Hepatits B Immunization Program For Staff, Malaysia

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HEPATITIS
&
PROGRAM IMUNISASI
HEPATITIS B
DI KALANGAN ANGGOTA KKM

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World Hepatitis Day
WHO organizes
World Hepatitis Day on July 28
every year to increase
awareness and understanding
of hepatitis.

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WHAT IS HEPATITIS B?
An infectious disease caused by H
epatitis B virus (HBV) which affects the liver.
Can cause lifelong infection (carrier).
Ultimately>>> liver cirrhosis/ liver cancer /
liver failure and death.
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Virus Hepatitis B
Can live in dried blood for 1/52
Incubation period : 30 - 180 days
( Average 75 days )
10% of the infected become carrier
70% carrier become chronic disease over the
years
30% will become cirrhosis/Carcinoma in ~ 30-40
yr
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Electron microscopy image
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HEPATITIS B VIRUS

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HEPATITIS B
> 90% of healthy adults who are infected
will recover and be completely rid of the
virus within six months.
Children < 6 years old who become
infected with Hep B virus are the most
likely to develop chronic infections.
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HEPATITIS B INFECTION
Initial - many have no symptoms
Some develop a rapid onset of sickness with
vomiting, jaundice, dark urine and
abdominal pain for a few weeks
May take 30 to 180 days for symptoms to begin.
In those with chronic disease, cirrhosis
and liver cancer may eventually develop.
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Normal liver
Hepatitis liver
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LAB. DIAGNOSIS OF HEP. B INFECTION
 Acute Hepatitis B infection
 Presence of HBsAg and IgM HBcAg.
 During initial phase of infection, patients are also
seropositive for HBeAg.
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LAB. DIAGNOSIS OF HEP. B INFECTION
Chronic Hepatitis B infection
 Persistence (>6 months) presence of HBsAg
( +/ - HBeAg).
 Persistence HBsAg is the principal marker of risk
for developing chronic liver disease and hepatocellullar
carcinoma (HCC) later in life.
 Presence of HBeAg indicates that the blood and body
fluids of the infected individual are highly contagious
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HEPATITIS B TRANSMISSION
Common routes of transmission :
Perinatal (from mother to baby at birth)
Early childhood infections (inapparent
infection through close interpersonal contact
with infected household contacts)
Unsafe injection practices (I.V. drug use)
Unprotected sexual contact

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HEPATITIS B INFECTION
Mechanism of Transmission
I.Blood
Sharps injury , including tattoo/ accupuncture
Any form of open wound contaminated by fresh / dried
blood
Eg . Sharing of towels, tooth brushes, shaving razors
IVDU
Dialysis
II.Body fluids
Semen, vaginal secretion
Delivery
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HEPATITIS B DI KALANGAN ANGGOTA KESIHATAN
Pendedahan kepada darah/cecair badan yang
tercemar
Kaitan pekerjaan:-
Pendedahan Kulit (Percutaneous )
 Bila kulit terluka / ditusuk oleh jarum / objek tajam eg scalpel
blade, trochar, bone fragment
Pendedahan mukokutanes (Mucocutaneous )
 Bila mata, permukaan dalam hidung/mulut atau kulit yang non-
intact terdedah kepada darah/cecair badan yg terkontaminasi spt
air ketuban dll.

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RISIKO TRANSMISI
Risiko bagi mendapat hepatitis klinikal
jika berlaku pendedahan kepada darah
mengandungi HBsAg positif dan HBeAg
positif adalah 22%-31% (CDC 2001)

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Langkah-langkah Pencegahan
Jangkitan Hepatitis B
Pencegahan pendedahan
Amalan standard precautions
Penggunaan alat perlindung diri (PPE)
Perlaksanaan cara kerja selamat (safer
procedures).
Pendidikan kesihatan dan latihan
Imunisasi Hepatitis B
Pengurusan pos-pendedahan
(Post-exposure prophylaxis)

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HIGH RISK GROUPS
Health care workers and laboratory personnel
Frequent blood transfusion recepient
I.v. drug users
Immunocompromised individuals
Infants of HBV carrier mothers
High risk sexual behaviour
Recipients of solid organ transplants

