Infectious Diseases - Hepatitis B & C

Question 1

How is Hep B transmitted?

Answer 1

Blood, blood products, sexual contact, IV drug

Question 2

Typical symptoms of Hep B

Answer 2

Anorexia
Vomiting
RUQ pain
Diarrhoea
Jaundice 50%

Question 3

What % of adults become chronic carriers?

Answer 3

10%, HbsAg remains detectable

Question 4

What % of vertically acquired infections become chronic carriers of Hep B?

Answer 4

90%

Question 5

What % of fetal infections occur
i) trans-placentally
ii) During delivery

Answer 5

i) 5% trans placenta
ii) 95% during delivery

Question 6

Which blood test would be +ve if a patient is actively infected with Hep B?

Answer 6

Hepatitis B Surface antigen
HBsAg

Patient is infective
HbeAg - core antigen, high infectivity

Question 7

Which blood test would be +ve if a patient has been vaccinated to Hep B?

Answer 7

HBsAb
Hepatitis B surface antigen
(If from vaccination will be +ve alone, if with HbcAb mean previous infection)

Question 8

What does a +ve Antibody to the Hep B core antigen?

Answer 8

Infection with Hep B
- If +ve with HbsAg - active infection
- If alone ?infection
- If with HbsAb - previous infection with Hep B

Question 9

If all test negative (HbsAg, HbsAb, HbcAb)?

Answer 9

Patient is not immune to Hep B, risk of infection, should get vaccine.

Question 10

If chronic hepatitis what happens to HbsAg?

Answer 10

Remains +ve for >6months, chronic hepatitis

Question 11

In Hep B, the bloods may also be characterised by:

Answer 11

High AST/ALT
Alk Phos may be elevated (not more than 3 x)
Albumin low
Leukopenia
Severe - coagulopathy

Question 12

What are the risks to the foetus with Hep B?

Answer 12

No congenital syndorme
Risk chronic hepatitis, cirrhosis, hepatocellular carincoma

Question 13

If a patient has +ve result for HbsAg - who should the patient be referred to?

Answer 13

Hepatologist
Gastroenterologist
Infectious disease specialist

Question 14

What medication can be offered to women to reduce the risk of transmission of Hep B to the neonate? What gestation? Level of Hep B DNA

Answer 14

Tenofovir Disoproxil
> 10E7 IU/ml
from 32 weeks

Question 15

How should women on Tenofovir been monitored?

Answer 15

HBV DNA 2 months after starting tenofovir
Month ALT

Question 16

When should tenofovir be stopped for Hep B?

Answer 16

4-12 weeks after delivery unless meets criteria for long term treatment

Question 17

How should the baby of mother with active Hep B be managed post delivery?

Answer 17

Offer active and passive Hep B immunisation
1) Hep B immunoglobulin within 12 hours of delivery
2) 1st HBV vaccine within 7 days
3) 2nd & 3rd dose HBV at 1 and 6 months
4) Test HbsAg at 12-15 months

Question 18

Can women with Hep B breastfeed?

Answer 18

If follow guidance for immunisation AND continue antiviral treatment

Question 19

What % of acute infection of Hep C will develop chronic infection?

Answer 19

60-80%

Question 20

What % of chronically infected with Hep C develop hepatocellular carcinoma?

Answer 20

1-5%

Question 21

How is Hep C spread?

Answer 21

IV drug abuse
Tattooing
Acupuncture
Blood transfusion

Question 22

Risk of vertical transmission of Hep C

Answer 22

5% - higher if connected with HCV and HIV.
Unclear if occurs before, during or after delivery.

Question 23

Can would with Hep C breastfeed?

Answer 23

It is not contraindicated

Question 24

Is treatment for Hep C recommended in pregnancy?

Answer 24

No

Question 25

Risk of transmission with needle stick injury?

Answer 25

1.8%