hepatitis B

Importance: Hepatitis B virus (HBV) infection affects an estimated 254 million people worldwide and causes approximately 1.1 million deaths annually. In 2022, there were approximately 1.2 million new HBV infections worldwide and 14 000 in the US.

Observations: HBV is a DNA virus transmitted through percutaneous or mucosal exposure to infected blood, semen, or body fluids. Mother-to-child transmission, which is the principal cause of chronic HBV infection globally, occurs in 70% to 90% of infants born to mothers who are hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive and in 5% to 20% of those born to HBsAg-positive/HBeAg-negative mothers. However, HBV vaccination and administration of hepatitis B immune globulin within 12 to 24 hours of birth prevent approximately 94% of perinatal infections, and adding antiviral therapy in pregnant women with high HBV DNA reduces transmission to less than 1%. Although universal birth-dose HBV vaccination is the most effective strategy for eliminating HBV infection, global birth-dose HBV vaccine coverage was only 45% in 2024. The risk of developing chronic infection (HBsAg positive for more than 6 months) is 90% if HBV infection occurs during infancy, 30% in children aged 1 to 5 years, and less than or equal to 5% in immunocompetent adolescents and adults. HBV infection is diagnosed by serologic testing: HBsAg indicates ongoing infection, antibody to HBsAg indicates immunity, and antibody to hepatitis B core antigen indicates ongoing or past infection. Serum HBV DNA levels quantify virus-replication activity. Assessment of liver inflammation and fibrosis with alanine aminotransferase (ALT) and noninvasive tests such as Fibrosis-4 index and liver elastography guide treatment decisions. Chronic HBV infection may progress to cirrhosis and hepatocellular carcinoma (HCC); the 5-year cumulative risk of cirrhosis is 8% to 15% in untreated chronic HBV infection, and annual HCC incidence is 3% to 5% among patients with cirrhosis. Antiviral therapies-pegylated interferon alfa and nucleos(t)ide analogues (entecavir or tenofovir)-suppress HBV DNA replication and reduce the risk of HCC by approximately 50%. Antiviral treatment is recommended for all patients with chronic HBV and cirrhosis and for those without cirrhosis who have high HBV DNA with elevated ALT or significant inflammation/fibrosis. Patients at high risk of HCC should undergo surveillance with ultrasonography and alpha-fetoprotein testing every 6 months.

Conclusions and relevance: HBV infection causes approximately 1.1 million deaths annually worldwide. Universal HBV vaccination, particularly birth-dose administration, is the most effective strategy to prevent HBV infection. Among patients with HBV infection, antiviral therapy decreases progression to cirrhosis and liver failure and reduces the risk of HCC.

Author/s:

Wen-Juei Jeng, Terry Cheuk-Fung Yip, Anna S. Lok

Routine Childhood Vaccines Given in the First 11 Months After Birth

John Bayhi — Thu, 02 Jan 2020 20:22:28 +0000

Date Added:

January 2, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc.

Publication Date:

December 23, 2019

URL:

Routine Childhood Vaccines Given in the First 11 Months After Birth

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.06.007

Keywords

vaccines

infants

immunizations

PMID (1):

31879133

MeSH

Haemophilus influenzae type b

Influenza

Human

Rotavirus

Strepococcus pneumoniae

Poliovirus

Advisory Committees

Vaccine-Preventable Diseases

This is a nice review from Mayo of the vaccines recommended for children under the age of one including rationale, effectiveness, and concerns.

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The US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases that currently pose threats of morbidity and mortality to infants and those around them, including the 3-dose hepatitis B (HepB) series. The first dose is due at birth. This series protects against maternal-infant transmission of the HepB virus and against exposure the rest of the infant's life. At age 2 months infants are to receive not only their second dose of HepB vaccine but also a series of vaccines directed against diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b. At 4 months, infants are to repeat those vaccines except for the HepB vaccine. At age 6 months infants are to finish the HepB series and receive the third doses of the other vaccines received at 2 and 4 months except for the rotavirus vaccine, depending on the brand used. Also, starting at 6 months, depending on the time of year, infants are to begin a 2-dose series against influenza separated by 28 days. Each of these vaccines is due at a time when the vaccine works to protect against an immediate risk and to provide long-term protection. These vaccine-preventable diseases vary in terms of the nature of exposure, the form of the morbidity, the risk of mortality, and the ability of routine vaccination to prevent or ameliorate harm.

Author/s:

Jacobson, RM

Hepatitis (and Other Liver Diseases)

Jeffrey Wilson — Sat, 06 Apr 2019 18:28:04 +0000

Date Added:

April 6, 2019

Journal/Publication:

American Family Physician

Publisher:

American Academy of Family Physicians

Publication Date:

March 1, 2019

URL:

Hepatitis (and Other Liver Diseases)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

A single link to content related to various types of hepatitis previously published in the American Family Physician. James W. Mold, MD, MPH

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This collection features the best content from AFP, as identified by the AFP editors, on hepatitis and other liver disease and related issues, including cirrhosis, chronic liver failure, hemochromatosis, hepatitis A, hepatitis B, hepatitis C, jaundice, and nonalcoholic fatty liver disease. New research may affect the interpretation and application of this material. Clinical judgment is advised. Note that AFP content published within the past 12 months is accessible to AAFP members and paid subscribers only.