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Source: Deming P. Viral hepatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed April 10, 2017.


  • Acute or chronic viral infection of liver.

  • Associated with development of:

    • Chronic cirrhosis.

    • Hepatocellular carcinoma (HCC)


  • DNA virus, Hepadnaviridae family.


  • Virion attaches to hepatocyte cell surface receptors and replicates.

  • HBV is not pathogenic to cells.

    • Immune response to virus cytotoxic to hepatocytes.

    • Destruction of heptocytes releases alanine transaminase (ALT), thus increasing levels.

  • Liver attempts to regenerate in environment of persistent inflammation, resulting in cirrhosis.

  • HCC develops after years of inflammatory processes provoked by ongoing HBV infection.


  • Infection transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids.1

    • Parenterally (injection drug use; needle sticks, or sharp instrument exposures)

    • Perinatally.

    • Sexually.


  • Prophylaxis with:

    • HBV vaccine for active immunity (Tables 1 and 2)

    • Hepatitis B immune globulin (HBIG) for temporary passive immunity in postexposure cases2

  • Common vaccine side effects include (lasting ~1–2 days)3

    • Soreness at injection site (3–29% most common)4

    • Fever (1–6% most common)4

    • Headache.

    • Fatigue.

    • Irritability.

  • Immunization goals:

    • Prevention of short-term viremia to limit:

      • Transmission of infection.

      • Clinical disease.

      • Chronic HBV infection.

TABLE 1.Recommendations for Hepatitis B Virus (HBV) Vaccination

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