Hepatitis B virus (HBV) infection is a major global public health problem, with an estimated 400-500 million people chronically infected worldwide. Each year there are around 10 million new cases and 1.3 million deaths, making HBV the 5th most common cause of cancer and 10th leading cause of death globally. India has an intermediate prevalence of HBV infection at around 3% of the population, or approximately 37 million carriers, and contributes significantly to the global disease burden.

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2. Hepatitis B virus (HBV)
infection is a global public
health problem.???
Yes ??
No ??
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3. Prevalence ? 400-500 million
Incidence ? 10 million
Mortality ? 1.3 million
5th cause of cancer
10th cause of death
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4. As per recent estimates, 10 million new
cases occur every year and nearly 400-
500 millions of people are chronic
carriers all over the world.
HBV infection is the cause of 5th most
common cancer and 10th leading cause
of death worldwide.
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5. •It is the cause of 30% cases of cirrhosis
and 60 -80% of all primary cancers in
the liver.
•At any point in time, nearly 30 % of the
world’s population shows serological
evidence of current or past infection
with HBV.
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6. •Prevalence of HBV infection varies
greatly in different parts of the world.
•The World Health Organization (WHO)
has classified HBV prevalence into high
(>8%), intermediate (2- 7%) and low
endemic <2 % areas
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7. •India falls in the intermediate range with an
estimated 1,00,000 deaths per year.
•India has approximately HBV carrier rate of 3.0%
with a high prevalence rate in the tribal population.
•With a population of more than 1.25
billion, India has more than 37 million HBV carriers
and contributes a large proportion of this HBV
burden.
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DEFINITION
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Hepatitis B is a viral infection that
infects the liver . The virus is
transmitted through contact with the
blood or other body fluids of an
infected person and can cause both
acute and chronic disease.
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10. GLOBAL BURDEN
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11. •It is estimated that about 2.0 billion of
the world's population has been
exposed to HBV, of whom 400-500
million harbour it chronically.
•In 2017, hepatitis B resulted in 1.3 million
deaths, mostly from complications
(including cirrhosis and hepato-cellular
carcinoma).
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GEOGRAPHICAL
DISTRIBUTION
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Hepatitis B prevalence is highest
in the WHO Western Pacific
Region and the WHO African
Region, where 6.2% and 6.1%
respectively of the adult
population is infected.
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In the WHO Eastern Mediterranean
Region, the WHO South-East Asia
Region and the WHO European
Region, an estimated 3.3%, 2.0%
and 1.6%% of the general
population is infected.
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16. INDIAN SCENARIO
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17. PREVALENCE
India falls in the intermediate endemicity
zone (prevalence of 2–7%, with an average
of 3- 4%), with a disease burden of about
50 million .
About 1 to 2% of those infected with
hepatitis B will die i.e. > 1.0 lakh people
each year..
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18. However, there is a wide geographic
variation in its prevalence – being
the highest in Tamil Nadu ,
Andaman and Arunachal Pradesh,
while lowest is from northern states i.e.
Punjab and Haryana
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19. EPIDEMIOLOGICAL
DETERMINANTS
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AGENT FACTOR

21. Hepatitis B Virus (HBV)
It is a complex, 42 nm double-shelled DNA virus originally
known as ―Dane Particle. It replicates in liver cell.
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22. HBV occurs in 3 morphology form in serum:
i. Small spherical particles with an average
Diameter of - 22nm.
ii.Filamentous or Tubules of varying length &
of - 22 nm diameter.
iii.Dane particle - 42 nm
•Out of 3 morphology forms, only the Dane
particle is considered infectious, other
circulating morphology forms are not infectious.
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23. Dane particle
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The virus is highly contagious and can
circulate, with 108–1010 infectious
particles/mL of blood.
Moreover, nosocomial transmissions of HBV
with an increasing number of outbreaks
have been reported worldwide over the
past few years.
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The hepatitis B virus can survive outside the body
for at least 7 days. During this time, the virus can
still cause infection if it enters the body of a
person who is not protected by the vaccine.
The Hepatitis virus is extremely hearty. It is able to
survive the body's highly acidic digestive tract and
can live outside the body for months.
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High temperatures, such as boiling
or cooking food or liquids for at least
one (1) minute at 185°F (85°C) will
kill the virus, although freezing
temperatures do not.

27. HOST FACTORS
(a) AGE : The outcomes of HBV infection are age-
dependent. Acute hepatitis B occurs in
approximately 1 per cent of perinatal, 10 per cent of
early childhood (1-5 years of age), and 30 per cent
of late (> 5 years age) HBV infections.
(b) Mortality from fulminant hepatitis B is
approximately 70 per cent.
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28. (c) The development of chronic HBV
infection is inversely related to age and
occurs in approximately 80-90 per cent
of persons infected prenatally.
And in 30 per cent infected in early
childhood (less than 6 years of age)
and in 5 per cent infected after 6 years
of age .
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30. HEPATITIS–B AND HIV INFECTION:
It is estimated that 10 per cent of the 37 million
people infected with HIV worldwide are co- infected
with HBV.
Although HBV infection appears to have a minimal
effect on the progression of HIV, the presence of HIV
markedly increases the risk of developing HBV-
associated liver cirrhosis and hepatocellular
carcinoma.
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31. High Risk Group:
 People from endemicregions
 Babies of mothers with chronicHBV
 Intravenous drug abusers
 People with multiple sexpartners
 Hemophiliacs and other patients requiting bloodand
blood producttreatments
 Health care personnel who have contact with blood
 Patients who areimmunocompromised.
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32. RESERVOIR OF INFECTION:
-Men is the only reservoir of infection which can
be spread either from carriers or from cases.
INFECTIVE MATERIAL:
-Contaminated blood is the main source,-Virus
has been found in body secretion such as saliva,
vaginal secretion& Semen in infected material.
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33. PERSISTENT CARRIER STATE
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The persistent carrier state has been defined as
the presence of HBsAg (with or without
concurrent HBeAg) for more than 6 months.
Cases may range from in apparent to
symptomatic cases.

