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home - Liver - Hepatitis B - Hepatitis B Epidemiology Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Also...

Knowledge


Identifies patients with acute hepatitis B and can a rtain the
severity of their illness

Defines the different phases of chronic hepatitis B infection with a
clear understanding of serological results

Appreciates risks of transmission to close contacts
Has awareness of indications for therapy in both HBeAg positive and
negative hepatitis and the potential influence of genotype on choice of
therapy

Identifies patients where prophylaxis is required to prevent
reactivation and vertical transmission

Can determine an appropriate surveillance programme for those
patients with varices and/or hepatocellular carcinoma

Identifies patients who are appropriate candidates for liver transplant


Skills
Demonstrates ability to take a relevant history perform examination
and organise appropriate investigations

Able to advise risks of viral transmission
Interprets results of blood tests for hepatitis B antigen and antibody
Appreciates when liver biopsy is appropriate
Be able to select the most appropriate treatment and how to monitor
patient response

Able to select appropriate imaging techniques for evaluation of
abnormal results
Behaviours
Appreciates the cultural differences in the ethnic populations infected
and the influence this may have on screening


Provides advice and education to families and shows appreciation of
the potential difficulties that may arise

Understands the importance of cooperation with virologists and staff
in other clinical laboratories

Hepatitis B Epidemiology

Overall epidemiologyWorldwide prevalence is related to the age at infection-perinatal infection more likely to confer chronicity. HBeAg +ve HBeAg -ve Infection rate of 32% Epidemiology of Hepatitis B Organ transplantation —Organ donors are routinely screened for HBsAg.Transmission of HBV infection has been reported after transplantation of extrahe-patic organs, such as kidneys and even cornea, from HBsAg positive donors. Nosocomial infection —Transmission from a needlestick was unlikely when serum HBV DNA is below 10(7) genome equivalents/mL .In UK cant work on exposure prone procedures if HBeAg negative but with HBV DNA > 1000 If <1000, need to be re-tested annually Percutaneous inoculation —IVDU accounts for 16 % of new infections. Can also get it via razors etc Sexual transmission —The major mode of transmissionSafe sex and vaccination of monogamous partners. Transfusion —Screen with both HBsAg and anti-HBc (hepatitis B core antibody- to detect donors who are in the window phase during recovery from acute hepatitis B) Vertical transmission in 39 % of infants of highly viremic mothers despite postnatal vaccination.Some evidence for 4-12 weeks of lamivudine in the 3rd trimester. Infection rate of 90% (at or after birth- C- section does not prevent maternal-infant transmission. Breast-feeding isn’t transmission risk but HBV DNA can be found in colostrum Routes of Transmission For adult aquisition most common risk factors:Sexual exposure (sexual contact with a person known to have hepatitis B, multiple sex partners, and men having sex with men).IVDU. Written by Dr Sebastian Zeki >8%- High2-8%- Intermediate<2%- Low

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