HEPATITIS-B

PREVENTION & CONTROL

Moderator: Dr. Vijay Khanal

Presented by: Rajat Chaudhary

Objectives:
•Control Measures
•Preventive Measures
Risk groups
• Parenteral drug users
• Homosexual(mens)
• Close contact of individual
*newborn of infected mother
*regular sexual partners
• Patient on chronic hemodialysis
• Patient with chronic liver disease
• Medical n nursing personnel
Control measures include:
• Immunization : most effective & cost saving means of prevention
• Awareness : a)to high risk group peoples and others
b) Health Personnel : are awared of adequate sterilization
of all instruments and practice of simple hygienic measures
c) Carriers : not to share razors or tooth brushes and use
barrier method of contraceptives

• Screening of blood & blood products: to reduce the chance that blood
supply system may contain pathogen
PREVENTION OF HEPATITIS B
-No specific treatment till now , prevention is the
best ..
-Following measures available
1.Hepatitis B Vaccine: (Active )
a.plasma derived vaccine
b.R DNA- Yeast derived vaccine
2.Hepatitis b immunoglobulin(HBIG) (Passive )
3.Passive-active immunization (Mixed )
1.General prevention
STANDARD PRECAUTIONS
• Uses of gloves
• Protective garments
• Mask & eye protective
• Disposal needle
• Bleach solution to decontaminate work surface
• Autoclaving for metal objects
2.Specific Prevention
• ACTIVE IMMUNIZATION (hep B vaccine )
• Firstly Introduced in 1982
• Derived from plasma of healthy human HBsAg carrier
In 1987 genetically engineered vaccine
• Recombinant yeast
• Nonglycosylated HBsAg
-CI in allergic pt with its components(not ci in
pregnancy and lactating)
-stored at 2-8 degree centigrade (frezzing must be
avoided as it dissociates antigen from alum ajuvant)
Source: cdc
 Pre exposure prophyalxis
In Nepal : As included in pentavalent along with
dpt,hib at 6 ,10,14 week
Some Faqs:
- can be given with other vaccines administerd at different sites
- In case of missed vaccine after 2nd or 3rd dose ,no need to restart
- Minimum interval : 1st and 2nd -4 week
: 2nd and 3rd - 8 week
- Complete vaccine series :
Upto 40 yr: 95 % protective antibody level
40- 60 : 90%
Above 60 : 65-75%
-The duration of protection is only 20 yrs and based on current scientific
evidence, life long.
Specific prevention continued..
B)Passive immunization
1. HBIG (Hepatitis B Immunoglobin)
-For immediate protection (lasts for approx. 3 months )
2 Dose:0.05 to 0.07 ml/kg body wt. Given 30 days apart
eg.- Surgeons, lab workers,
- new born infant of carrier mother
-sexual contact with acute hepatits b infected patients
-after liver transplatation
-given ideally within 6hr of inoculation not later than 48 hrs.
Reduces frequency of clinical illness but doesn’t prevent
infection
C. Passive Active Immunization
• HBIG and Hepatits B vaccine more efficacious than HBIG alone .
• They don’t interfere each other
• Ideal for : Post exposure prophylaxis
: Carrier state from infected mother to child

Dose: HBIG (0.05-0.07 ml/kg ) within 24 hr

: Hepatitis B vaccine 1ml formulation (20 microgram / ml)—IM—
within 7 days of expoxure (1st dose)
2nd and 3rd dose after 1 and 6 month respectively
Serologoical Testing in vaccine recipient
• 1. prevaccination testing: for
- in areas within prevalence (2% or higher) eg asia
,Africa
- drug users
-person receving cytotoxic and immunosupessants
-homosexuals
2.postvaccination testing : for
- chronic hemodyalsis pt.
-immunocompromised pt.eg hiv
- sex partner with Hbs +
3. Vaccine Non response (5% -even after 6 dose – may be
infected already)
Include vaccine factors (dose schedule inj site)
Includes host factors (old age>40 ,male ,obesity, smoking
,chronic disease.
Take home message:
• Not treated till dated but can be prevented and controlled
• Hep B vaccine at 0,1,6 month
• Hep B+HBIG more effective in perinatal transmission and post
exposure prophylaxis.
 REFERENCES

• Parks textbook of preventive and social medicine

• Nepal paediatrics society guidelines for childhood immunization.
• https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-
related-to-travel/hepatitis-b
• http://occmed.oxfordjournals.org/content/61/8/531.long#sec-30
• Articles from nature, Usc researches
When the student in a doctor
dies ,the doctor in a student
dies….

Thank you:-p