Hepatitis B: Difference between revisions
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==Background==
==Background==
[[File:Prevalence-of-hepatitis-b-surface-antigen.png|thumb|Baseline prevalence of Hepatitis B exposure.]]
[[File:Prevalence-of-hepatitis-b-surface-antigen.png|thumb|Baseline prevalence of Hepatitis B exposure.]]
*Blood-borne DNA virus
*Blood-borne DNA virus
*Incubation period: 1-3 months
*Incubation period: 1-3 months
*Virus can cause acute, chronic, or asymptomatic infection
*Virus can cause acute, chronic, or asymptomatic infection


==Clinical Features==
==Clinical Features==
[[File:Jaundice08.jpg|thumb|Jaundice of the skin]]
[[File:Jaundice08.jpg|thumb|Jaundice of the skin]]
[[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]]
[[File:Jaundice.jpg|thumb|Pediatric jaundice with icterus of sclera.]]
*[[Nausea/vomiting]]
*[[Special:MyLanguage/Nausea/vomiting|Nausea/vomiting]]
*[[RUQ pain]]
*[[Special:MyLanguage/RUQ pain|RUQ pain]]
*[[Jaundice]]
*[[Special:MyLanguage/Jaundice|Jaundice]]
*[[Fever]]
*[[Special:MyLanguage/Fever|Fever]]
 
 


==Differential Diagnosis==
==Differential Diagnosis==
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{{Acute hepatitis causes}}
{{Acute hepatitis causes}}
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{{STD DDX}}
{{STD DDX}}
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==Evaluation==
==Evaluation==
*[[LFTs]]
 
*[[Special:MyLanguage/LFTs|LFTs]]
**AST, ALT > 1000s
**AST, ALT > 1000s
**Elevated bilirubin
**Elevated bilirubin
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*Elevated INR
*Elevated INR
*CBC, BMP
*CBC, BMP
*Assess for alternative etiologies of symptoms as appropriate (see: [[jaundice]], [[RUQ pain]], [[nausea/vomiting]])
*Assess for alternative etiologies of symptoms as appropriate (see: [[Special:MyLanguage/jaundice|jaundice]], [[Special:MyLanguage/RUQ pain|RUQ pain]], [[Special:MyLanguage/nausea/vomiting|nausea/vomiting]])
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{{Acute hepatitis panel}}
{{Acute hepatitis panel}}
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===Evaluating Hepatitis B Serology Results===
===Evaluating Hepatitis B Serology Results===
[[File:Hepatitis B serology.jpg|thumb|Hepatitis B serology findings.]]
[[File:Hepatitis B serology.jpg|thumb|Hepatitis B serology findings.]]
{| {{table}}
{| {{table}}
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| Chronically infected||positive||anti-HBc- positive;      IgM anti-HBc- negative||negative
| Chronically infected||positive||anti-HBc- positive;      IgM anti-HBc- negative||negative
|}
|}


==Management==
==Management==
*Supportive care for acute disease
*Supportive care for acute disease


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{{Hepatitis B post exposure prophylaxis}}
{{Hepatitis B post exposure prophylaxis}}
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==Disposition==
==Disposition==
*Consider admission for:  
*Consider admission for:  
*INR >2, Bilirubin >30, hypoglycemia
*INR >2, Bilirubin >30, hypoglycemia
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*Intractable pain, inability to tolerate PO
*Intractable pain, inability to tolerate PO
*Significant comorbidity/immunocompromised or age >50 years
*Significant comorbidity/immunocompromised or age >50 years


==See Also==
==See Also==
*[[Viral hepatitis]]
 
*[[Acute hepatitis]]
*[[Special:MyLanguage/Viral hepatitis|Viral hepatitis]]
*[[Jaundice]]
*[[Special:MyLanguage/Acute hepatitis|Acute hepatitis]]
*[[Special:MyLanguage/Jaundice|Jaundice]]
 
 


==External Links==
==External Links==
*[[Antibiotics (By_Diagnosis)]]
 
*[[Special:MyLanguage/Antibiotics (By_Diagnosis)|Antibiotics (By_Diagnosis)]]
 
 


==References==
==References==
<references/>
<references/>


[[Category:ID]][[Category:GI]]
[[Category:ID]][[Category:GI]]
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Latest revision as of 23:00, 4 January 2026


Background

Baseline prevalence of Hepatitis B exposure.
  • Blood-borne DNA virus
  • Incubation period: 1-3 months
  • Virus can cause acute, chronic, or asymptomatic infection


Clinical Features

Jaundice of the skin
Pediatric jaundice with icterus of sclera.


Differential Diagnosis

Causes of acute hepatitis

Sexually transmitted diseases


Evaluation

  • LFTs
    • AST, ALT > 1000s
    • Elevated bilirubin
    • Elevated alk phophatase
  • Elevated INR
  • CBC, BMP
  • Assess for alternative etiologies of symptoms as appropriate (see: jaundice, RUQ pain, nausea/vomiting)

Interpreting Acute Hepatitis Panel Results

Anti-hepatitis A, IgM Hepatitis B surface antigen Anti-hepatitis B core, IgM Anti-hepatitis C Interpretation
Positive Negative Negative Negative Acute hepatitis A
Negative Positive Positive Negative Acute hepatitis B
Negative Positive Negative Negative Chronic hepatitis B infection
Negative Negative Positive Negative Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect
Negative Negative Negative Positive Acute or chronic hepatitis C; additional tests are required to make the determination


Evaluating Hepatitis B Serology Results

Hepatitis B serology findings.
Clinical Scenario HBsAg anti-HBc anti-HBs
Susceptible to infection negative negative negative
Immune due to natural infection negative positive positive
Immune due to Hep B infection negative negative positive
Acutely infected positive anti-HBc- positive; IgM anti-HBc- positive negative
Chronically infected positive anti-HBc- positive; IgM anti-HBc- negative negative


Management

  • Supportive care for acute disease

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history[2]

Unvaccinated

  • If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
  • If source is HGsAG(-) then start the HBV vaccine series
  • If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
    • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
    • Can also opt to perform second HBIG administration in one month
  • If source is HBsAg(-) then no treatment is needed
  • If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

  • If the source is HBsAg(+) then give HBIG x2 and no HBV series
  • If source is HGsAG(-) then no treatment is needed
  • If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

  • HBIG 0.06 mL/kg IM
    • Give in opposite arm from hepatitis B vaccine if patient also receiving vaccine
  • Vaccination series: HBV vaccine options:
    • Engerix-B 20mcg IM
    • Recombivax HB 10mcg IM


Disposition

  • Consider admission for:
  • INR >2, Bilirubin >30, hypoglycemia
  • Any GI bleeding
  • Intractable pain, inability to tolerate PO
  • Significant comorbidity/immunocompromised or age >50 years


See Also


External Links


References

  1. ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
  2. ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e
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