1. What the Infection Preventionist Needs to Know About Hepatitis B
Marwan Sweedan, M.B.Ch.B, CIC, CTBS

2. Disclosure
No relevant conflicts of interest or financial relationship exist.

3. Overview and framework
What is hepatitis and what are the types of viral hepatitis.
Global distribution and challenges of viral hepatitis.
Hepatitis B overview.
Hepatitis B transmission and population at risk.
Hepatitis B screening and result interpretation.
Occupational health and vaccination.
Exposure management.
Framework
World Health Organization
Centers for Disease Control and Prevention
APIC text

4. Hepatitis

7. A global challenge Viral Hepatitis B & C
Affecting 325 Million people globally.
1.34 million death every year.
Root causes of liver cancer.
It has become a major killer due to lack of global attention. [1][2]
Global health sector strategy on viral hepatitis

8. Hepatitis B According to WHO:
HBV can cause an acute and chronic disease.
An estimated 257 million people are living with HBV.
In 2015, HBV resulted in 887,000 deaths. Mostly from complications.
HBV is an important occupational hazard for healthcare workers.
It can be prevented by currently available safe and effective vaccination.

9. Hepatitis B (continue)
Geographically; the percentage of general population infected are:
6.2% in the WHO Western Pacific Region.
6.1% in the WHO African Region.
3.3% in the WHO Eastern. Mediterranean Region.
2.0% in the WHO South East Asia Region.
1.6% in the WHO European Region.
0.7% in the WHO Americans region.

10. Hepatitis B (continue)
According to the CDC, in the USA:
In 2016, a total of 3,218 cases of acute HBV were reported to the CDC from 48 states.
The overall incidence rate for 2016 was 1.0 cases per 100,000 (After adjusting for under-ascertainment and under-reporting, an estimation 20,900 acute HBV cases occurred in 2016) [3]
The incident of acute HBV is declined from

11. Hepatitis B transmission
Hep.B virus can survive outside the body for at least 7 days.
Incubation period range days after exposure
(APIC text days)
Transmitted (exposed to blood and body fluids such as saliva, menstrual, vaginal and seminal fluids).
Needle sticks or sharp instrument exposure.
Contact with blood or open sores of an infected person.
Birth to an infected mother. (in highly epidemic areas)
Injection drug use that involves sharing needles, syringes, or drug-preparation equipment.
Sharing items such as razors or toothbrushes with an infected person.
Sex with an infected partner.

12. Hepatitis B transmission (continue)
Hep.B is not transmitted or spread through:
Food or water.
Sharing eating utensils.
Breastfeeding.
Hugging and kissing.
Hand holding.
Coughing or sneezing

13. Population at risk Health care and public safety workers.
Hemodialysis patients.
A child born to infected mothers.
Injectable drug users.
Sex partners of infected persons.
Homosexual men.
Household contacts of known persons with chronic HBV infection.

14. How to screen for HBV
Screening should be done so that persons can be classified into the appropriate hepatitis B category and properly recommended to receive vaccination, counseling, and linkage to care and treatment.
Screening should include testing for three HBV screening seromarkers:
HBsAg.
Antibody to HBsAg [anti-HBs].
Antibody to hepatitis B core antigen [anti-HBc])

15. HBV screening interpretation
CDC offers an online training that covers the serology of hepatitis B and other types of viral hepatitis, available at 
Interpretation of Hepatitis B serologic test results PDF file

16. HBV screening interpretation
HBsAG
Anti-HBs
HBeAg
Anti-HBe
Anti-HBc
Acute HBV +
IgM
Window
Chronic HBV High infectivity
IgG
Chronic HBV low infectivity
Recovery
Immunized
First Aid for the USMLE step 1, edition

17. HBV screening
The following persons should be screened for three HBV sero-markers ([HBsAg], [anti-HBs], and [anti-HBc]) :
Persons born in countries with 2% or higher HBV prevalence.
Persons who inject drugs.
HIV-positive persons.
Household and sexual contacts of HBV-infected persons. Homosexual men.
Persons requiring immunosuppressive therapy.
Persons with end-stage renal disease (including hemodialysis patients).
Blood and tissue donors.
Persons infected with hepatitis C.
Persons with elevated alanine aminotransferase levels (>19 IU/L for women and >30 IU/L for men).
Incarcerated persons.
Pregnant women (HBsAg only is recommended)
Infants born to HBV-infected mothers (HBsAg and anti-HBs are only recommended)

18. Occupational health and vaccination
Employee health care personnel.
At time of hire, Healthcare Providers potential for exposure should be determined and their vaccination status assessed.
Post vaccination screening is advised for personnel at ongoing risk for blood exposure to determine the response
Non-employee health care personnel.

19. CDC recommended Vaccines for Healthcare Workers
If you don’t have documented evidence of a complete HBV vaccine series, or if you don’t have an up-to-date blood test that shows you are immune to hepatitis B (i.e., no serologic evidence of immunity or prior vaccination) then you should get the 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2).
Get anti-HBs serologic tested 1–2 months after dose #3
For more information about the Hepatitis B vaccination

20. Vaccines Single-antigen hepatitis B vaccines ENGERIX-B® RECOMBIVAX HB®
HEPLISAV-B™
Combination vaccines
PEDIARIX®: Combined hepatitis B, diphtheria, tetanus, acellular pertussis (DTaP), and inactivated poliovirus (IPV) vaccine. Cannot be administered before age 6 weeks or after age 7 years.
TWINRIX®: Combined Hepatitis A and hepatitis B vaccine. Recommended for persons aged ≥18 years who are at increased risk for both Hepatitis A virus and HBV infections.

21. Management of exposure

22. Management of exposure

23. Management of exposure

24. Management of exposure

25. Discussion

26. References https://www.who.int/features/qa/76/en/ [1]
[2]
CDC. Viral Hepatitis Surveillance–United States, [3]
Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM, High Value Care Task Force of the American College of P, et al. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167(11): [4]
APIC text of infection Control and Epidemiology, Volume III, chapters 97,100,101,103