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  • This graphic shows the distribution of risk factors in 2001. Persons with multiple sexual contacts, men who have sex with men, and sexual contact with a person known to have HBV infection account for 54 percent of cases with a known risk factor. Injection drug use accounts for 20 percent of cases. About 3 percent of cases are in people who have household contact with a person with acute or chronic hepatitis B. Fifteen years ago, health care workers accounted for 2 percent of HBV infections- 2 or 3 thousand new infections each year. Since that time, the rate of infection among health care workers has declined by 95 percent, and is now lower than the rate for the general population. Hepatitis B vaccine has made occupational HBV infection a thing of the past.


  • 1. HEPATITIS - B
  • 2. Hepatitis B: Virus Infection  More than 350 million chronically infected worldwide  Established cause of chronic hepatitis and cirrhosis  Human carcinogen—cause of up to 80% of hepatocellular carcinomas  More than 600,000 deaths worldwide in 2002
  • 3. Hepatitis B: Complications  Hospitalization  Fulminant hepatitis  Cirrhosis  Hepatocellular carcinoma  Death
  • 4. 0 10 20 30 40 50 60 70 80 90 100 Birth 1-6 mo 7-12 mo 1-4 yrs 5+ yrs Age of infection Carrierrisk(%) Risk of Chronic HBV Carriage by Age of Infection
  • 5. Hepatitis B: Perinatal Transmission  If mother positive for HBsAg and HBeAg 70%-90% of infants infected 90% of infected infants become chronically infected  If positive for HBsAg only 5%-20% of infants infected 90% of infected infants become chronically infected
  • 6. IDU 16% Other 5% Unknown 16% Hetero- sexual, multiple partners 39% MSM 24% Risk Factors for Hepatitis B MMWR 2006;55(RR-16):6-7
  • 7. Hepatitis B Virus Infection by Duration of High-Risk Behavior Years at Risk 0 3 6 9 12 15 0 20 40 60 80 100 Percentinfected IV drug user Homosexual men HCWs Heterosexual
  • 8. Hepatitis B Vaccine  Composition Recombinant HBsAg  Efficacy 95% (Range, 80%-100%)  Duration of Immunity 20 years or more  Schedule 3 Doses  Booster doses not routinely recommended
  • 9. Hepatitis B Vaccine Routine booster doses are NOT routinely recommended for any group
  • 10. Dose+ Primary 1 Primary 2 Primary 3 Usual Age Birth 1- 2 months 6-18 months* Minimum Interval - - - 4 weeks 8 weeks** Hepatitis B Vaccine Routine Infant Schedule * infants who mothers are HBsAg+ or whose HBsAg status is unknown should receive the third dose at 6 months of age ** at least 16 weeks after the first dose +an additional dose at 4 months is acceptable if the clinician prefers to use a combination vaccine that contains hepatitis B vaccine
  • 11. Dose Primary 1 Primary 2 Primary 3 Minimum Interval - - - 4 weeks 8 weeks* Usual Interval --- 1 month 5 months Hepatitis B Vaccine Adolescent and Adult Schedule *third dose must be separated from first dose by at least 16 weeks
  • 12. Adults at Risk for HBV Infection  Sexual exposure sex partners of HBsAg-positive persons sexually active persons not in a long- term, mutually monogamous relationship* persons seeking evaluation or treatment for a sexually transmitted disease men who have sex with men *persons with more than one sex partner during the previous 6 months
  • 13. Adults at Risk for HBV Infection  Percutaneous or mucosal exposure to blood  current or recent IDU  household contacts of HBsAg-positive persons  residents and staff of facilities for developmentally disabled persons  healthcare and public safety workers with risk for exposure to blood or blood-contaminated body fluids  persons with end-stage renal disease
  • 14. Adults at Risk for HBV Infection  Other groups international travelers to regions with high or intermediate levels (HBsAg prevalence of 2% or higher) of endemic HBV infection persons with HIV infection
  • 15. Pre-vaccination: Serologic Testing  Not indicated before routine vaccination of infants or children  Recommended for  all persons born in Africa, Asia, the Pacific Islands, and other regions with HBsAg prevalence of 8% or higher  household, sex, and needle-sharing contacts of HBsAg-positive persons  HIV-infected persons  Consider for  Groups with high risk of HBV infection (MSM, IDU, incarcerated persons)
  • 16. Post vaccination: Serologic Testing  Not routinely recommended following vaccination of infants, children, adolescents, or most adults  Recommended for: Infants born to HBsAg+ women Hemodialysis patients Immunodeficient persons Sex partners of persons with chronic HBV infection Certain healthcare personnel
  • 17. Hepatitis B Vaccine Adverse Reactions Pain at injection site Mild systemic complaints (fatigue, headache) Temperature ≥99.9°F (37.7°C) Severe systemic reactions Adults 13%-29% 11%-17% 1% rare Infants and Children 3%-9% 0%-20% 0.4%-6% rare
  • 18. Hepatitis B Vaccine Contraindications & Precautions  Severe allergic reaction to a vaccine component or following a prior dose  Moderate or severe acute illness
  • 19. THANK YOU… 