5-Minute Clinical Consult
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, ~3,200 cases of acute HBV in 2016
- 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). There has been a slight increase in new infections since 2014 (associated with increased IV drug use).
- 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.
- 1 million deaths annually
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].
- If HBsAG (+), obtain HBV DNA.
- Consider treating patients with high viral load at 28 weeks or history 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 hepatitis B 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, IVDUs, 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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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, ~3,200 cases of acute HBV in 2016
- 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). There has been a slight increase in new infections since 2014 (associated with increased IV drug use).
- 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.
- 1 million deaths annually
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].
- If HBsAG (+), obtain HBV DNA.
- Consider treating patients with high viral load at 28 weeks or history 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 hepatitis B 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, IVDUs, 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 February 20, 2020.
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 2020 February 20]. 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 -