Hepatitis B

Question 1

What is the first marker of Hepatitis B infection?

Answer 1

surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs (antibodies)

Question 2

What results of the blood test will imply acute Hepatitis B infection?

Answer 2

Presence of HBsAg antigen present in the first 1 - 6 months

Question 3

How is chronic hepatitis B infection diagnosed?

Answer 3

The presence of HBsAg antigen for more than 6 months

Question 4

What does the presence of Anti-HBsAG imply?

Answer 4

1. Implies immunity from either exposure or immunity 2. Negative in chronic disease

Question 5

What does the presence of Anti-HBeAg imply?

Answer 5

HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity

Question 6

What does the presence of Anti-HBcAg imply?

Answer 6

1. Implies previous (or current) infection so exposure from infection and not immunisation. 2. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. 3. IgG anti-HBc persists

Question 7

What antibodies will be present in the case of previous immunisation?

Answer 7

anti-HBs positive, all others negative

Question 8

What antibodies will be present in the case of previous hepatitis B infection (> 6 months ago), not a carrier?

Answer 8

anti-HBc positive, HBsAg negative

Question 9

What antibodies will be present in the case of previous hepatitis B infection and now a carrier?

Answer 9

anti-HBc positive, HBsAg positive

Question 10

How is Hepatitis B spread?

Answer 10

is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child.

Question 11

How long is the incubation period for Hepatitis B?

Answer 11

1 - 6 months incubation period

Question 12

Name 3 symptoms of Hepatitis B infection?

Answer 12

1. Fever 2. Jaundice 3. Elevated liver transaminases

Question 13

Name 3 complications of Hepatitis B infection?

Answer 13

1. chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy 2. fulminant liver failure (1%) 3. hepatocellular carcinoma

Question 14

Why is it important to screen those with a hepatitis B infection?

Answer 14

As chronic hepatitis B is often asymptomatic or only produces general malaise symptoms

Question 15

Name 6 groups of people at risk of Hepatitis B infection?

Answer 15

1. Household contacts of infected persons 2. Sexual contacts of infected persons 3. IV drug users 4. Those with multiple sexual partners 5. Those with a history of sexually transmitted disease 6. Homosexual men 7. Inmates of correctional facilities 8. Individuals with chronically elevated ALT/AST levels 9. People infected with HIV or HCV 10. Renal dialysis patients 11. Pregnant women

Question 16

When are children vaccinated against Hepatitis B?

Answer 16

Vaccinated at 2, 3 and 4 months of age

Question 17

How is immunity against Hepatitis B tested for in people with occupation exposure?

Answer 17

1. Anti HBs levels should be checked 1 - 4 months after primary immunisation

Question 18

How are anti - HsB levels interpreted in people being tested 4 months after primary immunisation due to occupational exposure?

Answer 18

> 100 Indicates adequate response, no further testing required. Should still receive booster at 5 years 10 - 100 Suboptimal response - one additional vaccine dose should be given. If immunocompetent no further testing is required < 10 Non-responder. Test for current or past infection. Give further vaccine course (i.e. 3 doses again) with testing following. If still fails to respond then HBIG would be required for protection if exposed to the virus

Question 19

What factors effect disease course?

Answer 19

1. Gender 2. Age at infection 3. Hepatitis B viral load 4. Duration of infection

Question 20

How is Hepatitis B managed?

Answer 20

pegylated interferon-alpha used to be the only treatment available. It reduces viral replication in up to 30% of chronic carriers.

Question 21

Can hepatitis B be transmitted by breast feeding?

Answer 21

No, it can’t unlike HIV