Hepatitis B

Background

• Blood-borne virus
• Incubation period: 1-3 months
• Virus can cause acute, chronic, or asymptomatic infection

Clinical Features

• Nausea/vomiting
• RUQ pain
• Jaundice
• Fever

Differential Diagnosis

Acute hepatitis

• Viral hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
• Acute alcoholic hepatitis
• Acetaminophen toxicity
• Mushroom toxicity
  • Crotinarius mushrooms
  • Gyromitra mushrooms
  • Amanita mushrooms
• Ischemic hepatitis

Evaluation

• AST, ALT > 1000s
• Elevated bilirubin
• Elevated alk phophatase
• Elevated INR

Acute Hepatitis Panel

Anti-hepatitis A, IgM	Hepatitis B surface antigen	Anti-hepatitis B core, IgM	Anti-hepatitis C	Interpretation
Positive	Negative	Negative	Negative	Acute hepatitis A
Negative	Positive	Positive	Negative	Acute hepatitis B
Negative	Positive	Negative	Negative	Chronic hepatitis B infection
Negative	Negative	Positive	Negative	Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect
Negative	Negative	Negative	Positive	Acute or chronic hepatitis C; additional tests are required to make the determination

Management

• Supportive care for acute disease

Hepatitis B Post-Exposure Prophylaxis

Treatment is generally initiated after coordination with occupational health and infectious disease service and based the the exposed patient's vaccination history

Unvaccinated

• If the source is HBsAg(+) then give HBIG x1 and initiate HBV vaccine in two separate sites
• If source is HGsAG(-) then start the HBV vaccine series
• If source blood is unavailable and high risk then give HBIG x1 initiate the HBV series
  • If source blood is low risk and unavailable then begin HBV series

Previously vaccinated non responder (one series)

Non responder status is defined as anti-has <10mIU/mL

• If the source is HBsAg(+) then give HBIG x 1 and begin revaccination series
  • Can also opt to perform second HBIG administration in one month
• If source is HBsAg(-) then no treatment is needed
• If source blood is unavailable and high risk then treat as if HBsAg(+)

Previously vaccinated non responder (two series)

Non responder status is defined as anti-has <10mIU/mL

• If the source is HBsAg(+) then give HBIG x2 and no HBV series
• If source is HGsAG(-) then no treatment is needed
• If source blood is unavailable then initiate the HBV series

Treatment Dosing

No contraindications for pregnancy or breast feeding

• HBIG 0.06 mL/kg IM
• Vaccination series: HBV vaccine options:
  • Engerix-B 20mcg IM
  • Recombivax HB 10mcg IM

Disposition

• Consider admission for:
• INR >2, Bilirubin >30, hypoglycemia
• Any GI bleeding
• Intractable pain, inability to tolerate PO
• Significant comorbidity/immunocompromised or age >50 years

See Also

• Viral hepatitis
• Acute hepatitis
• Jaundice

External Links

• Antibiotics (By_Diagnosis)

References

Authors

Claire, Neil Young, Daniel Ostermayer, Ross Donaldson