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{{Hepatitis B}}
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== Prevention ==
==Overview==
The risk of [[transmission]] of hepatitis B may be reduced by the implementation of certain measures proposed by the [[WHO]]. These include the [[vaccination]] of all infants within 24 hours of birth; [[vaccination]] of members of certain risk groups, including travelers to [[endemic]] areas and healthcare workers (if they have not been vaccinated yet); avoidance of sexual contact with a person who has acute or [[chronic hepatitis B]]; and avoiding sharing personal items such as razors or toothbrushes. The [[HBV]] vaccine is effective in preventing [[HBV infection]]s when it is administered either before exposure or shortly after exposure.<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name=MMWR-Hepatitis-B>Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016 </ref><ref name=MMWR-Hepatitis> Centers for Disease Control and Prevention. Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm  Accessed on October 4th 2016</ref>


While [[abstinence]] is the only guaranteed way of preventing sexual transmission of hepatitis B., latex [[condoms]], if used properly, greatly reduce the chances of transmission.
== Primary Prevention ==
According to the [[WHO]], the following measures should be implemented to prevent infection by [[hepatitis B virus]]:<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name=MMWR-Hepatitis-B>Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016 </ref><ref name=MMWR-Hepatitis> Centers for Disease Control and Prevention. Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm  Accessed on October 4th 2016</ref>


===Reactivation===
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
Hepatitis B virus DNA persists in the body after infection and in some people the disease re-occurs.<ref name="pmid17981227">{{cite journal
|+
|author=Vierling JM
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Primary Prevention}}
|title=The immunology of hepatitis B
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Recommendations}}
|journal=Clin Liver Dis
|-
|volume=11
| style="padding: 5px 5px; background: #DCDCDC;" | '''Hepatitis B vaccine '''
|issue=4
| style="padding: 5px 5px; background: #F5F5F5;" |
|pages=727–59, vii–viii
*The [[hepatitis B vaccine]] is the mainstay of [[hepatitis B]] prevention
|year=2007
*The complete [[vaccine]] series induces protective [[antibody]] levels in more than 95% of infants, children, and young adults
|month=November
*Protection lasts at least 20 years and may be lifelong
|pmid=17981227
*[[WHO]] recommends vaccination for:
|doi=10.1016/j.cld.2007.08.001
**All infants receive the [[hepatitis B vaccine]] as soon as possible after birth, preferably within 24 hours
|url=http://linkinghub.elsevier.com/retrieve/pii/S1089-3261(07)00081-5
***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:
|issn=
**All children and adolescents younger than 18 years old who have not previously been [[vaccinated]] should receive the [[vaccine]]
}}</ref> Although rare, reactivation is seen most often in people with impaired immunity.<ref name="pmid18184191">{{cite journal
**People who frequently require [[blood]] or [[blood]] products, dialysis patients, recipients of solid organ transplantations
|author=Katz LH, Fraser A, Gafter-Gvili A, Leibovici L, Tur-Kaspa R
**Incarcerated people
|title=Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta-analysis
**Injection drug users
|journal=J. Viral Hepat.
**Household and sexual contacts of people with chronic HBV infection
|volume=15
**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
|issue=2
**Travellers who have not completed their hepatitis B vaccination series should be offered the vaccine before leaving for [[endemic]] areas
|pages=89–102
|-
|year=2008
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Screening]] of all donated [[blood]]'''
|month=February
| style="padding: 5px 5px; background: #F5F5F5;" |
|pmid=18184191
*[[Screening]] of all donated [[blood]] has reduced the chance of getting [[hepatitis B]] from a [[blood transfusion]].
|doi=10.1111/j.1365-2893.2007.00902.x
|-
|url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1352-0504&date=2008&volume=15&issue=2&spage=89
| style="padding: 5px 5px; background: #DCDCDC;" | '''Hepatitis B immune globulin'''
|issn=
| style="padding: 5px 5px; background: #F5F5F5;" |
}}</ref>
*The hepatitis B immune globulin (HBIG) or [[hepatitis B vaccine]] shot may help prevent [[hepatitis B infection]] if it is administered within 24 hours of exposure
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lifestyle measures'''
| style="padding: 5px 5px; background: #F5F5F5;" |
* 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 used for snorting drugs)
* Clean blood spills with a solution containing 1 part household bleach for every 10 parts water
|}


