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    Chronic infection: Premature mortality from chronic liver disease: Average 60-90 days 5 yrs, 10% >=5 ys, 30%-50% 0.5%-1% 5yrs 5 years, 30%-90% >=5yr 5 year, 2%-10% 15%-25% Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms HBeAg anti-HBe Total anti-HBc Weeks after Exposure

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    Chronic infection: Premature mortality from chronic liver disease: Average 60-90 days 5 yrs, 10% >=5 ys, 30%-50% 0.5%-1% 5yrs 5 years, 30%-90% >=5yr 5 year, 2%-10% 15%-25% Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms HBeAg anti-HBe Total anti-HBc Weeks after Exposure

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    50 views15 pages

    Epatite B

    Uploaded by

    api-3704348
    Chronic infection: Premature mortality from chronic liver disease: Average 60-90 days 5 yrs, 10% >=5 ys, 30%-50% 0.5%-1% 5yrs 5 years, 30%-90% >=5yr 5 year, 2%-10% 15%-25% Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms HBeAg anti-HBe Total anti-HBc Weeks after Exposure

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    of 15

    Hepatitis B Virus

    Hepatitis B - Clinical Features


    • Incubation period: Average 60-90 days
    Range 45-180 days
    • Clinical illness (jaundice): <5 yrs, <10%
    ≥5 yrs, 30%-50%
    • Acute case-fatality rate: 0.5%-1%
    • Chronic infection: <5 yrs, 30%-90%
    ≥5 yrs, 2%-10%
    • Premature mortality from
    chronic liver disease: 15%-25%
    Acute Hepatitis B Virus Infection with Recovery
    Typical Serologic Course
    Symptoms
    HBeAg anti-HBe

    Total anti-HBc
    Titer

    HBsAg IgM anti-HBc anti-HBs

    0 4 8 12 16 20 24 28 32 36 52 100
    Weeks after Exposure
    Progression to Chronic Hepatitis B Virus Infection
    Typical Serologic Course
    Acute Chronic
    (6 months) (Years)
    HBeAg anti-HBe
    HBsAg
    Total anti-HBc

    Titer

    IgM anti-HBc

    0 4 8 12 16 20 24 28 32 36 52 Years
    Weeks after Exposure
    Rate of Reported Hepatitis B by Age Group
    25 United States, 1990
    100,000)

    20
    (per 100,000)

    15
    Rate (per
    Rate

    10

    0
    0-14 15-19 20-29 30-39 40+
    Age Group (Years)
    Source: CDC Viral Hepatitis Surveillance Program
    Age at Aquisition of Acute and Chronic HBV Infection
    United States, 1989 Estimates

    (4% ) Perinatal (24%)


    (4%) Children (12%)
    (1-10 yrs) Adult
    Adult
    (8%) Adolescent (6%) (59%)
    (83%)

    Acute HBV Infections Chronic HBV Infections


    Outcome of Hepatitis B Virus Infection
    100 by Age at Infection 100

    Symptomatic Infection (%)


    80 80
    Chronic Infection

    60 60
    Chronic Infection

    40 40
    (%)

    20 20

    Symptomatic Infection
    0 0
    Birth 1-6 months 7-12 months 1-4 years Older Children
    and Adults
    Age at Infection
    Global Patterns of Chronic HBV Infection

    • High (≥8%): 45% of global population


    – lifetime risk of infection >60%
    – early childhood infections common
    • Intermediate (2%-7%): 43% of global population
    – lifetime risk of infection 20%-60%
    – infections occur in all age groups
    • Low (<2%): 12% of global population
    – lifetime risk of infection <20%
    – most infections occur in adult risk groups
    Geographic Distribution of Chronic HBV Infection

    HBsAg Prevalence
    ≥8% - High
    2-7% - Intermediate
    <2% - Low
    Concentration of Hepatitis B Virus
    in Various Body Fluids

    Low/Not
    High Moderate Detectable

    blood semen urine


    serum vaginal fluid feces
    wound exudates saliva sweat
    tears
    breastmilk
    Hepatitis B Virus
    Modes of Transmission

    • Sexual
    • Parenteral
    • Perinatal
    Risk Factors for Acute Hepatitis B
    United States, 1992-1993
    Heterosexual*
    (41%)

    Injecting
    Drug Use
    (15%)

    Homosexual Activity (9%)


    Household Contact (2%)
    Health Care Employment (1%)

    Unknown (31%)
    Other (1%)

    * Includes sexual contact with acute cases, carriers, and multip le partners.
    Source: CDC Sentinel Counties Study of Viral Hepatitis
    Elimination of Hepatitis B Virus Transmission
    United States

    Objectives
    • Prevent chronic HBV Infection
    • Prevent chronic liver disease
    • Prevent primary hepatocellular carcinoma
    • Prevent acute symptomatic HBV infection
    Elimination of Hepatitis B Virus Transmission
    United States
    Strategy
    • Prevent perinatal HBV transmission
    • Routine vaccination of all infants
    • Vaccination of children in high-risk groups
    • Vaccination of adolescents
    – all unvaccinated children at 11-12 years of age
    – “high-risk” adolescents at all ages
    • Vaccination of adults in high-risk groups
    Estimated Incidence of Acute Hepatitis B
    United States, 1978-1995
    80 HBsAg screening
    of pregnant women Infant
    Cases per 100,000 Population

    Vaccine recommended immunization


    70 licensed recommended

    60
    OSHA Rule
    50 enacted
    Adolescent
    40 immunization
    recommended
    30

    20

    10
    Decline among
    homosexual
    men & HCWs
    Decline among
    injecting
    drug users
    *
    0
    78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95

    * Provisional date Year

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