Hepatitis b Presentation 66

HEPATITIS BIN PREGNANCYBy Dr. Marie Rose S. Yabut, MDFellow, Philippine Obstetrical & Gynecological SocietyChairman, Department of Obstetrics & GynecologyAmang Rodriguez Medical Center

What is Hepatitis B?CAUSED BY HEPATITIS B VIRUS (HBV)CAN LEAD TO LIVER CIRRHOSIS, LIVER FAILURE, LIVER CANCER (80%)LIVER CANCER IS THE 4TH LEADING CAUSE OF CANCER DEATH IN THE WORLD2ND LEADING CAUSE OF CANCER DEATH IN CHINAIN CALIFORNIA: 2ND LEADING CAUSE OF CANCER DEATHS AMONG CAMBODIAN and VIETNAMESE MEN, 4TH AMONG CHINESE and KOREAN MEN, 5TH AMONG FILIPINO MEN SILENT TRANSMISSION, SILENT PROGRESSION5% SURVIVAL RATEVACCINE PREVENTABLE CANCERThe FIRST ANTI-CANCER VACCINE = HEPATITIS B VACCINE (CDC)

GLOBAL INCIDENCEONE OF THE MOST COMMON INFECTIOUS DISEASES WORLDWIDERANKS BEHIND HIV AS THE 1OTH LEADING CAUSE OF DEATH WORLDWIDEONE THIRD OF THE WORLDS POPULATION BEEN INFECTED340-400M HAVE LIFELONG INFECTION

MORTALITYONE OUT OF FOUR CARRIERS WILL EVENTUALLY DIE OF LIVER FAILURE OR LIVER CANCER (UNTREATED/UNMONITORED)1M DIE YEARLY FROM CIRRHOSIS OR LIVER CANCERMOST ARE ASIAN

HBV & API ISLANDERSOf the 400M chronic carriers of HBV, 75% reside in AsiaIn the USA: 1 of 10 APIs chronically infected vs. 1 of 1000 in general population1 of 4 will die from liver cancer/failure, without treatment/monitoring

HBV TRANSMISSIONEXTREMELY VIRULENT VIRUS (100x MORE INFECTIOUS THAN HIV)SURVIVES OUTSIDE THE BODY UP TO 7 DAYS IN INFECTED BLOOD

HBV is transmitted through transfer of infected blood in the following ways: FROM MOTHER TO CHILD AT BIRTH (most common among APIs)CONTACT WITH INFECTED BLOOD (open wounds, blood transfusions, shared razors & toothbrushes)UNPROTECTED SEXSHARED NEEDLES (drug use, tattoos, piercings)REUSING NEEDLES

HBV is not transmitted through:CONTAMINATED FOODSALIVA, TEARS, SWEAT, URINE or STOOLCOUGHING or SNEEZINGSHARING FOOD or EATING UTENSILSKISSINGBREASTFEEDINGCASUAL CONTACT (such as kissing or hugging)

SYMPTOMS of HBV INFECTIONHepatitis B is a silent killer, it is asymptomatic, so many carriers feel perfectly normal.

SYMPTOMS OF HBV INFECTIONONLY 30% DEVELOP SYMPTOMSJAUNDICEFATIGUEABDOMINAL PAINLOSS OF APPETITE

MOST APIs ARE INFECTED AT BIRTH OR EARLY CHILDHOOD WHEN SYMPTOMS MAY NEVER DEVELOP.CHRONIC CARRIERS HAVE NO SYMPTOMS UNTIL CIRRHOSIS OR CANCER HAS DEVELOPEDABDOMINAL DISTENSION/PAINGI BLEEDINGFATIGUEEDEMAJAUNDICE

THREE POSSIBLE RESPONSES TO INFECTION

ACUTE HEPATITIS B WITH FULMINANT LIVER FAILUREACUTE HEPATITIS B WITH FULL RECOVERY and DEVELOPMENT of IMMUNITYCHRONIC INFECTION WITH HEPATITIS B

SPECIAL CONCERNS for INFANTS & APIsFOR INFANTS:Those infected as NEWBORNS have 90% chance of becoming carriers.Those infected during CHILDHOOD have 30% - 50% chance.FOR APIs:Prevention of perinatal transmission Screening is essential Sexually active adults should be vaccinated

DIAGNOSING HEPATITIS BBECAUSE OVER 10% OF THE ASIAN and PACIFIC ISLANDER COMMUNITY IS CHRONICALLY INFECTED WITH HEPATITIS B, ALL MEMBERS OF THE API COMMUNITY SHOULD BE SCREENED.

