Hepatitis B: Difference between revisions
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Revision as of 16:36, 27 September 2016
Background
- Blood-borne virus
- Incubation period: 1-3 months
- Virus can cause acute, chronic, or asymptomatic infection
Clinical Features
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phophatase
- Elevated INR
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 |
Management
- Supportive care for acute disease
Post Exposure Prophylaxis
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
- ↑ 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.
- ↑ Postexposure prophylaxis to prevent hepatitis b virus infection. CDC MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm?s_cid=rr5516a3_e