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Total anti-HBc
Titer
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
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
HBsAg Prevalence
≥8% - High
2-7% - Intermediate
<2% - Low
Concentration of Hepatitis B Virus
in Various Body Fluids
Low/Not
High Moderate Detectable
• Sexual
• Parenteral
• Perinatal
Risk Factors for Acute Hepatitis B
United States, 1992-1993
Heterosexual*
(41%)
Injecting
Drug Use
(15%)
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
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