=== Primary Prevention ===
Patients with [[chronic hepatitis B]] should be aware of the following:<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name=MMWR-Hepatitis-B>Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016 </ref>
{| style="border: 0px; font-size: 100%; margin: 3px; align:center;" align=center width="900px"
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|'''Education and Prevention of Hepatitis B'''}}
|-
|style="padding: 5px 5px; background: #DCDCDC;" |
*Importance of lifestyle modifications (e.g., 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 make use of 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, life-long antiviral therapy is recommended.
|-
|}


*If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission.  
==Vaccination==
*If you are pregnant, you should get a blood test for hepatitis B. Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
[[Hepatitis B vaccine]] is the most effective tool in preventing the [[transmission]] of [[HBV]] and [[HDV]]. [[Vaccines]] are composed of the surface antigen of HBV ([[HBsAg]]), and are produced by two different methods: plasma-derived and recombinant DNA. The [[natural reservoir]] for [[hepatitis B virus]] is man. Closely related [[hepadnaviruses]] have been found in woodchucks and ducks, but they are not [[infectious]] for humans.<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref>
*Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can't stop, never share drugs, needles, syringes, water, or "works", and get vaccinated against hepatitis A and B.  
*Do not share personal care items that might have blood on them (razors, toothbrushes).
*Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.  
*If you have or had hepatitis B, do not donate blood, organs, or tissue.  
*If you are a health-care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps (view current post-exposure prophylaxis recommendations).


== Vaccine ==
The primary hepatitis B immunization series conventionally consists of three doses of vaccine. Vaccination of infants and, in particular, delivery of hepatitis B vaccine within 24 hours of birth is 90–95% effective in preventing infection with HBV as well as decreasing HBV transmission if followed by at least two other doses. [[WHO]] recommends universal hepatitis B vaccination for all [[infants]] and specifies that the first dose should be given as soon as possible after birth.<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref Name=Hepatitis-B-Vac>Ni JD, Xiong YZ, Wang XJ, Xiu LC. Does increased hepatitis B vaccination dose lead to a better immune response in HIV- infected patients than standard dose vaccination: a meta-analysis? Int J STD AIDS. 2013;24(2):117–22.</ref> This strategy has resulted in a dramatic decrease in the prevalence of CHB among young children in regions of the world where universal infant vaccination programs have been implemented. A small proportion of vaccinated children (5–10%) have a poor response to vaccination and remain susceptible to acquisition of HBV infection throughout their lives.<ref name=WHO-Guideline-Hepatitis-B> World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name=hepatitis-B-virus>Liu CJ, Liou JM, Chen DS, Chen P J.Natural course and treatment of dual hepatitis B virus and hepatitis C virus infections. J Formos Med Assoc Taiwan. 2005;104(11):783–91.</ref>


''Main article [[Hepatitis B vaccine]]''
[[WHO]] recommends that [[hepatitis B vaccine]] be included in routine [[immunization]] services in all countries. The primary objective of hepatitis B [[immunization]] is to prevent chronic HBV infections, which result in [[chronic liver disease]] later in life. By preventing chronic HBV infections, the major reservoir for transmission of new infections is also reduced.


