Hepatitis B

Question 1

What is the most common ways that Hepatitis B is transmitted?

Answer 1

through blood and also through sexual contact.

**Low amount to non traceable levels in urine, sweat, feces, breast milk or tears

Question 2

Who are some of the at risk populations for hepatitis B in the US?

Answer 2

Sexual contacts
Household contacts
Intravenous drug users
Health care workers
People working with/receiving blood products or dialysis
Residents/staff of facilities for developmentally disabled persons

Question 3

What will you see in a newly infected (acute) infection with hepatitis B?

Answer 3

HBsAg positive
Anti-HBc positive
IgM anti-HBc positive
Anti-HBs negative

Question 4

What will you see in a patient with chronic infection hepatitis B?

Answer 4

HBsAg positive for more than 6 months
Total Anti-HBc positive
IgM anti-HBc negative
anti-HBs negative

Question 5

When would you order a PCR test (viral load)?

Answer 5

Indications 
Treatment decisions
Response to treatment
Chronic infection
Unusual presentation

Question 6

Absolutely requires HBV infection

Utilizes HBV protein shell

Answer 6

Hepatitis D

***Can occur acutely (coinfection) with HBV or as superinfection after HBV

Question 7

What is treatment for chronic hepatitis B?

Answer 7

Pegylated interferon and ribavirin
Protease inhibitors
Adefovir, entecavir, telbivudine, tenofovir
Lamivudine (virus may become resistant)

Question 8

Do we treat patient if E Antigen-Negative,

Normal ALT, viral load under 105

Answer 8

NO

***Follow patient with LFTs, alpha fetoprotein every six months.

Question 9

Do we treat patient if E Antigen-Negative, Abnormal ALT, viral load greater than 105

Answer 9

GI referral for treatment consideration

Question 10

Who are candidates for the hepatitis B vaccine?

Answer 10

All infants at birth, catch up all others < 19
Multiple sex partners, MSM, STDs, HIV, HCV, chronic HBV+ sexual partner
Health care workers
IV drug users
Dialysis patients
Diabetics aged 19–59 (higher incidence, poorer outcomes)

Question 11

If a patient is a “non-responder” after receiving the hepatitis B vaccine series what do you do?

Answer 11

Full series revaccination for non-responders

Copy of antibody titer lab results to patient

Question 12

What do we do with an individual exposed to hepatitis B who has written documentation of complete HBV vaccine series but no postvaccination testing

Answer 12

Give a booster dose of vaccine

ideally within 24 hours of exposure

Question 13

What do we do with an individual exposed to hepatitis B who is in the vaccination process?

Answer 13

give hepatitis B immunoglobulin (HBIG) and finish vaccine series on normal schedule

Question 14

What do we do with an individual exposed to hepatitis B who is unvaccinated?

Answer 14

Vaccine and HBIG
Simultaneous administration, separate injection sites
Vaccine series according to age-appropriate dose/schedule

Question 15

What is the course of action for PEP: Unknown HBsAg exposure from needle stick or sexual contact in person who has not completed vaccine series? or unvaccinated person?

Answer 15

Vaccine series continued to completion: persons not fully vaccinated
Vaccine series started as soon as possible: unvaccinated persons

Question 16

If mother is HBsAg positive, what do we do with baby when born?

Answer 16

Important to provide immunoglobulin and vaccination to baby immediately after birth.
***Baby’s antigen and antibody levels should be checked 2 to 3 months after vaccination

Question 17

What do we do with Hepatitis B in Premature Infants?

Answer 17

If birthweight is less than 2,000 grams and mother is HBsAg positive or unknown, give both Hepatitis B and Hepatitis B immunoglobulin (HBIG) at birth
Later, disregard vaccine and vaccinate again at age 1 month

Question 18

For newborn babies whose mothers are hepatitis B surface antigen or unknown what do we do?

Answer 18

Within 12 hours of birth administer HepB vaccine regardless of birth weight.
Administer second dose of vaccine right at 1 month
Administer third dose right at 6 months
Timing of these two doses is critical and should be tracked closely
**Test for hepatitis B surface antigen and antibody 2 months after third dose is administered
**Should be antibody positive (anti-HBs) and antigen negative (HBsAg) if treatment was successful