34. RESISTANCE:
Readily destroyed by sodium hypochlorite,
as is by heat sterilization in an autoclave
for 30-60 min.
INCUBATION PERIOD 45-180 days (usually
60-90 days)
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35. Mode of Transmission
Parenteral- IV drugabusers, health workers are at
increased risk.
Sexual- sex workers and homosexuals
Perinatal (Vertical) :mother (HBeAg+) →infant.
Mothers who are HBeAg positive are much more
likely to transmit . Perinatal transmission is the main
means of transmission.
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36. HUMORAL AND CELLULAR RESPONSES .
Hepatitis B virus has three distinct antigens - a surface
antigen, also known as "Australia antigen" {HBsAg), a core
antigen {HBcAg), and an "e" antigen (HBeAg).
They stimulate the production of corresponding
antibodies e.g., surface antibody (anti-HBs), core antibody
(anti-HBc) and "e" antibody (anti-HBe).
These antibodies and their antigens constitute very useful
markers.
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 HBsAg is the first serologic marker, developing
between 6 weeks and 6 months following
infection, but prior to onset of symptoms.
 Presence of HBsAg in serum may indicate acute
HBV infection, chronic HBV infection, or
asymptomatic carrier state.
 In acute infection, HBsAg usually disappears within
1 to 2 months after onset of symptoms.
 HBsAg persists in patients with chronic hepatitis.

38. •Antibody to HBsAg (Anti-HBs) becomes
detectable several weeks after HBsAg
has disappeared.
•The interval between disappearance of
HBsAg and appearance of anti-HBs is
known as the window period and may
be as long as 6 months.
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• Detection of anti-HBs usually indicates clinical
recovery and subsequent immunity to HBV.
• Anti-HBs may persist after resolution of the
infection.
• Therefore, the detection of anti-HBs does not
discriminate between current or previous
infection. Successful vaccination results in
detectable anti-HBs.

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HBeAg develops one week after HBsAg is detectable,
but before symptoms appear.
The presence of HBeAg correlates with the level of
infectivity; a patient is most likely to transmit the
virus when HBeAg is present.
HBeAg usually disappears about 3 weeks before
HBsAg disappears.
Persistence of HBeAg beyond 12 weeks usually
indicates progression to a chronic carrier state.

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Antibody to HBeAg (anti-HBE) is usually detectable
between 12 and 16 weeks, when HBeAg disappears.
When a patient is positive for HBsAg and anti-HBE,,
there is infectivity and a probable likelihood of
resolving the infection.
Anti-HBe may be detectable in a chronic carrier. The
presence of anti-HBe does not imply immunity to
HBV.

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Antibody to HBcAg (anti-HBc) appears during the
first few weeks after infection, shortly after the
onset of symptoms and rises to high levels during
convalescence.
IgM anti-HBc develops in the acute phase of HBV
infection, indicating an infection in the past 3 to 6
months. It is detectable during prodromal, acute,
and early convalescent phases

43. IgG anti-HBc develops in the late acute
phase of infection.
It is an accurate serological marker of
previous HBV infection, as it appears in all
patients infected with the hepatitis B virus
and may persist in individuals at low titer
long after HBV exposure.
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44. •In subclinical asymptomatic hepatitis B virus
infection, HBsAg and HBeAg are present for a
brief period or may not be detectable .
•However, this is followed by the appearance
of anti-HBc and anti-HBs.
•In these patients, detection of anti-HBc and
anti-HBs must be relied on as evidence of
previous HBV infection.
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45. •Chronic infection is defined as the absence
of concurrent hepatitis B core IgM antibody
(IgM anti-HBc) and by persistence of HBsAg
for at least 6 months.
•In chronic hepatitis B infection, HBsAg
appears during the incubation phase of the
disease and may persist for years and
possibly for life.
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46. concentration
HBsAg
Anti-HBc
Anti-HBs
Anti-HBe
8
HBeAg
12 16 20 24
Weeks post infection
28 32
Anti-HBc
IgM
36 40 44 52
Symptoms
ALT
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47. PREVENTION
Vaccination
- highly effective recombinant vaccines
Hepatitis B Immunoglobulin (HBIG) exposed within 48
hours of the incident/ neonates whose mothers are
HBsAg and HBeAg positive.
Other measures
-screeningof blooddonors, blood and body
fluid precautions.
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The HBIG should be given as soon as possible after an
accidental inoculation (ideally within 6 hours and
preferably not later than 48 hours). At the same time the
victim's blood is drawn for HBsAg testing.
The recommended dose is 0.05 to 0.07 ml/kg of body
weight ; two doses should be given 30 days apart HBIG
provides short-term passive protection whichlasts
approximately 3 months
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49. National Immunization Schedule
Vaccine When to Give Dose Route Site
Hepatitis B At birth or as
soon as
possible with
in 24 hours.
0.5 ml IM Antero lateral
side of mid
thigh
Hepatitis B
1,2,3
At 6, 10, 14
weeks
0.5 ml IM Antero lateral
side of mid
thigh
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50. Treatment
 Interferon Alfa (Intron A) Response
rate is 30 to 40%.
 Lamivudine (Epivir HBV) (relapse
,drug resistance)
 Adefovir dipivoxil (Hepsera)
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Find the Missing Millions

53. Thank You
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