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Sushil Paudyal
Department of Community


the South-East Asia Region and the European Region.1% respectively of the adult population is infected.Hepatitis B Also know as serum hepatitis Hepatitis B prevalence is highest in the Western Pacific Region and the African Region.2% and 6.0% and 1.3%. where 6. 2. an estimated 3. respectively .6%% of the general population is infected. In the Eastern Mediterranean Region.

Tubules of varying lengths and diameters 3. .Epidemiological Determinants Agent Factors (a)Agents : Causative agent : Hepatitis B virus. Dane particle which corresponds morphologically to hep B virus infection. Small spherical particle – stimulate production of surface antibodies 2. Hepadena virus family Double stranded DNA virus Also known as Dane particle (Diameter : 42nm) Replicate in the liver cells Occurs in 3 morphological forms 1.

Australian antigen Useful marker form epidemiology Ist marker to appear in blood after infection HBcAg : Core antigen Not detected in serum HBeAg : Enveloped antigen Indicate active viral replication .Associated antigens HBsAg: Surface Antigen.

high HBsAg titer. HBV Simple carrier Low HBsAg titer (d) Infective material Contaminated blood Body secretion like saliva.(b) Reservoir of infection : Man is only reservoir (c) Carriers Super carriers with high HBeAg. vaginal secretion and semen (e) Resistance Stable and capable of surviving for days on environmental surface (f) Period of communicability : Months to years . DNA polymerase.

1-5 years : 10 % >5 years : 30% (b) High risk group : Surgeons.Host Factors (a)Age : Perinatal approx 1% occurrence but has highest chance to develop chronic HBV 70% approx. dentists. sex workers. Iv drug users and infant of HBV carrier mothers (c) Humoral and cellular response : Antibodies are produced about 10 days after onset of jaundice . nurses. lab technicians and blood bank workers High incidence among homosexual.

jaundice. mild illness may have an anicteric course Acute : HBsAg. HBeAg(active replication). fever. upper abdominal pain arthralgia.HBc). Anti-HBe(low replication) Anti-HBs : previous infection (Anti. malaise. Window period : End of detection of HBsAg and appearance of anti HBsAg… .Clinical illness : Headache. IgG-HBc. vaccination ( without Anti-HBc). IgM-HBc. HBeAg Chronic : HBsAg(>6 months). skin rashes. anorexia.

Parenteral route: Commonest route 2. Direct contact : Deep kissing. sexual intercourse 4. Vertical : From carrier mother to babies 5. ear piercing. Horizontal : Child to child through physical contact with the skin condition like scabies and impetigo (b) Incubation Period : 50 -150 days . Percutaneous route : Tattooing. acupuncture 3.(a)Mode of Transmission : 1.

Clinical Courses: .

Anti-Hbe (low replication) . IgG-HBc. HBeAg Chronic infection : HBsAg(>6 months). HBeAg(active replication). IgM-HBc. Direct Examination (a) Immunoflorescence staning of infected hepatocytes show HBV core protein in nucleus and infectious Dane particle in cytoplasm. (b) Detection of viral DNA : In situ hybridization 2. Serology Recent infection : HBsAg.Laboratory Diagnosis : 1.

Stool : Clay colored 6. Blood count : Leucopenia with relative lymphocytosis .2 mg/dL ) (b) ALP : Increased (N= 44 to 147 IU/L) (c) AST/ALT : Increased (d) Albumin:Globumin = Altered (N=0. Liver Function Test : (a) Serum Bilirubin : Increased (N=0.8-2) 4.1 to 1. Urine Examination Urobilinogen increased in early stage 5.3.

Management : 1. Chronic Hepatitis : Goal of treatment (a) HBeAg seroconversion (b) reduction in HBV-DNA (c) normalization of the LFTs . Acute Hepatitis Full recovery occur in 90-95% case and remaining turn into chronic hepatitis 2.

Entecavir 0. Liver transplantation is indicated in FHF and ESLD .5 mg orally and 1 mg orally in case of lamivudine resistance for 48 weeks.1. Lamivudine 100 mg daily orally for 48 weeks 3. IFN. Adefovir 10 mg daily orally for 48 weeks. 4. 5.α either 10 million units thrice weekly or 5 million units daily for 4-6 months 2.

razors.Avoiding homosexuality and multiple sexual partners -Instruction to the carriers not to donate blood. not to share their razors -Use of condoms while having sex . needles. syringes among drugs abusers .Prevention and Control 1.Sterilization of syringes. Primary Prevention : (a) Health Promotion : Blocking the channel of transmission through Educating general public who are at the risk about : . catguts.Avoiding sharing of toothbrush. surgical instrument .

Based on surface antigen Each 1. 6 months Children <10 years of age should be given half dose provide immunity for 3-5 years Also included in national immunization program as pentavalent vaccine .0 ml dose of vaccine contains 20Ug of HBsAg Given in 3 doses at 0.(b) Specific Protection : (i) Active immunization (ii) Passive immunization (i) Active Immunization (a) Plasma derived vaccine It is formalin inactivated sub unit viral vaccine for i. 1.m injection.

. safe and effective as plasma derived vaccine Dose for adults is 10-20 mg at 0. laboratory workers. new born infant of carrier mothers Should be given as soon as possible ideally within 6 hours and not 3 later then 48 hours 2 dose given 30 days apart Provides short term passive protection which last for 3 months. 1 and 6 months (ii) Passive Immunization Hepatitis B Immunoglobin Used for immediate protection For those acutely exposed to HBsAg positive blood like surgeons.(b) Recombinant DNA-yeast derived vaccine It is a recombinant DNA vaccine elaborated from cultures of yeast cloned with HBsAg gene It is immunogenic.

Tertiary Prevention Reduction of no of complication Complication like: Fulminant hepatic failure Cholestatic hepatitis Relapsing hepatitis (biochemical/clinical) Hyperbilirubinaemia (in Gilbert’s syndrome) . adofovir Screening of HBV positive patient having HBsAg 3. Secondary Prevention Early Diagnosis and treatment Identification of HBsAg in blood and treatment with effective drug therpay like interferon.2. lamivudine.

myocarditis. atypical pneumonia.Renal failure Cirrhosis Hepatocellular carcinoma Aplastic anaemia. . pancreatitis. transverse myelitis and peripheral neuropathy are rare complications Liver transplantation is the final option.