QuickTime™ and a

TIFF (Uncompressed) decompressor

are needed to see this picture.

Hepatitis B
Overview
 Introduction
 Epidemiology
 Causes - modes of transmission
 Pathology
 Acute disease
 Chronic disease
 Prevention
 Vaccination
 Treatment
Introduction
 Hepatitis B is part of a family of viruses which
causes disease in mainly the liver.
 Other hepatitis viruses - Hepatitis A, C , D, E,
H VIRAL HEPATITIS
 Hepatitis A and E - transmitted orally (ie
contaminated water, food)
 Hepatitis B, C, G, H - blood borne virus -
transmitted through blood and body fluids
Epidemiology: Hepatitis B
 Worldwide
 2 billion people infected
 350 million suffering chronic HBV infection
 15-40% chronic infected patients develop liver
cirrhosis, liver failure, HCC
 10th leading cause of death worldwide
 500,000 - 1.2million deaths / year
 Hepatocellular cancer - 320, 000 deaths / year
 In tropical countries - between 1/7 and 1/20
people are chronic carrier states
Hepatitis B worldwide distribution

QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Transmission: HBV is present in

High Amounts in Moderate amounts in

Blood Sweat

Semen Breast milk

Vaginal Secretions Tears

Menstrual blood Urine

Saliva
Transmission
Highly infectious - resistant to breakdown, can
survive outside the body (unlike HIV)
 Contact with infected fluids

 Most common route of transmission in high

endemic places (ie here) is

 Perinatal
 Preschool years

More chance of developing chronic infection if

acquired during this time….
Transmission
 Percutaneous (through the skin)
 Needle sharing
 Acupuncture
 Ear piercing
 Tattooing
 Blood transfusions ****
 Other blood products (albumin, clotting factors, platelets)
 Close personal contact involving exchange
of blood or secretions
 Sex
 Child birth ****
 Preschool aged children
 Breastfeeding - no more risk than from delivery - but
more if cracked / bleeding nipples
High risk groups
 IV drug users
 Receivers of blood transfusions /***
haemodialysis
 Health staff in contact with blood ***
 Multiple sexual contacts
 Immunosuppressed individuals
 Babies born to mothers with chronic HBV ***
 People in endemic areas…..***
 Pathology - Acute disease
Not often seen at MTC as most transmission here occurs in
early childhood and children usually asymptomatic
 Incubation: 7-160 days after initial contact

 Often no jaundice (65%)

 Adults more severe than children

 Early symptoms

 Fatigue
 Anorexia
 Nausea and pain RUQ
 Fever = > when fever improves therefore recovery
 Lab tests: raised ALT, AST; raised ALP, bilirubin
Pathology - acute disease
Fulminant Hepatitis: 1% acutely infected
(usually adults who get acute infection - rare in children)
 More severe symptoms - can be fatal
 Severe liver damage
 Ascites
 Bleeding
 Liver shrinkage (not hepatomegaly)
Patients might get late symptoms:
 Arthritis
 Rash
 Cholestasis
Pathology - chronic Hep B
Chronic carrier state:
 More common in people infected in childhood (especially <1 year
=> 90% have chronic carrier state)
 These people are major reservoir for transmission
10-30% (1 in 4 to 1 in 10) people with chronic
carrier state get liver disease (can be symptomatic,
asymptomatic = > raised AST, ALT)
10% (1 in 10)of these patients suffer liver
cirrhosis
 Scarred liver tissue
 Blocks blood flow through liver
 Liver no longer can produce enzymes; clotting factors; detoxify
blood
 Main cause of liver cancer (Hepatocellular Cancer)
 Alcohol makes worse
Pathology - HCC
Hepatocellular Carcinoma (HCC)
 80% HCC associated with chronic HBV
infection
 Liver carcinoma occurs 9-35 years after HBV
infection
 Terminal condition = > transplant and
chemotherapy only treatment
 Worsened with alcohol/immunosuppression

(Hepatitis C can also result in HCC)

 QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Prevention QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.

 Active immunisation
 Hepatitis B vaccine
(contains S antigen)
require 3 vaccinations (0, 1, 6 months)
 At MTC available for
 usually for babies born to mothers with
HBV (0,1,6 months)
 Clinic staff
Summary
 Very common in this area
 Causes acute and chronic illness
 Main cause of liver cancer; causes
many deaths….
 Easily transmissible
But importantly…..
 Preventable!!
Quiz
1. What is Hepatitis B ? Is it
a) virus
b) Bacteria
c) Fungus
d) like TB
2. Which part of the body does Hepatitis B
cause most damage?
a) Lungs
b) Bone marrow
c) Liver
d) Eyes
e) Lymph nodes
Quiz
3. Name 3 other types of viruses that cause
hepatitis
4. Where in the world is hepatitis B found?
5. How is it most likely transmitted?
a) Air droplets (coughing, sneezing)
b) Skin contact
c) Blood
6. What would be the 3 most common modes of
transmission for the patients at MTC?
7. Would would be the most common mode of
transmission for currently uninfected staff?
Quiz
8. Name 3 symptoms you would see in
the acute phase of the illness
9. What is liver cirrhosis?
11. What do some people with liver
cirrhosis get?
12. How can we prevent hepatitis B
transmission?
Thank you
Questions