Hepatitis B is caused by the hepatitis B virus (HBV) and causes liver infection and inflammation. It is transmitted through contact with infected blood or bodily fluids. HBV can cause both acute and chronic infection. Chronic infection may lead to serious complications like cirrhosis and liver cancer. Hepatitis B is preventable through vaccination, which induces protective antibody levels in over 95% of people vaccinated.

1. HEPATITIS B
DR. MAHESWARI JAIKUMAR
maheswarijaikumar2103@gmail.com

2. HEPATITIS “B”
• Hepatitis is formerly known as
SERUM HEPATITIS is an acute
systemic infection with major
pathology in the liver, caused by
Hepatitis “B” Virus (HBV)

3. • It is clinically characterized by a
long incubation period (6 weeks
to 6 months) and a protracted
illness with a variety of
outcomes

4. • Persistent HBV infection may
cause progressive liver disease
including chronic active hepatitis
and hepatocellular carcinoma

5. • Hepatitis B virus can form a
dangerous alliance with
Hepatitis D virus and produce a
new form of virulent hepatitis
which is considered to be a wide
spread threat

6. AGENT
• HBV is a complex-nm, double-
shelled DN virus. It replicates in
the liver cells.

8. RESERVOIR OF INFECTION
• Man is the only reservoir of
infection. Hepatitis can spread
from either carriers or from case.

9. A PERSISTENT CARRIER
• A persistent carriers state is
defined as the presence of
HBAsg for more than six months.
Cases may range from
inapparent to symptomatic
cases.

10. INFECTIVE MATERIAL
• Contaminated blood is the main
source of infection (although the
virus is present in bodily
secretions such as saliva, vaginal
secretions, & semen)

11. RESISTANCE
• The virus is quite stable and
capable of for at least 7 days on
environment surfaces. It can be
readily destroyed by sodium
hypochlorite, heat sterilization in
an autoclave for 30-60 min

12. PERIOD OF COMMUNICABILITY
• The virus is present in the blood
during the incubation period and
during the acute phase of the
disease

13. COMMUNICABILITY

14. HOST FACTORS
• AGE : The outcome of HBV
infection are age dependent
• Acute hepatitis occurs
approximately 1 percent of
perinatal, 10% in early childhood
(1-5 yrs) 30% in late (>5 yrs)

15. HIGH RISK GROUP
• Surgeons
• Recipients of blood transfusion
• Health care personnel
• Laboratory personnel
• Homosexuals

16. • Commercial Sex Workers
• Percutaneous drug abusers
• Infants of HBV carrier mothers
• Recipients of solid organ
transplants
• Immuno compromised patients

17. • SEROLOGICAL SCREENING &
VACCINATION OF
HIGH RISK GROUP IS HIGHLY
RECOMMENDED

18. HBV & HIV INFECTION
• Presence of HIV markedly
increases the risk of developing
HBV associated liver cirrhosis
and hepatocellular carcinoma

19. HUMORAL & CELLULAR
RESPONSE
• Hepatitis B has three distinct
antigens
• 1.Surface antigen known as
Australian antigen (HBsAg)
• 2. Core antigen HBcAg
• 3.An “e” antigen HBeAg

20. • They stimulate the production of
corresponding antibodies
(ie:Surface antibody-anti HBs,
core antibody –anti-HBc and “e”
antibody –anti HBe

21. • These antibodies and their
antigens constitute very useful
markers of HBV infection
• Patients with HBV infection have
more than one markers

22. SEQUENCE OF HBV ANTIBODIES

23. HBsAg
• The appearance of HBsAg is the
first marker of infection
appearing before the evidence of
liver disease and persists
throughout clinical infection

24. Anti-HBs
• Specific antibody to HBsAg (anti-
HBs) appears in most individuals
after clearance of HBsAg and after
sucessful vaccination of HBsAg.
• Appearance of anti-HBs signals
recovery from HBV infection, non
infectivity & immunity

25. Anti-HBc
• IgM anti HBc appears shortly
after HBsAg is detected. Its
presence indicates diagnosis of
acute hepatitis B

26. HBeAg
• HBeAg is a soluble protein found
only in HBsAg positive
serum.HBeAg indicates viral
replication and infectivity.HBeAg
in serum beyond 3 months
indicates an increassed
likelihood of chronic hepatitis B
infection

28. HBV DNA
• The presence of HBV DNA in the
serum generally parallels the
presence of HBeAg. HBV DNA is
a sensitive and a precise marker
of viral replication and infectivity

30. HEPATITIS B-TIME LINE

31. MODE OF TRANSMISSION
• Parenteral route
• Perinatal transmission
• Sexual transmission
• Other routes

32. PARENTERAL TRANSMISSION
• Hepatitis B is essentially a blood-
borne infection. It is transmitted
by infected blood and blood
products through transfusions,
dialysis, contaminated syringes
and needles, ............cont...

