This document discusses hepatitis B screening algorithms and reporting for pregnant women in the UK. It provides background on the national screening program and standards for viral hepatitis B screening during pregnancy. The goals of antenatal hepatitis B screening are early detection of infection to enable treatment for the mother and reduce mother-to-child transmission risk by offering newborn vaccination and prophylaxis. The document reviews epidemiology data on acute hepatitis B cases in Europe and England and outlines the clinical outcome and diagnosis of hepatitis B infection through various serological markers. It presents the hepatitis B testing algorithm and provides clinical comments for reporting screening test results.
Provides information on diagnosis and management of HIV-2 in adults, including an overview of HIV-2 and clinical recommendations and key points regarding diagnosis and treatment of HIV-2, monitoring antiretroviral therapy (ART), pregnancy, and pre- and post-exposure prophylaxis (PrEP and PEP).
Find more information at https://www.hivguidelines.org/hiv-testing-acute-infection/hiv-2/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Provides information on diagnosis and management of acute HIV, including clinical recommendations and key points regarding presentation, diagnosis, and management, including while on pre- or post-exposure prophylaxis (PrEP or PEP).
Find more information at https://www.hivguidelines.org/hiv-testing-acute-infection/acute-hiv/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Provides information on pre-exposure prophylaxis (PrEP) to prevent HIV acquisition, including clinical recommendations and key points regarding PrEP efficacy and candidates, contraindications, lab testing, prescription, and monitoring PrEP.
Find more information at https://www.hivguidelines.org/prep-for-prevention/prep-to-prevent-hiv/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Provides information on diagnosis and management of HIV-2 in adults, including an overview of HIV-2 and clinical recommendations and key points regarding diagnosis and treatment of HIV-2, monitoring antiretroviral therapy (ART), pregnancy, and pre- and post-exposure prophylaxis (PrEP and PEP).
Find more information at https://www.hivguidelines.org/hiv-testing-acute-infection/hiv-2/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Provides information on diagnosis and management of acute HIV, including clinical recommendations and key points regarding presentation, diagnosis, and management, including while on pre- or post-exposure prophylaxis (PrEP or PEP).
Find more information at https://www.hivguidelines.org/hiv-testing-acute-infection/acute-hiv/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Provides information on pre-exposure prophylaxis (PrEP) to prevent HIV acquisition, including clinical recommendations and key points regarding PrEP efficacy and candidates, contraindications, lab testing, prescription, and monitoring PrEP.
Find more information at https://www.hivguidelines.org/prep-for-prevention/prep-to-prevent-hiv/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Universal HIV and Hepatitis C Testing in the UCSD Emergency Departments: It Takes a Small Village
Jill Blumenthal & Martin Hoenigl & George Lara-Paez & Miriam Zuazo
01/18/2019
UCSD HIV & Global Health Rounds
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
Provides information on management of syphilis in patients with HIV, including clinical recommendations and key points regarding transmission, prevention, screening, treatment, follow-up, and partner exposure.
Find more information at https://www.hivguidelines.org/sti-care/syphilis/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Hepatitis C Infection – Screening, Treatment and (as) Prevention in the Comm...icornpresentations
Professor Colm Bergin Consultant Physician in Infectious Diseases, St. James’s Hospital, Dublin. Clinical Professor of Medicine, Trinity College DublinAssociate Director, Wellcome Trust-HRB Clinical Research Facility at St. James’s Hospital, Dublin. Dean of Postgraduate Specialist Training, Royal College of Physicians, Ireland.
Universal HIV and Hepatitis C Testing in the UCSD Emergency Departments: It Takes a Small Village
Jill Blumenthal & Martin Hoenigl & George Lara-Paez & Miriam Zuazo
01/18/2019
UCSD HIV & Global Health Rounds
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
Provides information on management of syphilis in patients with HIV, including clinical recommendations and key points regarding transmission, prevention, screening, treatment, follow-up, and partner exposure.
Find more information at https://www.hivguidelines.org/sti-care/syphilis/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Hepatitis C Infection – Screening, Treatment and (as) Prevention in the Comm...icornpresentations
Professor Colm Bergin Consultant Physician in Infectious Diseases, St. James’s Hospital, Dublin. Clinical Professor of Medicine, Trinity College DublinAssociate Director, Wellcome Trust-HRB Clinical Research Facility at St. James’s Hospital, Dublin. Dean of Postgraduate Specialist Training, Royal College of Physicians, Ireland.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#HEPATITIS MADE EASY#HEPATITS B#HEPATITIS C#
This is a discussion of hepatitis B, hepatitis C and HIV in pregnancy, the optimal screening for these infections and the integration of management approach based on evidence. Lecture given during the 2018 PIDSOG post-graduate course "High-Yield OBGYN Infections 2.0: From Confusion to Clarity" at the Conrad Manila on November 12, 2018.
viral markers in diagnosis monitoring and treatment of hepatitis b and c.pptxPathKind Labs
Hepatitis B Virus and Hepatitis C Virus infections are transmitted by parentral route. Early diagnosis and treatment can prevent cirrhosis of liver in HCV cases as drugs which can cure the infection are now available.
Outline:
Introduction
Epidemiologic Determinants
Mode of transmission
Burden of Hepatitis-B
Prevention and treatment
Challenges
Recent Advances in Hepatitis B research
Strategies
References
Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver .
The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation.
An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected
Similar to 4. Samir Dervisevic hepatitis b antenatal screening algorithms and reporting (20)
Digital screening information event 2 October 2019PHEScreening
Slides from the event for antenatal screening co-ordinators in Birmingham on 2 October 2019 to discuss the plans for moving to digital screening information.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
4. Samir Dervisevic hepatitis b antenatal screening algorithms and reporting
1. HEPATITIS B-ANTENATAL
SCREENING ALGORITHMS AND
REPORTING
Dr Samir Dervisevic
Norfolk and Norwich University Hospitals/ University of East Anglia
NHS Infectious Diseases in Pregnancy Screening
Programme (IDPS) National Laboratory Workshop
Birmingham, 13 March 2019
2. INFECTIOUS DISEASES IN PREGNANCY
SCREENING PROGRAMME (IDPS)
• Executed by midwives, obstetricians, virologists, PHE;
• In addition: specialist MDT teams (neonatologists, virologists,
hepatologists and Genitourinary Medicine specialists) provide care as part
of the screening programme;
• Clinical conditions for which the screening is organised have a clearly
defined care pathway;
• The IDPS programme includes data collection;
• KPI measure how the screening programme is performing;
• The IDPS programme currently collects 4 KPIs.
2 Hepatitis B-Antenatal Screening Algorithms and Reporting
3. STANDARS FOR INFECTIOUS DISEASES IN
PREGNANCY
National standards: to insure a consistent approach across screening
programmes:
Viral Hepatitis B infection:
• HBsAg prevalence in pregnant women in the UK: 0.5% (ECDC 2016);
• All antenatal women in England offered screening for hepatitis B virus;
The purpose is to:
a) Enable early detection of acute or chronic infection;
b) Offer treatment to antenatal mothers who require it for their health;
c) Reduce the risk of MTCT of infection;
d) Offer postnatal prophylaxis to a newborn.
3 Hepatitis B-Antenatal Screening Algorithms and Reporting
4. VIRAL HEPATITIS B: THE BIGGER PICTURE
• The estimated prevalence of chronic HBV infection is at around 0.9% in
the countries of the European Union and European Economic Area;
• Prevalence of chronic HBV infection in the UK is 0.1-0.5%;
• It is estimated that 4.7 million Europeans may have chronic HBV;
• 180,000 people in the UK are chronically infected with HBV;
• The World Health Organisation calling on countries to continue to translate
their commitments to eliminate hepatitis (Geneva, 27 July 2017);
• “The global effort to eliminate viral hepatitis and HIV as public health
threats by 2030 (WHO 2017)”
4 Hepatitis B-Antenatal Screening Algorithms and Reporting
5. ACUTE HBV CASES IN EUROPE
5 Hepatitis B-Antenatal Screening Algorithms and Reporting
6. ACUTE HEPATITIS B IN ENGLAND
• Surveillance of acute hepatitis B is essential to target prevention and control
activities such as the selective immunisation programme;
• Public Health England implemented national surveillance standards for
hepatitis B in 2007 which provided the framework for more consistent
reporting of cases from individual Specialist Virology Centres;
• The surveillance definition for acute hepatitis B is:
1. HBsAg positive and
2. Anti-HBc IgM positive and
3. Abnormal liver function tests (ALT)
• All with a pattern consistent with acute viral hepatitis;
6 Hepatitis B-Antenatal Screening Algorithms and Reporting
7. ACUTE HEPATITIS B IN ENGLAND
• Cases classified as acute viral hepatitis B by the local PHE Centre or the
Specialist Virology Centres and/or with a documented positive anti-HBc IgM
were classified as acute cases;
• Liver function test results may not be available to PHE;
• Cases classified as acute viral hepatitis B by the PHE Centre but without
anti-HBc IgM test results, or not classified but with a positive anti-HBc IgM
reported were assumed to be probable acute hepatitis B cases;
• Cases classified as chronic infections or those not classified where anti-HBc
IgM was negative or equivocal were assumed to be chronic infections;
7 Hepatitis B-Antenatal Screening Algorithms and Reporting
8. ACUTE HEPATITIS B IN ENGLAND
8 Hepatitis B-Antenatal Screening Algorithms and Reporting
PHE 2018
9. EPIDEMIOLOGY OF HBV IN ENGLAND
• A total of 9,774 confirmed hepatitis B infections were reported from Specialist
Virology Laboratories in England in 2017 (PHE 2018);
• Out of those, a total of 445 (4.5%) were acute or probable acute cases of
hepatitis B;
• This gave an annual incidence of 0.8 per 100,000 populations;
• London is still the region with the highest incidence (1.43 per 100,000);
• The highest increase in incidence was reported from West Midlands (from
0.50 to 0.82 per 100,000 in 2016 and 2017 respectively) and South East
(from 0.49 to 0.68 per 100,000);
• The largest decrease was reported from North West (from 1.02 to 0.52 per
100,000 in 2016 and 2017 respectively) and London (from 1.70 to 1.43 per
100,000 in 2016 and 2017 respectively).
