hepatitis b carrier

7/31/2019 Hepatitis B Carrier

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Hepatitis B Carrier

By Ruby Lai

21/7/2006


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1. Who to screen

2. Clarify whether a true HB carrier

3. Counsel on contact tracing for thoseHBsAg+& HBsAb + w/o vaccination

4. Hep B Vaccination

5. Surveillance of hepatitis, cirrhosis, CA

6. Current treatment available &management guideline


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Cases discussion

1. M/21 no Hx of blood test on Hep Bstatus

2. M/35, Hep B vaccine 5 years ago,request check Hepatitis B status.

3. F/34 , husband Hep B carrier 4. F/40 detected HBsAg 3 months ago as

first time, request repeat Hepatitis B

Status 5. M/45, Known Hep B carrier, moderate

drinker,


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Who to screen

Health Care worker

Family history of Hep B carrier

Adolescent or Adult no hx of vaccination,esp. high risk group e.g. multiple sexualpartner, frequent blood transfusion,injecting drug, sexual partner Hep B

carrier. People with compromised immunity post-vacc serology need for the above group


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True Hep B carrier

The risk of carrier rate:

90-95% perinatal transmission

30% children age 1-5

5-10% older children, adolescent, adult

Route of transmission: perinatal, paternal,sexual

China & South East Asia high prevalence>8% Carriers


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True Hep B carrier

Once HBsAg detected, it should berepeated at least 6 months later to confirmthe true Hep. B Carrier Status

So usually advise repeat HBsAg & HBsAbone year later

Persist HBsAg confirm Carrier status.


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Contact Tracing

Sexual partner

Children

Parent Sibling


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Hepatitis B vaccination

Regimen 0, 1, 6 is widely used

Efficacy >95% seroconversion rate

Post vaccination serology usually not needexact some special group of people

Routine boostering not recommended

after 3 doses


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Hepatitis B vaccination

1st & 2nd dose not 12weeks

3rd dose not evidence of efficacy after 10months

More tight schedule earilar protection


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Hypo-responder-anti-HBs titre 0-10mIU/ml

Non-responder -anti-HBs titre

Factor: Obesity, male sex,smoker, olderage, immunocompromised status.

Suggest repeat 3 standard dose

18-25% respond in 2nd course


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When to start Surveillance

To increase the chance of intervention andimprove survival,

Early detection of subclinical HCC

By AFP (Alpha-fetal protein)

By USG Liver

Sensitivity for AFP alone(74.2%), USGLiver Alone (81.9%)


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How frequent

A single tumour


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Case 1

M/21 no Hx of blood test on Hep B status

Management:

1. Born in HK?

2. Vaccination program completed

3. If vaccine before, low risk, no need tocheck

4. If vaccine before high risk, check

5. If no vaccine, check


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Case 2

M/35, Hep B vaccine 5 years ago, requestcheck Hepatitis B status.

Management:

1. Check if only high risk group

2. Boostering usually not required because

of natural boostering


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Case 3

F/34 , husband Hep B carrier

Management:

1. Suggest check Hep B status


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Case 4

F/40 detected HBsAg 3 months ago as first time,request repeat Hepatitis B Status

Management:

1. Suggest recheck HBsAg and HBsAb 6 to Iyear after the last blood test

2. Advise husband and sibling, parent to check

HBsAg status 3. Advise healthy life style and regular liver

assessment if Hep B carrier confirmed


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Case 5

5. M/45, Known Hep B carrier, moderatedrinker,

Management:

1. Advise quit alcohol

2. Advise family member to check Hep B

status 3. Regular liver assessment including ALT,

AFP, USG liver in 4-6 months interval


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Current Management for Chronic

Hepatitis

Antiviral Treatment

- Lamivudine

- Adefovir- Interferon Alfa (IFN-)

? Traditional Chinese Herbal Medicine


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Lamivudine

Benefit:

1. HBeAg seroconversion durability of respond aftercessation of treatment is 38%-77%

Problem:1. Lamivudine resistent Mutant(14%, 38%, 49%,66%, 69% in first, 2nd, 3rd, 4th & 5th

yrs of treatment )2. Relapsing rate 36-54% in 3 years, most occur in first

year3. Duration of treatment 1 year or more


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Adefovir

Benefit:1. low resistent2.

Problem:1. Cost high2. HBeAg seroconversion rate on 12%3. ALT raise again after stop the treatment

4. Duration of treatment 1 year or more


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Interferon Alfa

Benefit:1. Short duration 4-6 months2. Lack of resistent mutants

Problem:1. High cost2. Side effect (Early Flu like symptom: chill,

headache, fever, malaise, tachycardia, myalgia,arthralgia


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When to start Tx

a) HBeAg+ CHB with ALT >2x ULN &compensated liver should be observed for3-6 months for spontaneous

seroconversion from HBeAg toHBeAb(HKP7/04, AA)

if after 3-6 months ALT remains >2xULN & HBV DNA >10^5 copies/ml

consider Tx (HKP7/04)


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When to start Tx

b) HBeAg- CHB with HBV DNA >10^5 copies/ml& ALT >2x ULN on repeated testing (HKP7/04),at least 1 month between observations (AP)

c) HBV cirrhosis with HBV DNA >10^4 (HKP7/04,AA)

d) ALT in a rising trend or with ALT> 5xULN (AP)


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When to start Tx

ALT >2x ULN & HBV DNA


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Thank You

hepatitis b carrier

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