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    Hepatitis B

    Hepatitis B is a topic covered in the 5-Minute Clinical Consult.

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    Basics

    Description

    Systemic viral infection associated with acute and chronic liver disease and hepatocellular carcinoma (HCC)

    Epidemiology

    Incidence
    • Predominant age: can infect patients of all ages
    • Predominant sex: fulminant hepatitis B virus (HBV): male > female (2:1)
    • In the United States, ∼3,000 cases of acute HBV in 2014
    • African Americans have the highest rate of acute HBV infection in the United States.
    • Overall rate of new infections is down 82% since 1991 (due to national immunization strategy).
    • Vaccine coverage for the birth dose ∼72% in United States

    Prevalence
    • In the United States, 800,000 to 1.4 million with chronic HBV.
    • Asia and the Pacific Islands have the largest populations at risk for HBV.
    • Chronic HBV worldwide: 350 to 400 million persons
      • 1 million deaths annually
        • Second most important carcinogen (behind tobacco)
        • Of chronic carriers with active disease, 25% die due to complications of cirrhosis or HCC.
        • Of chronic carriers, 75% are Asian.

    Etiology and Pathophysiology

    HBV is a DNA virus of the Hepadnaviridae family highly infectious via blood and secretions

    Genetics
    Family history of HBV and/or HCC

    Risk Factors

    • Screen the following high-risk groups for HBV with HBsAg/sAb. Vaccinate if seronegative (1)[A]:
      • Persons born in endemic areas (45% of world)
      • Hemodialysis patients
      • IV drug users (IVDUs), past or present
      • Men who have sex with men (MSM)
      • HIV- and HCV-positive patients
      • Household members of HBsAg carriers
      • Sexual contacts of HBsAg carriers
      • Inmates of correctional facilities
      • Patients with chronically elevated AST/ALT levels
    • Additional risk factors:
      • Needle stick/occupational exposure
      • Recipients of blood/products; organ transplant recipients
      • Intranasal drug use
      • Body piercing/tattoos
      • Survivors of sexual assault
    Pediatric Considerations
    • Shorter acute course; fewer complications
    • 90% of vertical/perinatal infections become chronic
    Pregnancy Considerations
    • Screen all prenatal patients for HBsAg (1)[A].
    • Consider treating patients with high viral load at 28 weeks or hx of previous HBV (+) infant with oral nucleos(t)ide medication beginning at 32 weeks to reduce perinatal transmission (2)[C].
    • Infants born to HBV-infected mothers require HB immune globulin (HBIg) (0.5 mL) and HBV vaccine within 12 hours of birth.
    • Breastfeeding is safe if HBIg and HBV vaccines are administered and the areolar complex is without fissures or open sores. Oral nucleos(t)ide medications are not recommended during lactation.
    • HIV coinfection increases risk of vertical transmission.
    • Continue medications if pregnancy occurs while on an oral antiviral therapy to prevent acute flare.

    General Prevention

    Most effective: HBV vaccination series (3 doses)

    • Vaccinate
      • All infants at birth and during well-child care visits
      • All at-risk patients (see “Risk Factors”)
      • Health care and public safety workers
      • Sexual contacts of HBsAg carriers
      • Household contacts of HBsAg carriers
    • Proper hygiene/sanitation by health care workers, IVDU, and tattoo/piercing artists
      • Barrier precautions, needle disposal, sterilize equipment, cover open cuts
    • Do not share personal items exposed to blood (e.g., nail clipper, razor, toothbrush).
    • Safe sexual practices (condoms)
    • HBsAg carriers cannot donate blood or tissue.
    • Postexposure (e.g., needle stick): HBIg 0.06 mL/kg in <24 hours in addition to vaccination

    Commonly Associated Conditions

    HIV, hepatitis C coinfection

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    Citation

    Stephens, Mark B., et al., editors. "Hepatitis B." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116266/all/Hepatitis_B.
    Hepatitis B. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116266/all/Hepatitis_B. Accessed March 24, 2019.
    Hepatitis B. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116266/all/Hepatitis_B
    Hepatitis B [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 March 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116266/all/Hepatitis_B.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Hepatitis B ID - 116266 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116266/all/Hepatitis_B PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -