HEPATITIS "B"

1. HEPATITIS B
DR. MAHESWARI JAIKUMAR
maheswarijaikumar2103@gmail.com

2. HEPATITIS “B”
• Hepatitis is formerly known as
SERUM HEPATITIS is an acute
systemic infection with major
pathology in the liver, caused by
Hepatitis “B” Virus (HBV)

3. • It is clinically characterized by a
long incubation period (6 weeks
to 6 months) and a protracted
illness with a variety of
outcomes

4. • Persistent HBV infection may
cause progressive liver disease
including chronic active hepatitis
and hepatocellular carcinoma

5. • Hepatitis B virus can form a
dangerous alliance with
Hepatitis D virus and produce a
new form of virulent hepatitis
which is considered to be a wide
spread threat

6. AGENT
• HBV is a complex-nm, double-
shelled DN virus. It replicates in
the liver cells.

8. RESERVOIR OF INFECTION
• Man is the only reservoir of
infection. Hepatitis can spread
from either carriers or from case.

9. A PERSISTENT CARRIER
• A persistent carriers state is
defined as the presence of
HBAsg for more than six months.
Cases may range from
inapparent to symptomatic
cases.

10. INFECTIVE MATERIAL
• Contaminated blood is the main
source of infection (although the
virus is present in bodily
secretions such as saliva, vaginal
secretions, & semen)

11. RESISTANCE
• The virus is quite stable and
capable of for at least 7 days on
environment surfaces. It can be
readily destroyed by sodium
hypochlorite, heat sterilization in
an autoclave for 30-60 min

12. PERIOD OF COMMUNICABILITY
• The virus is present in the blood
during the incubation period and
during the acute phase of the
disease

13. COMMUNICABILITY

14. HOST FACTORS
• AGE : The outcome of HBV
infection are age dependent
• Acute hepatitis occurs
approximately 1 percent of
perinatal, 10% in early childhood
(1-5 yrs) 30% in late (>5 yrs)

15. HIGH RISK GROUP
• Surgeons
• Recipients of blood transfusion
• Health care personnel
• Laboratory personnel
• Homosexuals

16. • Commercial Sex Workers
• Percutaneous drug abusers
• Infants of HBV carrier mothers
• Recipients of solid organ
transplants
• Immuno compromised patients

17. • SEROLOGICAL SCREENING &
VACCINATION OF
HIGH RISK GROUP IS HIGHLY
RECOMMENDED

18. HBV & HIV INFECTION
• Presence of HIV markedly
increases the risk of developing
HBV associated liver cirrhosis
and hepatocellular carcinoma

19. HUMORAL & CELLULAR
RESPONSE
• Hepatitis B has three distinct
antigens
• 1.Surface antigen known as
Australian antigen (HBsAg)
• 2. Core antigen HBcAg
• 3.An “e” antigen HBeAg

20. • They stimulate the production of
corresponding antibodies
(ie:Surface antibody-anti HBs,
core antibody –anti-HBc and “e”
antibody –anti HBe

21. • These antibodies and their
antigens constitute very useful
markers of HBV infection
• Patients with HBV infection have
more than one markers

22. SEQUENCE OF HBV ANTIBODIES

23. HBsAg
• The appearance of HBsAg is the
first marker of infection
appearing before the evidence of
liver disease and persists
throughout clinical infection

24. Anti-HBs
• Specific antibody to HBsAg (anti-
HBs) appears in most individuals
after clearance of HBsAg and after
sucessful vaccination of HBsAg.
• Appearance of anti-HBs signals
recovery from HBV infection, non
infectivity & immunity

25. Anti-HBc
• IgM anti HBc appears shortly
after HBsAg is detected. Its
presence indicates diagnosis of
acute hepatitis B

26. HBeAg
• HBeAg is a soluble protein found
only in HBsAg positive
serum.HBeAg indicates viral
replication and infectivity.HBeAg
in serum beyond 3 months
indicates an increassed
likelihood of chronic hepatitis B
infection

28. HBV DNA
• The presence of HBV DNA in the
serum generally parallels the
presence of HBeAg. HBV DNA is
a sensitive and a precise marker
of viral replication and infectivity

30. HEPATITIS B-TIME LINE

31. MODE OF TRANSMISSION
• Parenteral route
• Perinatal transmission
• Sexual transmission
• Other routes

32. PARENTERAL TRANSMISSION
• Hepatitis B is essentially a blood-
borne infection. It is transmitted
by infected blood and blood
products through transfusions,
dialysis, contaminated syringes
and needles, ............cont...

