Hepatitis B Quick Guide

On this page:
Screening
Vaccination Status
Diagnosis
Reporting Cases
Treatment
Risk Reduction
Rationale
Full Provider Guide Chapter: Hepatitis B

Screening

Vaccination Status

  • Vaccinate previously unvaccinated and susceptible children and adults.
  • To avoid missing opportunities for vaccination, give all children the first dose of hepatitis B vaccine at their first visit. If serologic test results indicate immunity or chronic infection, no additional vaccine doses should be given.
  • Current hepatitis B vaccination recommendations include universal vaccination of infants beginning at birth, routine vaccination of previously unvaccinated children and adolescents, and vaccination of previously unvaccinated adults at increased risk of infection.
      • All susceptible refugees should be considered at increased risk. While the newly arrived refugee is no longer experiencing an endemic environment in the U.S., refugee communities tend to congregate and may continue to passively act as a host environment for those who are infected with HBV.

Diagnosis

  • To determine hepatitis B infection status, all newly arrived refugees should have the following serologic tests performed:
    • HBsAg (hepatitis B surface antigen; a positive test indicates acute OR chronic infection)
    • Anti-HBs (antibody to hepatitis B surface antigen; a positive test indicates immunity due to natural infection)
    • Anti-HBc (antibody to hepatitis B core antigen [“core antibody”]; a positive test indicates natural infection [acute, chronic, or resolved]).
  • The combination of results of these three tests allows health care providers to determine whether the individual has acute or chronic HBV infection, is immune or susceptible.
      • HBsAg positive identifies acute or chronic HBV infection; HBcoreAb positive alone identifies previously exposed subjects; and anti-HB core positive and anti-HBs positive together, identifies those who have seroconverted.

Reporting Cases

  • Hepatitis B is a reportable disease per Minnesota Rules Governing Communicable Diseases. Both acute and chronic infections with HBV should be reported to the Minnesota Department of Health (MDH).
  • Reporting is required of both health care providers and laboratories.

Treatment

  • Treatment for acute HBV is supportive. Several treatments are available for chronic HBV infection.
  • All infected persons should be managed by a knowledgeable provider or specialist.
  • Persons with chronic HBV infection should have regular monitoring to determine whether disease is progressing and to identify liver damage or hepatocellular carcinoma.
  • Household contacts of infected persons should be screened and if susceptible, vaccinated.

Risk Reduction

  • HBV is transmitted by parenteral or mucosal exposure to blood or other body fluids from persons with acute or chronic HBV infection. The highest concentrations of HBV are found in blood, vaginal fluid, semen, and saliva; low titers are found in other body fluids. Worldwide, most infections occur from infected mother to child, from child-to-child contact in household settings, and from reuse of unsterilized needles and syringes.

Teach your patient about risk reduction measures

    • Cover all cuts and open sores with a bandage.
    • Throw away used personal items such as tissues, menstrual pads, or tampons.
    • Wash hands well after touching blood or body fluids.
    • Clean up blood spills using appropriate personal protective equipment; clean the area with a bleach solution (one part bleach and nine parts water).
    • Do not share toothbrushes, razors, needles for ear piercing, earrings, nail files, nail clippers, scissors, or anything that may come in contact with blood or body fluids.

    Rationale

  • HBV is endemic in many of the refugee-producing parts of the world; screening results for HBV in Minnesota suggest a higher prevalence of hepatitis B infection among primary refugees than among the general U.S. population (i, ii). 

Full Provider Guide Chapter: Hepatitis B

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i. Ugwu C, Varkey P, Bagniewski S, Lesnick T. Ser-epidemiology of hepatitis B among new refugees to MN. J Immigr Minor Health. 2008;10:469-474.

ii. Armstrong GL, Goldstein ST. Hepatitis B: Global epidemiology, diagnosis and prevention. In: Walker P, Barnett E, eds. Immigrant Medicine. Philadelphia, PA: Saunders Elsevier; 2007:321-341.

     

 

 

 


Updated Thursday, 12-Jan-2012 14:22:45 CST