1. This document discusses Hepatitis B, including its causes, transmission, prevalence in Yemen, clinical features, diagnosis, and prevention. 2. Yemen has an intermediate prevalence of Hepatitis B, between 2-7% of the population, with mortality from viral hepatitis being 22% of deaths. 3. The disease is caused by the Hepatitis B virus and transmitted through blood or bodily fluids. It can range from acute to chronic infection leading to cirrhosis or liver cancer. Prevention focuses on vaccination, sterilization of medical equipment, and screening blood donors.

1. By: Najwa Abdullah
Under the supervision of:
Dr. Mohammed Al-Hakami
Community medicine
Faculty of medicine
Ibb university
25-08-2022
HEPATITIS B
(HBV)

2. • It is an inflammatory disease of the liver,
caused by Hepatitis B virus (HBV),
transmitted usually parenterally, and
• Clinically characterized by a
1. long incubation period,
2. prolonged period of illness, often
on to chronic liver disease such as
chronic hepatitis, cirrhosis of liver, in
about 5 to 15 percent of the cases it may
even lead to primary hepato-cellular
carcinoma.
3. Case Fatality Rate (CFR) is about 15
percent.

3. • HBV-infection (disease) is endemic all over the world.
• More than 2 billion people worldwide have been infected with HBV and
out of them 350 million are chronically infected. The latter are prone to a
risk of liver cancer and cirrhosis.
• Every year one million carriers are dying of these two conditions. World is
now divided into three zones based on the prevalence of carrier state as:
1. Low prevalence zone: HBV carrier rate is < 2 percent of the population.
2. Intermediate prevalence zone: HBV carrier rate is 2 to 7 percent.
Childhood infections are frequent.
3. High prevalence zone: HBV carrier rate is 7 to 20 percent, childhood
infections are highly frequent..

4. • According to the latest WHO data published in 2020 Hepatitis B
deaths in Yemen reached 299 or 0.19% of total deaths.
• The age adjusted death rate is 2.02 per 100,000 of population
ranks Yemen 7th in the world.

5. • Prevalence of HBV and HCV may be different in different regions
and various groups of the same community.
• According to WHO studies, the prevalence rates of HBV & HCV
are as below 👇🏻
HBV HCV
10.5% in Sana’a 2.37%
4.75% in Aden 0.6%
5.6% in Hajah 0.8%
26.3% in Soqatra 5.1%
2.7% in Mukala
1.8% in Ibb city 1.99%

6. Yemen has an intermediate level which is
2%-7% of HBV
2.5%-4.9% of HCV
Mortality rate from viral hepatitis is 22%
3% death from HBV infection
18% death from HCV infection

7. • Causative agent: HBV is a DNA virus, a
member of the family Hepadnaviridae.
• Antigenically it is a complex virus. It has
three distinct, antigens namely
1. outer glycoprotein named as ‘Surface
antigen’ (Australia antigen) (HBs Ag),
2. the inner nucleoprotein as ‘Core antigen’
(HBc Ag) and
3. the ‘e-antigen’ (HBe Ag).

8. ANTIGENS ANTIBODIES
 Outer glycoprotein named
as ‘Surface antigen’
(Australia antigen) (HBs Ag)
Diagnostic of active HBV-
infection.
 Surface antibody
(anti-HBs)
Diagnostic of previous HBV infection.
(Immunity)
 Inner nucleoprotein as
‘Core antigen’ (HBc Ag) and
associated with DNA-
polymerase activity
 Core antibody
(anti-HBc)
• Appears during acute HBV
infection
• persists in Chronic HBV Carriers,
but not in individuals who
recover from infection.
• Its persistence indicates
continuation of HBV replication
 e-antigen (HBe Ag) high infectivity  e-antibody
(anti-Hbe)
Its development indicates that the
infectivity is reduced.

9. 1. Surface antigen is the first to
be detected. It appears during
incubation period and
during acute illness. Usually
cleared after 4 to 6 months.
2. The next to appear are core
antigen and e-antigen.
3. E-antigen is detected within 3
to 5 days following the
appearance of surface antigen.
It persists for 2 to 6 weeks.
1. Those who recover from HBV
infection, surface antigen
disappears and surface
antibody and core-antibody
appear.
2. Those who become carriers,
surface antigen persists and
there is no production of
surface antibodies. However,
core-antibody will be positive.

