Hepatitis B

Question 1

acute hepatitis B infection

Answer 1

infection acquired in the last 6 months
prodrome of rash, arthralgias, myalgias, fever
subclinical hepatitis in 70%
symptomatic hepatitis may include: fever, nausea, jaundice, RUQ pain
symptoms usually resolve after a few weeks

Question 2

incubation period of hep B

Answer 2

1-6 months

Question 3

chronic hep B infection

Answer 3

Chronic HBV infection is defined as infection persisting for more than 6 months with detection of HBsAg and, possibly, signs and symptoms of liver damage.
Most patients are inactive, noncontagious carriers.

Question 4

how does age impact likelihood of developing chronic HBV

Answer 4

The younger when infected, the more likely a patient develops chronic HBV
90% of infants
∼ 50% of children between 1 and 5 years
Only 5% of adults

Question 5

HBsAg

Answer 5

hepatitis B surface antigen
protein on the surface of HBV
first evidence of infection
detectable 1-12 weeks after exposure
presence for >6 months indicates chronic infection

Question 6

HBcAg

Answer 6

Hepatitis B core antigen
HBcAg is not part of the serologic testing for HBV because HBcAg forms the nucleocapsid of the virus particle, which lies beneath the viral surface. It does not circulate as a free protein in significant quantities in the blood.

Question 7

HBeAg

Answer 7

Hepatitis B e antigen
Protein secreted by infected hepatocytes into the bloodstream
Indicates active viral replication and thus high transmissibility and a poor prognosis

Question 8

Anti-HBs

Answer 8

anti hep b surface antibody
Indicates immunity to HBV due to resolved infection or vaccination
Usually appears within 3 months of infection or vaccination

Question 9

Anti-HBc

Answer 9

anti hep B core antibody
Anti-HBc IgM: indicates recent infection with HBV (within ≤ 6 months)
Anti-HBc IgG: indicates resolved or chronic infection

Question 10

Anti-HBe

Answer 10

anti hep B e antibody
indicates long-term clearance of HBV and thus low transmissibility

Question 11

how to identify acute infection

Answer 11

presence of HBsAg with no Anti-HBs
presence of IgM for Anti-HBc
presence of HBeAg with no Anti-HBe

HBV DNA may or may not be detectable
raised transaminases

Question 12

how to identify an infection in the window period

Answer 12

presence of Anti-HBc IgM
raised transaminases

Question 13

how to identify chronic infection

Answer 13

presence of HBsAG with no anti-HBs
presence of Ant-HBc IgG
presence of HBV DNA

Question 14

how to tell between active and inactive chronic infection

Answer 14

HBeAg will be present in active
Anti-HBe will be present in inactive

higher HBV DNA count in active
transaminases may be raised in active

Question 15

how to identify resolved infection of HBV

Answer 15

no HBsAg
presence of Anti-HBs
presence of Anti-HBc IgG
presence of Anti-HBe

no HBV DNA

Question 16

how to identify HBV vaccination

Answer 16

no HBsAg
presence of Anti-HBs

no other antibodies and no HBV DNA

Question 17

how to tell between resolved infection versus HBV vaccination

Answer 17

resolved infection has presence of all three antibodies
vaccination only has Anti-HBs

Question 18

Seroconversion of HBsAg to anti‑HBs indicates

Answer 18

resolution of acute hepatitis.

Question 19

during the window period, the only markers of infection are

Answer 19

During the window period, anti-HBc IgM and anti-HBe may be the only markers available to diagnose an acute HBV infection.

Question 20

treatment approach for acute hep B

Answer 20

supportive care and patient education
antiviral therapy is generally not indicated
infections are usually self limited

Question 21

when might antiviral therapy be used for chronic HBV

Answer 21

decisions made by a specialist based on the risk of liver related morbidity and mortality
cirrhosis or advanced fibrosis
acute liver failure
immune active phase with significantly elevated HBV DNA levels
HBV reactivation
immunosuppression
confection with HIV or HCV

Question 22

supportive care and patient education in HBV

Answer 22

Avoid hepatotoxic medications.
Advise alcohol cessation.
Educate patients on measures to prevent HBV transmission

Question 23

measures to prevent HBV transmission

Answer 23

Vaccinating household and sexual contacts
Abstaining from blood and tissue donation
Practicing safer sex (e.g., using condoms)
Covering open wounds
Cleaning up blood spills with diluted bleach
Avoiding IV drug use or practicing harm reduction strategies if injecting drugs
Avoiding sharing of personal care items, such as razors, toothbrushes, glucometers, and injection equipment

Question 24

how long can HBV survive outside the body

Answer 24

HBV can survive outside the body (e.g., in dried blood on a surface) for at least 7 days, and remains infectious during that time.

Question 25

long term complications of Hep B

Answer 25

liver cirrhosis hepatocellular carcinoma extra hepatic manifestations eg. polyarteritis nodosa, glomerulonephritis, aplastic anaemia reactivation of previous HBvinfection due to immunosuppression post hepatitis syndrome

Question 26

what to do if a healthcare worker is exposed to HBV

Answer 26

verify vaccination status and immune response history if vaccination is complete and there is recorded anti-HBs > 10, the source patient HBsAg is not needed otherwise, you need to measure the source patient HBsAg

Question 27

when to administer HBV vaccine/prophylaxis in healthcare worker HBV exposure

Answer 27

if the HCW has a documented Anti-HBs > 10, no action is required if the HCW has a complete HBV vaccination but immune response is unknown, measure the HCW Anti-HBs and the course patient HBsAg. if the source patient is antigen negative, the HCW will need a vaccine, if the source patient is antigen positive, the healthcare worker will need a vaccine and HBIG. if the HCW has incomplete vaccine history, do the above and complete the vaccine series.

Question 28

what do to for non occupational exposure

Answer 28

this includes high risk sexual contact and needle sharing Obtain vaccination history and measure HBsAg, anti-HBs, and anti-HBc in unvaccinated exposed patients. administer vaccine unless Anti-HBs is > 10 if the source patient has known positive HBsAg, administer HBIG as well.