9 Hepatitis B-Antenatal Screening Algorithms and Reporting
10. EPIDEMIOLOGY OF HBV IN ENGLAND
• The majority of HBV cases in 2017 were in men (70.4%) with overall
incidence of 1.14 per 100,000;
• The corresponding incidence in women in 2017 was 0.47 per 100,000;
• Only 68 cases (15.3%) of the total acute or probable acute hepatitis B
cases had their ethnicity recorded:
1. 67% White;
2. 14.7% Black British;
3. 8.8% Asian British;
• The commonest reported risk attributed was heterosexual exposure,
implicated as the probable route of exposure in 54.8% of cases;
10 Hepatitis B-Antenatal Screening Algorithms and Reporting
12. DIAGNOSIS OF HBV INFECTION:
SEROLOGICAL MARKERS
A battery of serological tests are used for the diagnosis of hepatitis B
infection:
1) HBsAg=used as a general marker of infection;
2) Anti-HBc IgM=marker of acute infection and flare-up;
3) Anti-HBc= marker of current or past infection;
4) HBeAg= indicates active replication of virus and marks high infectivity;
5) Anti-HBe=generally coincides with significant reduction in replication unless
the virus develops mutations;
6) HBV DNA =measures virus load and indicates the level of replication.
Used in follow-ups and in patients who are on treatment.
12 Hepatitis B-Antenatal Screening Algorithms and Reporting
13. HBsAg assay
(min. sensitivity level
0.05 IU/mL)
Detected Not detected
Perform
neutralisation /
alternative assay
Detected Not detected
Test other markers
Test Anti-HBc (total)
Detected Not detected
Test other markers
REPORT
Likely non-specific
reactivity. Please
send another
sample.
REPORT
Hepatitis B surface
antigen not
detected
See reporting hepatitis B screening test
results table
Day 1 – receipt of
sample in the
laboratory
Day 8 – reporting
of screening
results
13 Hepatitis B-Antenatal Screening Algorithms and Reporting
HEPATITIS B TESTING ALGORITHM
14. CLINICAL COMMENTS FOR REPORTING HBV
SCREENING TESTS RESULTS
HBsAg
screen
HBsAg
neut*
Anti-HBc
total
Anti-HBc
IgM
HBeAg Anti-HBe Clinical Comments for Reports
1 Not
detected Not necessary
• Hepatitis B surface antigen not
detected
• No evidence of Hepatitis B infection
2 Det Det Ndet Ndet Det
or Ndet
Ndet • Hepatitis B surface antigen
detected:
screen positive.
• Suggests early acute infection with
hepatitis B and high risk of
transmission to the baby.
• Please send an EDTA blood sample
for HBV DNA by PCR.
• Refer rapidly to appropriate specialist.
• Indicates baby will require vaccine
plus HBIG
14 Hepatitis B-Antenatal Screening Algorithms and Reporting
15. CLINICAL COMMENTS FOR REPORTING
HBV SCREENING TESTS RESULTS
15 Hepatitis B-Antenatal Screening Algorithms and Reporting
HBsAg
screen
HBsAg
neut*
Anti-HBc
total
Anti-HBc
IgM
HBeAg Anti-HBe Clinical Comments for Reports
3 Det Det Det Det
(High)
Det/
Ndet
Det/
Ndet
• Hepatitis B surface antigen detected:
screen positive
• Confirms early acute infection with hepatitis B and
high risk of transmission to the baby
• Refer rapidly to an appropriate specialist
• Indicates baby will require vaccine plus HBIG
4 Det Det Det Det
(Low)
Det Ndet • Hepatitis B surface antigen detected:
screen positive
• Consistent with a flare in chronic infection with
hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine and HBIG
5 Det Det Det Det
(Low)
Ndet Det • Hepatitis B surface antigen detected:
screen positive
• Consistent with a flare in chronic infection with
hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine.
• HBV DNA quantification should be undertaken. If
HBV DNA level is equal or above 1x106 IU/ml baby
should receive HBIG in addition to vaccine.
