Instruction for safety...

                                        Hepatitis – B

* How will you manage a patient of HBV infections?

Management:

History:

-                           Blood transfusion

-                             I/V drug abuse

-                             Jaundice of the patient’s sexual partner

-                            Sexual exposer

Clinical features:

a.                          Features of acute hepatitis

b.      Chronic hepatitis: - May be asymptomatic

-                                                                     Mild, slowly progressive hepatitis

Investigations:

1.                             Liver function test:

        ü  Serum bilirubin – High

        ü  ALT/SGPT & AST/SGOT – High

        ü  Alkaline phosphatase – Slightly high

2.                           Viral markers:

         ü  HB_sAg, anti-HB_sAg antibody

         ü  HB_cAg, anti-HB_cAg antibody

         ü  HB_eAg, anti-HB_eAg antibody

3.       Viral load:

          HBV – DNA can be measured by polymerase chain reaction ( PCR ) in the blood

4.                           Ultrasonogram of hepatobiliary system

5.                            Liver biopsy: in chronic case

Treatment of HBV:

1.                                       Acute hepatitis B: Supporative care with monitoring for acute liver failure, which occurs in less then 1% of case

A.                                Supporative treatment:

ü  Bed rest

ü  Normal diet

ü  Adequate fluid and electrolyte balance

ü  Avoid some drugs, eg: sedative- narcotics, analgesic, tranquilizers & alcohol

ü  Follow up

ü  Immuno serum globulin can be effective in an outbreak of hepatitis

B.      Treatment of complications

2.                            Chronic hepatitis B:

·         Treatment are still limited, with no drug able to eradicate hepatitis B infection completely

·         The indication for treatment is a high viral load in the presence of active hepatitis, as demonstrateed by elevated serum transminases and/or histological evidence of inflammation

             Drugs can be used:

-                       Interferon – alpha

-                                      Lamivudin, 100mg/day orally

-                                  Adefovir

-                                  Entecavir (more effective than lamivudin)

-                                   Telbivudin

-                                        Tenofovir, 300mg/day

              Liver transplantation with prophylactic lamivudin & hepatitis – B immunuglobulins.

* Routes of transmission of HBV

1. Horizontal transmission (10%)

v  Injections drug use

v  Infectated unscreen blood products

v  Tattoos / acupuncture needles

v  Sexual ( homosexual & heterosexual )

2.Vertical transmission (90%)

v  HB_sAg-positive mother

* Prevention of HBV infection

1.  Recombinent hepatitis-B vaccine containing HB_sAg

2. Intramascular injection of hyperimmune serum should be given within 24 hours of

3. Neonates born to hepatitis-B infected mothers should be immunized at birth and given immunoglobulin

4. Other measures:

ü  All blood donars should be screened for HBV infection & blood positive HB_sAg should be rejected

ü  Adequate sterilization of all surgical instruments

ü  Use of barrier methods of contraceptive with an infected patient

ü  Not to share razors and tooth brushes
(REF: Devidson/medicine)