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Disease Name: Hepatitis B


Quick Links

Please review the Idaho Reportable Disease Rules (IDAPA 16.02.10) for the most up-to-date information.

The American Association for the Study of Liver Disease maintains Guidelines for Treatment of Chronic Hepatitis B in both adults and children here: http://www.aasld.org/sites/default/files/guideline_documents/hep28156.pdf.

Occupational Exposures

See the quick-reference table in Appendix D, from the 2013 CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr6210.pdf

Non-Occupational Exposures

 See the quick-reference table in Appendix E, from the ACIP Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults, Appendix B: Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection. MMWR Recommendations and Reports, 2006. Available http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf


Overview / Case Definition

Hepatitis B Acute

Clinical Description

An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) levels >100 IU/L.

A documented negative hepatitis B surface antigen (HBsAg) laboratory test result within 6 months prior to a positive test (either HBsAg, hepatitis B “e” antigen (HBeAg), or hepatitis B virus nucleic acid testing (HBV NAT) including genotype) result does not require an acute clinical presentation to meet the surveillance case definition.

Laboratory Criteria for Diagnosis

Hepatitis B Chronic

Clinical Description

No symptoms are required. Persons with chronic hepatitis B virus (HBV) infection may have no evidence of liver disease or may have a spectrum of disease ranging from chronic hepatitis to cirrhosis or liver cancer.

Laboratory Criteria for Diagnosis

AND a positive result on one of the following tests:

OR


Restrictions

None


Reporting

1 day

Reportable by Healthcare and Labs:

Reportable by Food Service Facility:

Suspect Reportable: Yes

Reporting Timeframe: 1 day



Diagnosis / Testing

Hepatitis B Serology Interpretation

 Tests

 Results

 Interpretation

 HBsAg

 anti-HBc

 anti-HBs

 Negative

 Negative

 Negative

 Susceptible

 HBsAg

 anti-HBc

 anti-HBs

 Negative

 Negative

 Positive with ≥10 mlU/ml 

 Immune due to vaccination

 HBsAg

 anti-HBc

 anti-HBs

 Negative

 Positive

 Positive

 Immune due to natural infection

 HBsAg

 anti-HBc

 IgM anti-HBc

 anti-HBs

 Positive

 Positive

 Positive

 Negative

 Acutely infected

 HBsAg

 anti-HBc

 IgM anti-HBc

 anti-HBs

 Positive

 Positive

 Negative

 Negative

 Chronically infected

 HBsAg

 anti-HBc

 anti-HBs

 Negative

 Positive

 Negative

 Four interpretations possible*

     
  1. May be recovering from acute HBV infection.
  2. May be distantly immune and test not sensitive enough to detect very low level of anti-HBs in serum.
  3. May be susceptible with a false positive anti-HBc.
  4. May be undetectable level of HBsAg present in the serum and the person is actually a carrier.

Infant Follow-up Testing: Test for HBsAg and antibody to HBsAg 1--2 months after completion of >3 doses of a licensed hepatitis B vaccine series (i.e., at age 9--18 months, generally at the next well-child visit). Testing should not be performed before age 9 months or within 4 weeks of the most recent vaccine dose.

Adult Follow-up Testing: All individuals who test positive for HBsAg should be re-tested in six months unless they are already known to be chronically infected. A chronic case is anyone who is HBsAg positive on two tests six months or more apart.


Treatment

Infants born to HBsAg-positive women should receive hepatitis B immune globulin (HBIG) and initiate the hepatitis B vaccine series within 12 hours of birth.  Both should be administered by IM injection. Hepatitis B vaccine should be administered concurrently with HBIG, but at a different site. Subsequent doses of vaccine should be administered at two months of age, and the third dose at six months of age according to the ACIP recommended schedule.  HBIG should be administered as soon as possible, but within 7 days of birth, although the efficacy of HBIG administered after 48 hours of age is not known. If HBIG has not been administered, it is important that the infant receive the second dose of hepatitis B vaccine at one month and not later than two months of age because of the high risk of infection. The last dose should be administered at age six months. If a four-dose schedule is used (only with infants born of HBsAg positive mothers who are <2000g), the second and third doses should be administered at 1 and 2–3 months of age, respectively, and the fourth dose at 6–7 months of chronologic age.


Additional Information

The American Association for the Study of Liver Disease maintains Guidelines for Treatment of Chronic Hepatitis B in both adults and children here: http://www.aasld.org/sites/default/files/guideline_documents/hep28156.pdf.

Occupational Exposures

See the quick-reference table in Appendix D, from the 2013 CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr6210.pdf

Non-Occupational Exposures

 See the quick-reference table in Appendix E, from the ACIP Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults, Appendix B: Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection. MMWR Recommendations and Reports, 2006. Available http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf


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