Hepatitis B primary prevention

Hepatitis Main Page
Hepatitis B
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Hepatitis B from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Treatment
Medical Therapy
Surgery
Primary Prevention
Hepatitis B Vaccination
Hepatitis B Vertical transmission
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hepatitis B primary prevention On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hepatitis B primary prevention All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hepatitis B primary prevention
CDC on Hepatitis B primary prevention
Hepatitis B primary prevention in the news
Blogs on Hepatitis B primary prevention
Directions to Hospitals Treating Hepatitis B
Risk calculators and risk factors for Hepatitis B primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Primary Prevention

According to the WHO, the following measures should be applied to prevent infection by hepatitis B virus:

Prevention of Infection

The hepatitis B vaccine is the mainstay of hepatitis B prevention. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate: A 3-dose schedule of hepatitis B vaccine, with the first dose (monovalent) being given at birth and the second and third (monovalent or combined vaccine) given at the same time as the first and third doses of DTP vaccine 4 doses, where a monovalent birth dose is followed by 3 monovalent or combined vaccine doses, usually given with other routine infant vaccines The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is possibly lifelong. All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine if they live in countries where there is low or intermediate endemicity. In those settings it is possible that more people in high risk groups may acquire the infection and they should also be vaccinated. They include: People who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations People interned in prisons Injecting drug users Household and sexual contacts of people with chronic HBV infection People with multiple sexual partners, as well as health-care workers and others who may be exposed to blood and blood products through their work Travellers who have not completed their hepatitis B vaccination series should be offered the vaccine before leaving for endemic areas Screening of all donated blood has reduced the chance of getting hepatitis B from a blood transfusion. Mandatory reporting of the disease allows state health care workers to track people who have been exposed to the virus. The vaccine is given to those who have not yet developed the disease. The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent hepatitis B infection if it is given within 24 hours of exposure. Lifestyle measures for preventing transmission of hepatitis B: Avoid sexual contact with a person who has acute or chronic hepatitis B Use a condom and practice safe sex Avoid sharing personal items, such as razors or toothbrushes. Do not share drug needles or other drug equipment (such as straws for snorting drugs) Clean blood spills with a solution containing 1 part household bleach to 10 parts water Hepatitis B (and hepatitis C) viruses cannot be spread by casual contact, such as holding hands, sharing eating utensils or drinking glasses, breast-feeding, kissing, hugging, coughing, or sneezing.

Patients with chronic hepatitis B should be aware of the following:

Education and Prevention of Hepatitis B

Importance of lifestyle modifications, such as reduction of alcohol consumption Risk of transmission to others: Household memebers with negative test results for HBV serologic markers should be vaccinated. Regular sexual partners with negative test results for HBV serologic markers should be vaccinated. Casual sexual partners or unvaccinated regular sexual partners should prefer barrier protection methods. Pregnant HBsAg-positive women should inform their healthcare providers, so that Hepatitis B Immune Globulin and hepatitis B vaccine may be administered to the infant after delivery. Healthcare workers infected with hepatitis B should consult an expert review panel. In case of organ transplant, in which anti-HBc-positive organ donors are used for HBV seronegative recipients, HBV infection should be prevented with the administration of antiviral therapy. 6-12 months of prophylactic therapy may be sufficient for organ transplants, other than hepatic. For hepatic transplants, it is recommended life-long antiviral therapy.

Reactivation

Hepatitis B virus DNA persists in the body after infection and in some people the disease re-occurs. Although rare, reactivation is seen most often in people with impaired immunity.

Vaccine

Main article Hepatitis B vaccine

Several vaccines have been developed for the prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from plasma obtained from patients who had long-standing hepatitis B virus infection. However, currently, these are more often made using recombinant DNA technology, though plasma-derived vaccines continue to be used; the two types of vaccines are equally effective and safe.

HBsAg is the antigen used for hepatitis B vaccination. Vaccine antigen can be purified from the plasma of persons with chronic HBV infection or produced by recombinant DNA technology. Vaccines available in the United States use recombinant DNA technology to express HBsAg in yeast, which is then purified from the cells by biochemical and biophysical separation techniques (81,82). Hepatitis B vaccines licensed in the United States are formulated to contain 10--40 µg of HBsAg protein/mL. Since March 2000, hepatitis B vaccines produced for distribution in the United States do not contain thimerosal as a preservative or contain only a trace amount (<1.0 mcg mercury/mL) from the manufacturing process (83,84).

Hepatitis B vaccine is available as a single-antigen formulation and also in fixed combination with other vaccines. Two single-antigen vaccines are available in the United States: Recombivax HB® (Merck & Co., Inc., Whitehouse Station, New Jersey) and Engerix-B® (GlaxoSmithKline Biologicals, Rixensart, Belgium). Of the three licensed combination vaccines, one (Twinrix® [GlaxoSmithKline Biologicals, Rixensart, Belgium]) is used for vaccination of adults, and two (Comvax® [Merck & Co., Inc., Whitehouse Station, New Jersey] and Pediarix® [GlaxoSmithKline Biologicals, Rixensart, Belgium]) are used for vaccination of infants and young children. Twinrix contains recombinant HBsAg and inactivated hepatitis A virus. Comvax contains recombinant HBsAg and Haemophilus influenzae type b (Hib) polyribosylribitol phosphate conjugated to Neisseria meningitidis outer membrane protein complex. Pediarix contains recombinant HBsAg, diphtheria and tetanus toxoids and acellular pertussis adsorbed (DTaP), and inactivated poliovirus (IPV).