Hepatitis B

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Background

  • Blood-borne virus
  • Incubation period: 1-3 months
  • Virus can cause acute, chronic, or asymptomatic infection

Clinical Features

Differential Diagnosis

Acute hepatitis

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

Acute Hepatitis Panel

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

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[1]

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
  • 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. Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e