%)

* Includes sexual contact with acute cases, carriers, and multip le partners.
Source: CDC Sentinel Counties Study of Viral Hepatitis
Elimination of Hepatitis B Virus Transmission
United States

Objectives
• Prevent chronic HBV Infection
• Prevent chronic liver disease
• Prevent primary hepatocellular carcinoma
• Prevent acute symptomatic HBV infection
Elimination of Hepatitis B Virus Transmission
United States
Strategy
• Prevent perinatal HBV transmission
• Routine vaccination of all infants
• Vaccination of children in high-risk groups
• Vaccination of adolescents
– all unvaccinated children at 11-12 years of age
– “high-risk” adolescents at all ages
• Vaccination of adults in high-risk groups
Estimated Incidence of Acute Hepatitis B
United States, 1978-1995
80 HBsAg screening
of pregnant women Infant
Cases per 100,000 Population

Vaccine recommended immunization


70 licensed recommended

60
OSHA Rule
50 enacted
Adolescent
40 immunization
recommended
30

20

10
Decline among
homosexual
men & HCWs
Decline among
injecting
drug users
*
0
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95

* Provisional date Year