Source: Deming, P. Viral Hepatitis. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7979809. Accessed May 31, 2012.
- 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
- HBV 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:
- Parenterally (injection
- Prophylaxis with:
- HBV vaccine for active
immunity (Table 1)
- HBV Ig for temporary passive immunity in postexposure cases
- Vaccine side effects include:
- Soreness at
- 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 |Favorite Table|Download (.pdf)
Table 1. Recommendations
for Hepatitis B Virus (HBV) Vaccination
|Adolescents, including all previously unvaccinated children <19 years old|
|All unvaccinated adults at risk for infection|
|All unvaccinated adults seeking vaccination (specific risk factor not required)|
|Men and women with history of other STI and persons with
history of multiple sex partners (>1 partner/6 months)|
|Men who have sex with men|
|Household contacts and sex partners of persons with chronic
HBV infection and healthcare and public safety workers with exposure
to blood in workplace|
|Clients and staff of institutions for developmentally disabled|
|International travelers to regions with high or intermediate
levels (HBsAg prevalence ≥2%) of endemic HBV infection|
|Recipients of clotting factor concentrates|
|STI clinic patients|
|HIV patient/HIV-testing patients|
|Drug abuse treatment and prevention clinic patients|
|Correctional facilities inmates|
|Chronic dialysis/ESRD patients|
|Persons with chronic liver disease|
- No risk factors identified in majority of acute infections.
- Sexual contact
- Multiple partners
- Men who have sex with men
- Known HBV-positive person
- Injection-drug users
- Household contact with HBV-positive person
- Incubation period
- 4–10 weeks
- Highly infective
- Usually asymptomatic
- Immunoactive (symptomatic) phase
- Marked increases in ALT
- Infants generally asymptomatic
- 85–95% of children ages 1–5 years
- Seroconversion to anti-hepatitis B core antigen (anti-HbcAg)
- Chronic HBV (Table 2) diagnosed when detect hepatitis
B surface antigen (HbsAg) and HbcAg and high serum titer
of HBV DNA for >6 months (Table 3).
- Age most predictive factor for developing chronic HBV.
- Perinatal infections almost always result in chronic HBV.
- Chronic HBV risk