VIRAL HEPATITIS B

EPIDEMIOLOGY
MANAGEMENT & PREVENTION

- Hema priyadharshini .M
HEPATITIS B ( SERUM HEPATITIS )
 It is an acute systemic infection with major
pathology in the LIVER , caused by hepatitis B
virus .
 It can be either acute or chronic .
 Acute hepatitis B is self limiting marked by acute
inflammation and hepatocellular necrosis .
 Chronic hepatitis B is a persistent HBV infection
with or without active viral replication and with
hepatocellular injury and inflammation .
 HBV can form alliance with delta virus and
produce a new form of virulent hepatitis.
EPIDEMIOLOGICAL DETERMINANTS
AGENT FACTORS :
 AGENT :
 HBV is a complex, 42 nm, double shelled DNA virus
,originally known as Dane particles .
 It replicates in the liver cells .
 It appears in three morphological forms in the serum
of the patient ,
-small spherical particles (22 nm), which are
antigenic and stimulate surface antibody production
- tubules of varying length
- Dane particles .
 Of the three forms , Dane particle is infectious and
other forms are not infectious.
• RESERVOIR OF INFECTION : Man is the only
reservoir of infection which can be spread from
carriers or from cases .
• INFECTIVE MATERIAL : Contaminated blood is
the main source of infection.
• RESISTANCE : It is quite stable and an survive on
environmental surfaces for 7 days . It can be readily
destroyed by sodium hypochlorite and by heat
sterilization in autoclave for 30 to 60 mins .
• PERIOD OF COMMUNICABILITY : It is usually
several months ( years in chronic carriers ) or untill
disappearance of HBsAg and appearance of surface
antibodies .
HOST FACTORS :
AGE :
 Acute hepatitis B occurs 1% in perinatals ,10% in early
childhood (1-5 yrs) and 30% in late (>5 yrs)
 Conversely chronic develops 80-90% in perinatals, 30%
in early childhood and 5% after 6 years .
• HIGH RISK GROUPS :
 This include surgeons ,recipients of blood transfusion,
laboratory personnel, percutaneous drug abusers ,
homosexuals , infants of HBV carrier mothers ,
immunocompromised.
• HEPATITIS B AND HIV : It occcurs as coinfection with
HIV , and leads to development of HBV associated liver
cirrhosis and hepatocellular carcinoma.
HUMORAL AND CELLULAR RESPONSES :

It has 3 distinct antigens

- a surface antigen ( Australian antigen ) HBsAg
- a core antigen HBcAg
- ‘e’ antigen HBeAg .
They stimulate corresponding antibodies
-surface antibody ( anti HBs )
-core antibody ( anti HBc )
- ‘e’ antibody ( anti HBe )
They serve as markers of HBV infection.
DANE PARTICLE
MODES OF TRANSMISSION :
 Parenteral route : transmitted by infected blood
and blood products through transfusions, dialysis,
contaminated syringes and needles , pricks of skin,
accidental innoculations ,immunisation ,traditional
tattooing ,accupuncture ,shared razors ,etc.,
 Perinatal transmission : rarely in utero and most
commonly occurs at birth due to leak of maternal
blood into baby`s circultion (vertical transmission)
or ingestion or accidental blood inoculation
 Sexual transmission : saliva ,vaginal ,menstrual and
seminal fluids act as vehicles of transmission.
 Other routes : child – child ( horizontal
transmission ) through skin cuts and grazes .
MODES OF
TRANSMISSION
INCUBATION PERIOD :
- 30 to 180 days .The average period is 75 days .
CLINICAL PICTURE :
ACUTE HEPATITIS B : CHRONIC HEPATITIS B:
 Anorexia  In some – inactive
 Nausea and vomiting  In others
 Malaise - progressive liver
 Right upper quadrant fibrosis leads to
abdominal pain cirrhosis with end stage
 Dark urine liver disease
 Jaundice - increased risk of
hepatocellular
carcinoma.
 MANAGEMENT AND PREVENTION :
Since there is no specific treatment ,prevention has main
aim in managing viral hepatitis B.
 HEPATITIS B VACCINE : The rHB vaccine introduced
in 1986 has now replaced plasma derived HB vaccine .
Active substance in it is HBsAg.
- available as monovalent formulation or in fixed
combination with other vaccines .
- when immunizing at birth
only monovalent HB vaccine
should be used .
-adult dose is 10 -20
micrograms initially and again
at 1 and 6 months . Children
(<10yrs) half the adult dose at same interval .
 - For reliable absorption deltoid muscle is preferred.
(In children under 2 yrs anterolateral aspect of thigh)
- It is included under National Immunization
programmes with recommended schedules which
includes birth dose and which do not include .
- 1st dose at birth followed by 2nd and 3rd dose at the
time of DPT vaccine ( in India 4 doses are given ).
-Minimal recommended interval between the doses
is four weeks .
- If the primary series is interrupted after the 1st dose,
2nd dose should be given as soon as possible and 2nd
and 3rd dose seperated by min. of 4 weeks . If only 3rd
dose is delayed ,it should be administered quickly.
 Routine pre exposure vaccines should be given for
high risk individual .
 1 ml of formulation given . 2nd dose not less than 4
weeks interval and 3rd dose after 4 to 6 months .
 But the 1st and 3rd dose should be separated no less
than 16 weeks .
 HB vaccine is contraindicated in individuals with h/o
allergic reactions .
 Stored at 2°– 8° C. Freezing must be avoided .
 PENTA VALENT VACCINE : It is a combined
vaccine giving protection against diphtheria,
pertussis, tetanus, hepatitis B , haemophilus influenza
type b.
HEPATITIS B IMMUNOGLOBLIN ( HBIG) :
- It provides immediate and short term protection for
those who are exposed acutely to HBsAg positive
blood .
- 0.05 to 0.07 ml /kg of body weight, in two doses given
30 days apart .
PASSIVE ACTIVE IMMUNIZATION :
- The simultaneous administration of HBIG and
hepatitis B vaccine .
- It provides both prophylaxis and prevention of the
carrier state .
OTHER MEASURES : All donors must be screened for
HBV infection ,adequate sterilization of all instruments
and practice of simple hygiene by health personnel.
TREATMENT:
- No specific treatment for acute hepatitis B
- CHV can be treated with drugs like Tenofovir or
Entecavir .