• If low birth weight of < 1.5 kg baby will require HBIG in
addition to vaccine.
16. THE SIGNIFICANCE OF HIGHAND LOW
ANTI-HBc IgM
• High level of detectable Anti-HBc IgM is a marker of acute HBV infection (in
addition to raised ALT, high HBV DNA etc);
• Flare-ups of chronic HBV infection are common and may be confused with
acute infection;
• Flare-ups are usually associated with low level of detectable Anti-HBc IgM;
• The differentiation between these two conditions is important because of
the different strategy in the management of an antenatal woman and her
newborn;
• Different assays in use in the UK have different cut-off values, their
interpretation requires opinion of a trained Virologists;
• History of HBV infection, if available, is helpful;
• Results of biochemistry: ALT, bilirubin, AST and INR should be taken into
consideration.
16 Hepatitis B-Antenatal Screening Algorithms and Reporting
17. THE SIGNIFICANCE OF HIGHAND LOW
ANTI-HBc IgM
• Anti-HBc IgM is indirect marker of HBV virus replication, reflecting the host’s
response to HBcAg;
• Local Anti-HBc assay (VIDAS):
• In acute hepatitis, Anti-HBc titres are generally high (>100 PEI/ml);
• High level progressively decrease over 6 months;
• In cases of chronic hepatitis, appearance of Anti-HBc IgM reflects hepatic
cytolysis (active phase of the disease).
17 Hepatitis B-Antenatal Screening Algorithms and Reporting
Test value (PEI/ml) Interpretation
<5 Not detected
>5 and <10 equivocal
>10 detected
18. CLINICAL COMMENTS FOR REPORTING
HBV SCREENING TESTS RESULTS
18 Hepatitis B-Antenatal Screening Algorithms and Reporting
HBsAg
screen
HBsAg
neut*
Anti-HBc
total
Anti-HBc
IgM
HBeAg Anti-HBe Clinical Comments for Reports
3 Det Det Det Det
(High)
Det/
Ndet
Det/
Ndet
• Hepatitis B surface antigen detected:
screen positive
• Confirms early acute infection with hepatitis B and
high risk of transmission to the baby
• Refer rapidly to an appropriate specialist
• Indicates baby will require vaccine plus HBIG
4 Det Det Det Det
(Low)
Det Ndet • Hepatitis B surface antigen detected:
screen positive
• Consistent with a flare in chronic infection with
hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine and HBIG
5 Det Det Det Det
(Low)
Ndet Det • Hepatitis B surface antigen detected:
screen positive
• Consistent with a flare in chronic infection with
hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine.
• HBV DNA quantification should be undertaken. If
HBV DNA level is equal or above 1x106 IU/ml baby
should receive HBIG in addition to vaccine.
• If low birth weight of < 1.5 kg baby will require HBIG in
addition to vaccine.
19. CLINICAL COMMENTS FOR REPORTING HBV
SCREENING TESTS RESULTS
HBsAg
screen
HBsAg
neut*
Anti-HBc
total
Anti-
HBc
IgM
HBeAg
Anti-
HBe
Clinical Comments for Reports
6 Det Det Det Ndet Ndet Det • Hepatitis B surface antigen detected: screen
positive
• Consistent with chronic hepatitis B infection.
• Refer to an appropriate specialist.
• Indicates baby will require vaccine.
• If low birth weight of < 1.5 kg baby will require HBIG in
addition to vaccine.
• HBV DNA quantification should be undertaken.
• If HBV DNA level is equal or above 1x106 IU/ml baby
should also receive HBIG
7 Det Det Det Ndet Det Det • Hepatitis B surface antigen detected:
screen positive
• If HBeAg and Anti-HBe are both positive, this is
consistent with chronic infection with hepatitis B
• Refer to an appropriate specialist.
• Baby will require vaccine and HBIG.
8 Det Det Det Ndet Ndet Ndet • Hepatitis B surface antigen detected: screen
positive
• If HBeAg and Anti-HBe are both negative, this is
consistent with chronic infection with hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine and HBIG
9 Det Det Det Ndet Det Ndet • Hepatitis B surface antigen detected:
screen positive
• Consistent with chronic infection with
hepatitis B.
• Refer to an appropriate specialist.
• Baby will require vaccine and HBIG
19 Hepatitis B-Antenatal Screening Algorithms and Reporting
20. GREEN BOOK CHAPTER 18 V3 2018
20 Hepatitis B-Antenatal Screening Algorithms and Reporting
21. ACKNOWLEDGEMENT
a. Samreen Ijaz, PHE;
b. Judith Timms, IDPS Laboratory Advisor;
c. Nadia Permalloo, PHE;
d. Sonia Segalini, PHE;
e. Sharon Webb;
f. IDPS Laboratory Task Group
21 Hepatitis B-Antenatal Screening Algorithms and Reporting