Hep A & B Flashcards
(53 cards)
1
Q
- RNA virus Picornavirdae Family
- Acute, self limiting, low fatality rate
- Confers lifelong immunity
A
Hep A
2
Q
Hep A
- Transmission? (2)
- Treatment?
A
- Fecal-oral route
- Ingestion - contaminated water/foods prepared using water
-
Tx: supportive care
- Immune globulin
- Handwashing hygiene
- Prevention w/ vaccination is preferred!
- NO ROLE FOR ANTIVIRAL agents!!
3
Q
Hep A Vaccine
- Start schedule at what age?
The ____ of vaccines changes at age ___, but the ____ is the same - What vaccine is only for adults?
A
- 1 year old
- dose / 19 y/o / schedule of administration (0, 6-18 months)
- TWINRIX*
4
Q
4 ADEs of the Hep A vaccine
A
- Soreness / warmth at injection site
- HA
- Malaise
- Pain
5
Q
Efficacy of Hep A vaccine is decreased in which 2 scenarios?
A
- HIV pts w/ CD4 counts <200
-
Co-infected HIV/HCV pts
- HCV = hep C virus
6
Q
When does the Hep A pre-exposure prophylaxis vaccine need to be given prior to departure to endemic areas?
A
- Vaccine can be given regardless of schedule dates of departure
-
If pt is older, immunocompromised, or has hx of chronic liver disease, or other chronic medical condition: If the patient is traveling within 2 weeks then give BOTH Ig and Vaccine
- IG=passive coverage
- Vaccine= active coverage
7
Q
What is the Post-exposure prophylaxis for Hep A?
A
- Administer either Vaccine or IG
8
Q
What is the concern for the vaccine as post-exposure prophylaxis?
A
Uncertain efficacy in adults older than 40 years or with underlying conditions
9
Q
Hep A - Post-Exposure Prophylaxis
- Vaccine brands are interchangeable for _____.
A
booster shots
10
Q
Hep A
- ___ for pre and post exposure when vaccine is not an option
A
IG
11
Q
Hep A Pre/Post exposure
- Recall that with recent ___ exposure, post-exposure prophylaxis with _____ is preferred.
A
HAV / vaccine
12
Q
Hep A Pre/Post exposure
- Pts who receive at least 1 dose of the HAV vaccine at least ___ prior to exposure do NOT need pre-exposure or post-exposure prophylaxis w/ IG
A
1 month
13
Q
Hep A Pre/Post exposure
- IG is indicated when vaccination is NOT an option
- IG prophylaxis is preferred in 5 cases?
A
- <12 months or >40 years
- Immunocompromised
- Chronic liver disease
- Underlying medical conditions
- When vaccine contraindicated
14
Q
Hep A
- Vaccine confers ____ immunity
- Immunoglobulin confers ____ immunity.
A
- Vaccine: active
- IG: passive
15
Q
Preparation of concentrated antibodies against HAV
- 85% reduction in infectivity & moderation of infection if given within the first ___ weeks of infection
- Anaphylaxis has been reported in pts w/ ___ deficiency
A
- 2 weeks
- IgA
16
Q
Dosing of Hep A pre/post exposure
- Post-exposure prophylaxis and for short term pre-exposure coverage is for <__ months. Dose =0.02
- Long term pre-exposure prophylaxis of < or = ___ months. Dose =0.06 (dose is tripled for longer exposure)
A
- 3 months
- 5 months
17
Q
Administration sites for Hep A pre/post exposure
- Older than 24 months use which 2 muscles?
- Younger than 24 months use which muscle?
A
- >24 months: deltoid or gluteal
- <24 months: anterolateral thigh muscle
18
Q
Hep B
- How many genotypes? US?
Transmission? - Highly infectios (50-100x more infectious than HIV)
- Stable in environment for at least __ days
- Incubation for both acute & chronic infections?
*
A
- 10, US-G
- sexually, parenterally, perinatally (present in saliva, semen, vaginal excretions)
- 7
- 6 weeks to 6 months
19
Q
What is the most predictive factor for developing a chronic infection of Hep B?
A
Age
- Perinatal (100% immune tolerance to virus)
- Infants & children (30%) are at high risk for chronic infection
- Adults <5%
20
Q
- Hep B leads to an increased risk for what 2 conditions?
- Which sex is more at risk?
A
- Cirrhosis
- Hepatocellular carcinoma
- Men
21
Q
T/F
- Hep B virus itself does not seem to be pathogenic to cells
- Immune response to the virus is cytotoxic to _____
A
True
- hepatocytes
22
Q
______ is critical to viral clearance of Hep B
- Suppress HBV replication, prevents disease progression to cirrhosis and HCC
- Loss of HBsAg
- Confers _____
- Loss of HBeAg
- Confers _____
A
The immune response
- HBsAg: immunity & clearance
- HBeAg: infection resolved
23
Q
Patients who continue to have detectable HBsAg for more than __ months have chronic HBV.
- Infections can be controlled, cure is NOT possible bc/ HBV template is integrated into the ______.
A
- 6
- host genome
24
Q
What is the “acute supportive” tx of Hep B?
A
Immune Globulin (IVIG) for acute exposure
25
What is the prevention for Hep B?
* Vaccine at 0, 1, and 6 months
* Serology marker anti-HBsAg only (Anti HBs)
26
2 things for Chronic Management of Hep B
* Interferons
* Antivirals
27
* What is the vaccine schedule of Hep B for adults?