33. • pricks of skin, handling of infected
blood, accidental inoculation of
minute quantities of blood such as
may occur during surgicakl and
dental procedures, immunization ,
traditional tatooing,ear piercing,
nose piercing ritual circumscission,
acupuncture etc

34. • Accidental percutaneous
inoculations by shared razors
and tooth brushes have been
implicated as occasional causes
of hepatitis B

35. PERINATAL TRANSMISSION
• Spread of infection from HBV
mothers to their babies is an
important factor for the high
prevalence of HBV infection

36. • Infection of the baby is usually
anicteric and is recognized by the
appearance of surface antigen
between 60-120 days after birth

37. SEXUAL TRANSMISSION
• The sexually promiscuous
particularly male homosexuals
are at very high risk of infection
with Hepatitis B

38. OTHER ROUTES
• Transmission from child-to-child
(called horizontal transmission)
is reported. Transmission occurs
when children play to gather or
share the same bed

39. INCUBATION PERIOD
• 30 to 180 days
• Lower doses of virus often
results in longer incubation
period. The average incubation
period is 75 days

41. CLINICAL FEATURE
• The symptoms and
manifestations of HBV infection
are similar to those of the other
types of viral hepatitis

42. • The clinical manifestations are
complicated by the carrier state
and by chronic liver disease
• Chronic liver disease may be severe
and may progress ro primary liver
cancer

43. CLINICAL COURSE

44. PROGRESSION OF DISEASE

46. PREVENTION & CONTAINMENT
• The following measures are
recommended. Administration
of Hepatitis B vaccine is found to
be highly efficient in the
prevention

47. HEPATITIS B VACCINE
• Plasma derived hepatitis vaccine
is currently in use. Hepatitis B
vaccine is available as
monovalent formulation or in
fixed combination with other
vaccines (including DPT, Hib,
Hepatitis A)

49. • When immunizing against HBV at
birth, only monovalent hepatitis B
vaccine should be used
• The dose for adult is 10-20
microgramsinitially (depending on
formulation) and again at 1 and 6
months

50. • Children under 10 yrs of age should
be given half of the adult dose at
the same time intervals
• For greatest reliability of
absorption the deltoid muscle is
preferred for injection

51. • For infants and children under 2
years, antero- lateral aspect of
thigh is used as vaccination site
• Intradermal administration is not
recommended as immune
response is less reliable
particularly in children

52. • The hepatitis B vaccine does not
interfere with immune response to
any other vaccine and vice versa
• The birth dose of hepatitis b can be
given safely together with BCG
vaccine, however the vaccines
should be given at different sites

53. • The complete vaccine series
induces protective antibody
levels in more than 95% of
infants, children and young
adults
• After the age of 40 yrs,
protection following primary
vaccine drops below 90%

54. • The duration of protection is at
least 15yrs based on scientific
evidence
• All children aged less than 18 yrs
and not previously vaccinated
should receive vaccination

55. • Hepatitis B vaccine is
contraindicated for individuals
with history of allergic reactions
to any of the vaccine
components
• Neither pregnancy nor lactation
is a contraindication for the
vaccine

56. STORAGE OF VACCINE
• The vaccine should be stored at
2-80 degree C
• Freezing must be avoided ass it
dissociates antigen from the
alum adjuvant

57. HEPATITIS “B” IMMUNOGLOBULIN
• For immediate protection HBIG
is used for those acutely exposed
to HBsAg positive blood (eg:
surgeons, nurses, lab workers)

58. • HBIG should be given
immediately following accidental
inoculation (ideally within 6 hrs
and preferably not later than 48
hrs)
• At the same time the victim’s
blood should be sent for testing

59. • If the test is negative vaccination
should be started immediately and
a full course be given
• If the test is postive for surface
antibody, no further action is
required

60. • The recommended dose is 0.05
to 0.07 ml/kg body weight. Two
doses should be given 30 days
apart.
• HBIG provides short term
passive protection which lasts
for approximately 3 months

61. PASSIVE ACTIVE IMMUNIZATION
• The simultaneous administration of
HBIG and hepatitis B vaccine is more
efficacious than HBIG alone

62. • The combined procedure is ideal
both for prophylaxis of persons
accidently exposed to hepatitis +ve
blood and for prevention of carrier
state in the newborn babies of
carrier mothers
• HBIG (0.05-0.07ml/kg) should be
administered as soon as possible
and within 24 hrs)

63. • If possible Hepatitis b vaccine 1
ml (20mcg/1ml) should be given
IM within 7 days of exposure and
second and third doses should
be given one and six months,
respectively after the first dose

64. OTHER MEASURES
• All blood should be screened for
HBV infection. Voluntary blood
donation should be encourages
as purchase blood has shown a
higher risk of post transfusion
hepatitis

65. • Health personnel should be
alerted to the importance of
adequate sterilization of all
instruments and to practice
hygienic measures

66. • Carriers should be educated
not to donate blood, not to
share razors or tooth brushes
and use barrier methods of
contraception

67. THANK YOU