DIAGNOSING HEPATITIS BIDENTIFY CHRONIC CARRIERSHepatitis B surface antigen blood test(HBsAg):(+)= Hepatitis B carrier Has chronic infection(-) = Not a Hepatitis B carrier Does not have chronic Hepatitis B

CHECK FOR IMMUNITY AGAINST HBVHepatitis B surface antibody blood test (HBsAb or anti-HBs):(+) =Protected from hepatitis B infection Has immunity against HBV Vaccination & booster shots not needed(-) = Not protected from hepatitis B infectionIf negative for HBsAg, individual is not a carrier, and vaccination is needed for future protection

DIAGNOSING HEPATITIS BANOTHER TEST THAT MAY BE OF INTEREST:Hepatitis B core total antibody Blood Test (HBcAb or Anti-HBc):Main purpose is to indicate prior infection from hepatitis B (past or on-going). It does not indicate any protection from future infection.

Anti- HBc test result:

(+) =Indicates past or current infection with hepatitis B =Does not indicate protection from chronic hepatitis B(-) =Indicates that this patient has never been infected with HBV

HEPATITIS B TEST INTERPRETATIONHBsAg (+)chronic carrierAnti-HBs (-)

HBsAg (-)immune to HBVAnti-HBs (+)

HBsAg (-)needs vaccinationAnti-HBs (-)

IMPORTANT STEPS for PREGNANT MOTHERS and their NEWBORNSEXPECTING MOTHERS SHOULD BE TESTED FOR HBsAg BECAUSE PERINATAL TRANSMISSION AT BIRTH CAN OCCUR.ALL NEWBORNS SHOULD BE VACCINATED AND RECEIVE THE FIRST DOSE OF THE HEPATITIS B VACCINE SERIES WITHIN 12-24 HRS OF BIRTH.

INFANTS BORN TO HEALTHY, HBsAg-NEGATIVE MOTHERS SHOULD BE VACCINATED BEFORE LEAVING THE HOSPITAL. SUBSEQUENT DOSES: 1ST DOSE:within 12 hrs of birth2nd DOSE:Age 1 2 months3rd DOSE:Age 6 months

INFANTS BORN TO HBsAg-POSITIVE MOTHERS SHOULD GET THE HEPATITIS B IMMUNE GLOBULIN (HBIg) IN ADDITION TO TO RECEIVING THE FIRST SHOT OF THE HEPATITIS B VACCINE SERIES WITHIN 12 HOURS OF BIRTH.1ST DOSE/HBIg: Within 12 hrs of birth (shots can be given at the same time)2nd DOSE: Age 1 2 months3rd DOSE: Age 6 monthsTesting for HBsAg/Anti-HBs: Age 915 months

INFANTS BORN TO MOTHERS WHOSE HBsAg STATUS IS UNKNOWN:MOTHERS TESTED FOR HBsAg. IF POSITIVE, INFANT SHOULD RECEIVE HBIg AS SOON AS POSSIBLE, BEFORE AGE 1 WEEK.1ST DOSE:Within 12 hours of birthIf mother is HBsAg+, HBIg dose within first week after birth2ND DOSE:Age 1 -2 months3RD DOSE:Age 6 monthsIf mother is HBsAg+, TESTING FOR HBsAg/ Anti-HBs at Age 9 15 months

THANK YOU!!!

WHAT IS HEPATITIS B?

> a disease caused by infection with the hepatitis B virus (HBV)> can lead to cirrhosis of the liver, liver failure, liver cancer> one of the most common infectious diseases worlwide> ranks behind HIV as the 1oth leading cause of death