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Hepatitis B Vaccination programme
Protect healthcare workers as that there is NO
CURE for Hep B.
HOW?? The only way is by PREVENTION…
Individuals with complete Hep B
immunization and positive seroconversion
are protected from the risk of Hep B infection.
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What is Hep B vaccination?
Hep B vaccine contains Hepatitis B
surface antigen (HBsAg).
After vaccination, antibody (anti-
HBs) to HBsAg is established in the
bloodstream.
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Hep B Immunisation Programme
Hep B immunisation in Malaysia for
MOH staff started in 1989 using 3-
dose regime.
 MOH staff to be immunised with Hep B:
 Doctors/Dentists
 Nurses/Dental Nurses/MA
 PPK
 Lab technicians/Peg Sains
 Radiographers
 General Healthcare Workers
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OBJEKTIF PENGUKUHAN
PROGRAM
Memastikan anggota
Kementerian Kesihatan Malaysia
(KKM) yang berisiko untuk
mendapat jangkitan hepatitis B
dilindungi dengan pemberian
imunisasi hepatitis B.

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KUMPULAN
Kumpulan 1 :
Anggota KKM yang tidak pernah
mendapat imunisasi hepatitis B /
yang telah mendapat imunisasi
hepatitis B tetapi tidak lengkap.
Kumpulan 2 :
Anggota KKM yang telah menerima
imunisasi hepatitis B yang lengkap
sebelum ini tetapi tidak mengetahui
status imunisasi mereka.

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Hep B immunisation schedule
3 doses
1 dose of Hep B vaccine: 20µg/1ml
Method: IM (deltoid)
CI: Severe allergy to previous Hep B
vaccination.
Side effect: Pain at injection site, Fever
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Immunisation dose Schedule (month)
First 0
Second 1
Third 6

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Proses Pemberian Imunisasi Dan Saringan (Kumpulan 1)
∆
∆

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Proses Pemberian Imunisasi Dan Saringan (Kumpulan 2)
∆∆
∆∆

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Kepentingan Penentuan Seroconversion
Memberi peluang kepada non-
responder untuk mendapat imunisasi
ulangan
Tidak melengahkan pemberian HBIG
kepada non-responder jika berlaku
pendedahan eg NSI

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Failure To Develop Anti-Hbs
 Fail to respond (anti-Hbs Ab < 10 mIU/ml):
 Repeat course of 3 vaccinations
 Those who still do not respond to a 2nd course of
vaccination may respond to:
intradermal administration / high dose vaccine /
double dose of combined Hep. A and B vaccine.
 Those who still fail to respond will require Hep. B
immunoglobulin (HBIG) if exposed to Hep. B
virus.
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Failure To Develop Anti-Hbs
 Risk factors for poor responder:
 > 40 years
 overweight
 Smoking
 alcoholics
 immunosuppressed
 on renal dialysis
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Special Reminders!
Hep B immunisation to pregnant ladies
are not recommended but in case of high
risk or other special situations, the
physician could consider it justified.
 Abortions not required in unconcious
vaccination.
MOH staff advised not to get pregnant
until they received complete Hep B
immunisation.
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Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Type of
Hepatitis
A B C D E

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PROGRAM IMUNISASI HEPATITIS B
DI KALANGAN ANGGOTA KKM
SUMMARY

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QUESTION
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Q: RISIKO TRANSMISI
Risiko bagi mendapat hepatitis
klinikal jika berlaku
pendedahan kepada darah
mengandungi HBsAg positif
dan HBeAg positif adalah ?
(CDC 2001)

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A1 :RISIKO TRANSMISI
Risiko bagi mendapat hepatitis klinikal
jika berlaku pendedahan kepada darah
mengandungi HBsAg positif dan HBeAg
positif adalah 22%-31% (CDC 2001)

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Q2 : Virus HBV
? of the infected become carrier ?
70% carrier become chronic disease over
the years
30 % will become cirrhosis/Carcinoma in ~ 30-
40 yr
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A2 :Virus HBV
10% of the infected become carrier
70% carrier become chronic disease over the
years
30% will become cirrhosis/Carcinoma in ~ 30-40
yr
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Thank
you
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