33. • pricks of skin, handling of infected
blood, accidental inoculation of
minute quantities of blood such as
may occur during surgicakl and
dental procedures, immunization ,
traditional tatooing,ear piercing,
nose piercing ritual circumscission,
acupuncture etc

34. • Accidental percutaneous
inoculations by shared razors
and tooth brushes have been
implicated as occasional causes
of hepatitis B

35. PERINATAL TRANSMISSION
• Spread of infection from HBV
mothers to their babies is an
important factor for the high
prevalence of HBV infection

36. • Infection of the baby is usually
anicteric and is recognized by the
appearance of surface antigen
between 60-120 days after birth

37. SEXUAL TRANSMISSION
• The sexually promiscuous
particularly male homosexuals
are at very high risk of infection
with Hepatitis B

38. OTHER ROUTES
• Transmission from child-to-child
(called horizontal transmission)
is reported. Transmission occurs
when children play to gather or
share the same bed

39. INCUBATION PERIOD
• 30 to 180 days
• Lower doses of virus often
results in longer incubation
period. The average incubation
period is 75 days

41. CLINICAL FEATURE
• The symptoms and
manifestations of HBV infection
are similar to those of the other
types of viral hepatitis

42. • The clinical manifestations are
complicated by the carrier state
and by chronic liver disease
• Chronic liver disease may be severe
and may progress ro primary liver
cancer

43. CLINICAL COURSE

44. PROGRESSION OF DISEASE

46. PREVENTION & CONTAINMENT
• The following measures are
recommended. Administration
of Hepatitis B vaccine is found to
be highly efficient in the
prevention

47. HEPATITIS B VACCINE
• Plasma derived hepatitis vaccine
is currently in use. Hepatitis B
vaccine is available as
monovalent formulation or in
fixed combination with other
vaccines (including DPT, Hib,
Hepatitis A)

49. • When immunizing against HBV at
birth, only monovalent hepatitis B
vaccine should be used
• The dose for adult is 10-20
microgramsinitially (depending on
formulation) and again at 1 and 6
months

50. • Children under 10 yrs of age should
be given half of the adult dose at
the same time intervals
• For greatest reliability of
absorption the deltoid muscle is
preferred for injection

51. • For infants and children under 2
years, antero- lateral aspect of
thigh is used as vaccination site
• Intradermal administration is not
recommended as immune
response is less reliable
particularly in children

52. • The hepatitis B vaccine does not
interfere with immune response to
any other vaccine and vice versa
• The birth dose of hepatitis b can be
given safely together with BCG
vaccine, however the vaccines
should be given at different sites

53. • The complete vaccine series
induces protective antibody
levels in more than 95% of
infants, children and young
adults
• After the age of 40 yrs,
protection following primary
vaccine drops below 90%

54. • The duration of protection is at
least 15yrs based on scientific
evidence
• All children aged less than 18 yrs
and not previously vaccinated
should receive vaccination

55. • Hepatitis B vaccine is
contraindicated for individuals
with history of allergic reactions
to any of the vaccine
components
• Neither pregnancy nor lactation
is a contraindication for the
vaccine

56. STORAGE OF VACCINE
• The vaccine should be stored at
2-80 degree C
• Freezing must be avoided ass it
dissociates antigen from the
alum adjuvant

57. HEPATITIS “B” IMMUNOGLOBULIN
• For immediate protection HBIG
is used for those acutely exposed
to HBsAg positive blood (eg:
surgeons, nurses, lab workers)

58. • HBIG should be given
immediately following accidental
inoculation (ideally within 6 hrs
and preferably not later than 48
hrs)
• At the same time the victim’s
blood should be sent for testing

59. • If the test is negative vaccination
should be started immediately and
a full course be given
• If the test is postive for surface
antibody, no further action is
required

60. • The recommended dose is 0.05
to 0.07 ml/kg body weight. Two
doses should be given 30 days
apart.
• HBIG provides short term
passive protection which lasts
for approximately 3 months

61. PASSIVE ACTIVE IMMUNIZATION
• The simultaneous administration of
HBIG and hepatitis B vaccine is more
efficacious than HBIG alone

62. • The combined procedure is ideal
both for prophylaxis of persons
accidently exposed to hepatitis +ve
blood and for prevention of carrier
state in the newborn babies of
carrier mothers
• HBIG (0.05-0.07ml/kg) should be
administered as soon as possible
and within 24 hrs)

63. • If possible Hepatitis b vaccine 1
ml (20mcg/1ml) should be given
IM within 7 days of exposure and
second and third doses should
be given one and six months,
respectively after the first dose

64. OTHER MEASURES
• All blood should be screened for
HBV infection. Voluntary blood
donation should be encourages
as purchase blood has shown a
higher risk of post transfusion
hepatitis

65. • Health personnel should be
alerted to the importance of
adequate sterilization of all
instruments and to practice
hygienic measures

66. • Carriers should be educated
not to donate blood, not to
share razors or tooth brushes
and use barrier methods of
contraception

67. THANK YOU