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Introduction to hepatitis B and C for healthcare workers. ศตวรรษ ทองสวัสดิ์ ภาควิชาอายุรศาสตร์. 1910.1030(f) Hepatitis B Vaccination and Post - exposure Evaluation and Follow - up -- .. 1910.1030 ( f )( 1 ) 1910.1030 ( f )( 1 ) General . 1910.1030(f)(1)(i)
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Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up --
The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.
Hepatitis B Vaccination.
Hepatitis B vaccination shall be made available after the employee has received the training required in paragraph (g)(2)(vii)(I) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
A. The HBV invades the cell by binding to surface receptors
B. the virus is taken up by the cell
C. enzymes extend the S(+) strand to form a covalently closed circular double-stranded DNA (CCC-DNA)
D. The HBV genome in its core migrates to the nucleus
E.& F. Additional viral structural protein messenger RNAs pass into the cytoplasm and are translated
G. The pregenome and viral DNA polymerase are packaged into new capsids
H.& I. The pregenome is then destroyed. The L(−) strand (H) is then used as a template for formation of the S(+) strand
J. the mature cores (I) are packaged into HBsAg particles, which accumulate in the endoplasmic reticulum and exit the cell
Weeks after Exposure
Hepatitis B acute infection and resolution
Hepatitis B acute infection turn into chronicity
Weeks after Exposure
³8% - High
2-7% - Intermediate
<2% - Low
Prevalence of chronic hepatitis B
Asymptomatic with normal ALT
HBe +, HBV DNA +
Spontaneous HBe to Anti-HBe: rare
Increase ALT with active histology
HBV DNA + but usually low
HBe to Anti-HBe : 2.7-25% /year
No symptom with normal ALT
HBeAg -, HBsAg + (cytoplasm),
HBV DNA (host DNA)
5-10% Chronic Carrier
Adapted from Feitelson, Lab Invest 1994
Depends on ALT
ALT > 1 x ULN (n=41)
ALT > 2 x ULN (n=26)
Duration of Therapy (years)
Response to lamivudine treatment
Guan R . J. Gast. Hep. 2001; 16 Suppl.: Abs 160
% Incidence of YMDD mutant HBV
69 - 75%
47 - 56%
16 - 32%
At year of Lamivudine therapy
Atkins M. et al. Hepatology. 1998.
(Lam 100 mg: 38 pts, Lam 25 mg: 7 pts, Lam 25 100 mg: 10 pts)
Occurred 4-94 weeks (median 24 wks) after emergence of the YMDD mutant
Mean Fu =
* abrupt increase of ALT by 2 folds and to a level greater than 5 x ULN or to a level > 300 IU/L
Hepatitis flare from YMDD resistance
Liaw YF. et al. Hepatology. 1999.
Assembly & budding
Positive strand synthesis
LAM, ADV, and TDF
HBV Polymerase ?
Removal of pregenome
Negative strand synthesis
2.4/2.1 kb RNA
3.5 kb RNA
Role of oral antivirals
* The schedule for hepatitis B vaccination is flexible and varies. Consult the ACIP statement on hepatitis B (11/91), AAP\'s 2003 Red Book, or the package insert for details.Note: For adult dialysis patients, the Engerix-B dose required is 40µg/2.0ml (use the adult 20µg/ml formulation) on a schedule of 0, 1, 2, and 6 months. For Recombivax HB, a special formulation for dialysis patients is available. The dose is 40µg/1.0ml and it is given on a schedule of 0, 1, and 6 months.
All abnormal ALT
20-30% in 10-20 yr.
Medium rate 0.133 /y
Very rapid fibrosis 0.36/y
30 years to cirrhosis
11 years to cirrhosis
Very slow fibrosis 0.04/y
100 years to cirrhosis
HCV genotypes and subtypes
P. Simmonds, Philos Trans R Soc Lond B Biol Sci 2001;356:1013-26
1b2a, 2b, 2c, 3a
1a, 1b2a, 2b, 3a
1b, 3, 6
Adapted from Fang J Clin Liver Dis 1997;1:503.
Pegylated-interferon alfa + ribavirin
Fibrosis regression or retardation in CH-C patients treated with interferon (IFN)
untreated (+0.10 unit/year)
non-SR (+0.024 unit/year)
SR (-0.28 unit/year)
After IFN treatment