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.
{{For|hepatitis B vaccine|Hepatitis B vaccine}}


'''Hepatitis B Vaccine'''
==References == 
{{Reflist|2}}


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).
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== References == 
[[Category:Gastroenterology]]
{{Reflist|2}}
[[Category:FinalQCRequired]]
 
[[Category:Emergency mdicine]]
[[Category:Hepatitis|B]]
[[Category:Disease]]
[[Category:Viruses]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
 
{{WH}}
{{WS}}

Latest revision as of 22:05, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Sara Mehrsefat, M.D. [3]

Overview

The risk of transmission of hepatitis B may be reduced by the implementation of certain measures proposed by the WHO. These include the vaccination of all infants within 24 hours of birth; vaccination of members of certain risk groups, including travelers to endemic areas and healthcare workers (if they have not been vaccinated yet); avoidance of sexual contact with a person who has acute or chronic hepatitis B; and avoiding sharing personal items such as razors or toothbrushes. The HBV vaccine is effective in preventing HBV infections when it is administered either before exposure or shortly after exposure.[1][2][3]

Primary Prevention

According to the WHO, the following measures should be implemented to prevent infection by hepatitis B virus:[1][2][3]

Primary Prevention Recommendations
Hepatitis B vaccine
  • The hepatitis B vaccine is the mainstay of hepatitis B prevention
  • 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 may be lifelong
  • WHO recommends vaccination for:
    • 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:
    • All children and adolescents younger than 18 years old who have not previously been vaccinated should receive the vaccine
    • People who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations
    • Incarcerated people
    • Injection 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
Hepatitis B immune globulin
Lifestyle measures
  • 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 used for snorting drugs)
  • Clean blood spills with a solution containing 1 part household bleach for every 10 parts water

Patients with chronic hepatitis B should be aware of the following:[1][2]

Education and Prevention of Hepatitis B
  • Importance of lifestyle modifications (e.g., 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 make use of 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, life-long antiviral therapy is recommended.

Vaccination

Hepatitis B vaccine is the most effective tool in preventing the transmission of HBV and HDV. Vaccines are composed of the surface antigen of HBV (HBsAg), and are produced by two different methods: plasma-derived and recombinant DNA. The natural reservoir for hepatitis B virus is man. Closely related hepadnaviruses have been found in woodchucks and ducks, but they are not infectious for humans.[1]

The primary hepatitis B immunization series conventionally consists of three doses of vaccine. Vaccination of infants and, in particular, delivery of hepatitis B vaccine within 24 hours of birth is 90–95% effective in preventing infection with HBV as well as decreasing HBV transmission if followed by at least two other doses. WHO recommends universal hepatitis B vaccination for all infants and specifies that the first dose should be given as soon as possible after birth.[1][4] This strategy has resulted in a dramatic decrease in the prevalence of CHB among young children in regions of the world where universal infant vaccination programs have been implemented. A small proportion of vaccinated children (5–10%) have a poor response to vaccination and remain susceptible to acquisition of HBV infection throughout their lives.[1][5]

WHO recommends that hepatitis B vaccine be included in routine immunization services in all countries. The primary objective of hepatitis B immunization is to prevent chronic HBV infections, which result in chronic liver disease later in life. By preventing chronic HBV infections, the major reservoir for transmission of new infections is also reduced.

For hepatitis B vaccine, see Hepatitis B vaccine.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016
  2. ↑ 2.0 2.1 2.2 Morbidity and Mortality Weekly Report. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. (2006). http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf Accessed on October 4th, 2016
  3. ↑ 3.0 3.1 Centers for Disease Control and Prevention. Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm Accessed on October 4th 2016
  4. ↑ Ni JD, Xiong YZ, Wang XJ, Xiu LC. Does increased hepatitis B vaccination dose lead to a better immune response in HIV- infected patients than standard dose vaccination: a meta-analysis? Int J STD AIDS. 2013;24(2):117–22.
  5. ↑ Liu CJ, Liou JM, Chen DS, Chen P J.Natural course and treatment of dual hepatitis B virus and hepatitis C virus infections. J Formos Med Assoc Taiwan. 2005;104(11):783–91.


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