Hepatitis B

Question 1

Hepatitis B Screening

Answer 1

• Screen all women with HBsAg (detects active infection) + anti-HBs, anti-HBc
• If ‘at risk’ for future infection (all above are negative) asses need for vaccination

Question 2

Steps if HBsAg +ve

Answer 2

1. Test HBeAg / HBeAb / HBV DNA / LFTs
2. Refer to specialist
3. Ensure screening +/- vaccination of household contact
4. Check maternal hep A IgG. If non immune offer vaccination.

Question 3

Management if HBV DNA >200,000

Answer 3

1. Offer mother tenofovir from 24-28 weeks’ gestation and continue up to 12 weeks delivery (if given only for prevention of perinatal transmission).
2. Give hepatitis B IG and birth dose HBV vaccine to the infant (within 12 hours)

Question 4

After stopping antivirals for HBV

Answer 4

Monitor for hepatic flare
- check ALT every 4 weeks for 2-3 months

Question 5

Management if HBV DNA <200,000

Answer 5

HBIG (100IU IM) and birth dose HBV vaccine to infant

Question 6

Mode of Delivery HVB

Answer 6

• Insufficient evidence to recommend caesarean section to prevent transmission
• Minimise antenatal and intrapartum procedures, especially in women with high viral load

Question 7

Breastfeeding HBV

Answer 7

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