10. • Human being is the only known reservoir of infection.
• Such a reservoir may be a case or a carrier.
• A case may be an inapparent subclinical case or an active,
symptomatic case.
• The risk of becoming a carrier is 5 to 10 percent among adults
and about 50 percent among infants.

11. • Contaminated blood is the
main source of infection.
• However, surface antigen
has been found in the body
fluids such as saliva, semen,
vaginal secretions, urine,
cerebrospinal fluid, ascitic
fluid and joint fluids. Last
three are least infectious

12. • This varies from several months to several years.
• In other words, the person is communicable during the last one
month of incubation period, during the acute phase of illness
and until the surface antigen disappears

13. 1. Age incidence: In areas of high prevalence, infection is
acquired in the early age. In areas of low prevalence, infection
is acquired in the later ages.
2. Sex incidence: men ˃ women

14. • Parenteral route (the commonest route of transmission) The disease is
transmitted through contaminated blood and blood-products.
• Percutaneous route: Accidental inoculations can occur during surgical,
dental procedures, mass immunizations and traditional tattooing, ear
piercing, nose piercing, ritual circumcision, acupuncture, etc.
• Direct contact: by kissing and by sexual intercourse. So HBV is often
considered as sexually transmitted disease.
• Vertical transmission: Transmission of HBV from carrier mothers to their
babies is an important factor for the prevalence of the disease in endemic
areas.
• Other routes: Breast-milk transmission, from child to child, when there are
skin conditions like scabies, impetigo or other injuries.

15. • The high-risk occupational groups are surgeons, dentists,
nurses, lab-technicians, and blood-bank workers. Incidence is
also high among homosexuals, sex workers, IV drug abusers and
infants of HBV carrier mothers.

16. • 50 to 150 days (Average =100 days)

17. 1. Onset is insidious with loss of
appetite, nausea, vomiting and
grade fever. Often myalgia and
arthralgia also occurs.
2. Onset of icterus, high colored urine
and light colored stools.
3. Hepato-splenomegaly often
occurs.
4. A syndrome of fever, arthralgia or
arthritis, urticarial rashes occur in
10% of patients.
5. Chronic hepatitis may evolve into
persistent hepatitis, or cirrhosis of
liver or even primary hepatocellular
carcinoma.

18. • Surface antigen appears early in the disease and disappears soon.
There may be a short window period after the infection when HBs
Ag may not be detected.
• In chronic carriers, HBs Ag may persist for several months or even
indefinitely.
• Surface antibody (anti–HBs) is usually present soon after the onset of
jaundice and then persists indefinitely. It indicates good immunity.
• Core-antibody (anti–HBc) appears during con valescence.
• The presence of e-antigen (HBe Ag) suggests an infected person with
increased risk of transmitting HBV.

19. • Blocking the channel of transmission:
1. Sterilization of syringes, needles, catguts, surgical instruments, etc.
2. Avoiding sharing of toothbrush, razors, syringes among drug-abusers,
etc.
3. Screening of blood donors for HBs Ag
4. Avoiding homo-sexuality and multiple sexual partners
5. Instructions to the carriers—not to donate blood, not to share their
razors, bath brush, tooth–brush, etc. with others, and to use condoms
while having sex
6. Sterilization of instruments (simple heating over a flame) before
adopting procedures like nose piercing, ear pricking, acupuncture and
tattooing.

20. • Protection of susceptibles:
Active immunization: Four types of vaccines are currently
available.
A. Plasma Derived Vaccine (PDV): It is a subunit vaccine,
containing surface antigen (HBs Ag). The vaccine is safe,
effective and is widely used.
B. Recombinant DNA—yeast derived vaccine: In this type, the
yeast cloned with surface antigens – gene is cultured and the
vaccine is prepared. It is also equally safe, effective and
immunogenic as that of plasma derived vaccine, but is more
costlier than PDV.

21. • The regular dosage schedule consists of 3 doses, each of 1.0 mL,
containing 20 mcg of HBs Ag for adults, at 0, 1 and 6 months, IM either in
deltoid region of arm or anterolateral aspect of thigh.
• Children below 10 years, including neonates require 0.5 mL, containing 10
mcg.
• Protective antibody titer is obtained after the third dose and is 95 percent
effective. Immunity lasts for about 3 to 5 years. Booster dose once in 5
years.
• Rapid schedule is recommended for high-risk individuals such as
dentists, lab-technician in blood bank, etc. as pre-exposure
The schedule is 0, 1 and 2 with a booster dose at 12 months, followed
regular booster dose, once in 8 years.