* What are the 2 names of the vaccines?
* 1 mL IM at 0, 1, & 6 months (3 doses)
* Engerix-B
* Recombivax HB
28
**Hep B Vaccine for infants**
* Amount?
* Doses / Schedule?
* 2 vaccines names?
* 0.5 mL/dose
* 3 doses at 0, 1, & 6 months
* Engerix-B
* Recombivax HB
29
What do the combination vaccines for infants for Hep B contain?
* Hep B
* DTaP
* HIB
## Footnote
**(\*\*Should not be used for the "birth" dose of Hep B, but may be used to complete the course beginning after the infant is 6 weeks old or greater\*\*)**
**--\> DTaP and HIB are given at 2 months old**
30
Newborn first dose depends on the ____ status of the mother
HBsAG
31
**Infants w/ HBsAg ____ mothers**
* first dose: 0.5 mL at birth or before discharge (may be delayed in certain cases)
negative
32
**Infants w/ HBsAg ____ mothers:**
* 1st dose: 0.5 mL \***within first 12 hours of life\***, even if premature and regardless of birth weight
* Hepatitis immune globulin should be administered at the same time at a different site
Positive
33
Infants with mother's HBsAg status **\_\_\_\_**
* 1st dose: 0.5 mL \***within 12 hours of birth\*** even if premature and regardless of birth weight
Unknown
34
**Serologic testing and revaccination may be necessary in patients w/ \_\_\_\_\_\_.**
* Serologic testing is recommended __ - __ months after the final dose of the primary vaccine series & ____ to determine the need for booster doses
renal impairment
* 1 -2
* annually
35
**Serologic Testing & Revaccination for Hep B**
* Persons w/ anti-HBs concentrations of \<\_\_\_ should be revaccinated with __ doses of the vaccine
* 10 mIU/mL
* 3 doses
36
What adjustment is needed for hepatic impairment for serologic testing w/ Hep B?
No adjustment needed
37
Hypersensitivity to which 3 things w/ Hep B?
* Yeast
* Hep B vaccine
* any component of the formulation
38
**Syncope associated w Hep B vaccine**
* reported w/ injectable vaccines
* May be accompanied by which 3 sxs?
* transient visual disturbances
* weakness
* tonic-clonic movements
39
What are the 5 dermatologic ADEs from Hep B vaccine?
* **Angioedema**
* Petechiae
* Pruritis
* Rash
* Urticaria
40
What may diminish the therapeutic effect of Hep B vaccines (inactivated)?
Immunosuppressants
41
Hep B Vaccines should be given __ inches apart or in separate arms.
2
42
**Treatment of Hep B may require ___ therapy w/ resistance as a concern.**
* Post - exposure within __ days
* Hep B Immunoglobulin
* Adult: .06ml/kg IM
* Follow with HBV
* Long Term Therapy
* 7
43
What is the treatment for Chronic Hep B?
* Immunomodulating agent: PEG-INF alpha (PegaSys) **(interferon)**
* **Antivirals:**
* Lamivudine
* Adefovir
* **Entecovir\*\*\***
* Telbivudine
* **Tenofovir\*\*\***
* **Vaccinate against HAV**
44
* Long term Hep B therapy may require long term therapy which has the potential for developing \_\_\_\_.
Resistance
45
**Long Term Hep B Therapy**
* Resistance to ____ and _____ is most common!
* Resistance to ___ and ____ can occur...
* Less resistance to ______ (=
* Optimal tx of resistant strains is \_\_\_\_\_
* **MC:** lamivudine & Telbivudine
* **Can occur:** Adefovir & Entecavir
* **Least:** Tenofovir
* Unknown
46
**Recommendations for pts w/ Hep B**
* Vaccinate ____ and ____ contacts
* Avoid \_\_\_\_\_
* what other atypical tx option?
* **sexual & household**
* **alcohol**
* **milk thistle**
* (protective & restores liver hepatocytes, not replicated in western medicine. GOOD evidence of being hepatoprotective)
* Also not replicated & has good evidence: horse chestnut given for HF
47
What 2 circumstances of Chronic Hep B require immediate treatment?
* Jaundice
* Decompensation
48
Suggested management algorithm based on AASLD for chronic Hep B pts w/ **CIRRHOSIS?**
* **If ALT \<2 or less than ULN**
* --\> observe
* **If ALT \>2**
* Initial tx: IFN, PEG - IFN, Entecavir, or Tenofovir
* **Immediate tx if jaundice or decompensation**
49
**Goal of Hep B Tx**
* Hepatic damage is sustained by \_\_\_\_\_
* Drug therapy suppresses viral replication by either ____ or ____ (the nucleoside agents - NAs)
* ongoing viral replication
* immunomodulating agents / antivirals
50
**Tx of Chronic Hep B\*\***
_ADE:_
* HA, fatigue, upper abd pain
* lactic acidosis
Entecavir
51
**Tx of Chronic Hep B\*\***
_ADE:_
* Nausea, abd pain, diarrhea
* dizziness, nephropathy
* lactic acidosis
Tenofovir disoproxil
52
**Tx of Chronic Hep B\*\***
_ADE:_
* Flu-like sxs
* fatigue
* **mood disturbances\*\* (depression)**
* Cytopenias
* Autoimmune disorders
Pegylated interferon alfa-2a
53
What is almost a guaranteed ADE of Pegylated interferon alfa-2a?
Depression, so start antidepressants before giving interferon.
