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Hepatitis B 101

Hepatitis B 101. Prodrome of arthralgia or arthritis may precede the rash (generalized, erythematous, maculopapular, and/or urticarial x 4-7 days) which precedes jaundice and underlying abnormal LFTs. Diagnosis by serology of HBsAg positivity. Transmission via Blood/ Body secretions.

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Hepatitis B 101

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  1. Hepatitis B 101 • Prodrome of arthralgia or arthritis may precede the rash (generalized, erythematous, maculopapular, and/or urticarial x 4-7 days) which precedes jaundice and underlying abnormal LFTs. • Diagnosis by serology of HBsAg positivity. Transmission via Blood/ Body secretions. • Full recovery takes weeks-months(six) and 5-10% become HBV carriers – with future risk of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. • Up to 70% born to HBV carrier moms acquire HBV during birth, and 50% of these become chronic HBV carriers (persistent infection). • Highest prevalence of chronic carriage moms in central Africa, East Asia, Pacific Islands, and among Eskimo populations. • No HBV test is mandated by JC…but consider getting HBsAg on these high risk groups & any pregnant students (since offspring need immediate Rx with HBIG & vaccinations. • If HBsAg positive, will check tests shown on chart to clarify status and make Rx plan. • If not already infected, future HBV disease can be AVOIDED by vaccination series (@ 0, 1, & 4 months intervals). • Clinical presentation of Hepatitis B Virus (HBV) indistinguishable from other hepatitis causes and is quite variable from asymptomatic (common) to fulminant hepatic failure (rare).

  2. TEST IF Pos, means: Contagious? Immunity? Abnormal LFTs? HBsAg (Surface Antigen) A) Active Dz Now B) Persistent infection C) Recent Vaccine A) Yes B) Yes, Especially If HbeAg+ C) No Pending A) Yes B) Variable C) No HBcAg (Core Antigen) Active Dz Now Yes Pending Yes HBcAB Only (Core Antibody) Dz in past- now resolved No Yes No HBsAB Only (Surface Antibody) Had vaccine No Yes No HBcAB& HBsAB Both Dz in past-now resolved No Yes No Understanding Hepatitis B Lab Tests

  3. TREATMENT OPTIONS • Acute HBV: No specific therapy for acute HBV is available, i.e., supportive… • But DO contract to prevent transmission via blood/body secretions (condoms). • See attached “Recommended Postexposure Prophylaxis for Exposure to Hepatitis B Virus” Chart re: contacts. • Persistent HBV: Consult GI Specialist to give direction re: • Further lab tests, e.g., HCV, HDV, HIV, subsequent LFTs • HBV DNA Assay. • Screening for hepatocellular CA with alpha-fetoprotein and liver ultrasound • Liver biopsy • Vaccination for Hepatitis A - if not already protected. • Possible Treatments: Alpha Interferon, Lamivudine, Adefovir dipivoxil

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