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Hepatitis B 101 . Erin M. Bachus Adult Immunization Coordinator Communicable Disease Prevention Unit San Francisco Department of Public Health. Learning Objectives. By the end of this presentation, participants will be able to: Explain the differences between Hepatitis A, B, and C

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Hepatitis b 101

Hepatitis B 101

Erin M. Bachus

Adult Immunization Coordinator

Communicable Disease Prevention Unit

San Francisco Department of Public Health

Learning objectives
Learning Objectives

  • By the end of this presentation, participants will be able to:

    • Explain the differences between Hepatitis A, B, and C

    • Discuss the vaccination schedule for Hepatitis A and Hepatitis B

    • Understand the basic serological testing methods for Hepatitis B

Hepatitis a
Hepatitis A

  • Transmission

    • Fecal-Oral transmission

  • Self-Limiting - does not become chronic

    • Infection = Protection

  • Who is at risk?

    • Men who have Sex with Men,

    • Travelers

      • all areas of the world except Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia)

    • Contacts of infected persons

    • Users of illegal drugs

  • Highly effective vaccine – 2 dose series, separated by 6 months

Hepatitis c
Hepatitis C

  • Transmission

    • Blood transmission

      • Transmission through sex is possible, but not probable

  • Can lead to chronic illness

  • Who is at risk?

    • Users of illegal drugs

    • Recipients of clotting factors before 1987

    • Infants of infected mothers

    • Hemodialysis patients

  • NO vaccine

Hepatitis b
Hepatitis B

  • Transmission

    • Via blood and body fluids

      • Hep B is 100x more infections than HIV

  • Who is at risk?

    • Persons with multiple sex partners or diagnosis of a sexually transmitted disease

    • Men who have sex with men

    • Sex contacts of infected persons

    • Injection-drug users

    • Persons born in HBV endemic areas (see map)

    • Household contacts of chronically infected persons

    • Infants born to infected mothers

    • Infants/children of immigrants from areas with high rates of HBV infection

    • Health care and public safety workers with exposure to blood

    • Hemodialysis patients

Hepatitis b1
Hepatitis B

  • Symptoms

    • Experienced by 30% of people

      • May include:

        • Jaundice

        • Fatigue

        • Abdominal pain

        • Anorexia

  • Hep B can cause lifelong (chronic) infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death

    • Serologic testing and lifelong monitoring of chronically infected persons is essential for the prevention of severe liver disease

Prevention of hepatitis a b and c
Prevention of Hepatitis A, B, and C

  • Having protected sex

  • Avoiding drug use or using harm reduction methods while using them

    • i.e. not sharing needles

  • Good hand washing

  • Number one – Get vaccinated!

    • No vaccine for hep C


  • Hepatitis A

    • 2 dose series

      • Each dose separated by 6 months

    • Incredibly effective

      • 95-97% of people are fully protected after 1 dose!

  • Hepatitis B

    • 3 dose series

      • Schedule: 0,1,4-6 months

  • Combination hep A/hep B

    • Called Twinrix

    • 3 dose series

      • Schedule: 0,1,6 months

        *Minimum intervals only! Vaccine series never need to be restarted!*

Hepatitis b and chronic infection
Hepatitis B and Chronic Infection

  • < 1% of general population develops chronic infection

  • Chronic infection risk decreases with age

    • Up to 90% of infants infected at birth

    • 30-50% of those infected between age 1 and 5 years

    • 5% of those infected as adults

  • Persons born in endemic countries have a much higher risk of chronic infection

    • 1 in 10 people!

    • Not related to genetics

  • 1 in 4 of those with chronic infection will die prematurely from cirrhosis or liver cancer

    • San Francisco is working on preventing this!!

Serologic testing for hep b
Serologic Testing for Hep B

  • Blood test used to detect:

    • HBsAg – determines if an active infection is present

    • Anti-HBs – determines if a person has immunity to the disease, either from previous infection or vaccination

    • Many free or low-cost places in SF to go

  • Very important!

    • Saves lives

    • As many as 1 in 10 Asians are infected and many of them are unaware due to a lack of symptoms

Mmwr recommendations and reports 9 19 08
MMWR Recommendations and Reports 9.19.08

  • “Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection”

    • First ever published screening recommendations for chronic hepatitis B

      • Who should be tested?

        • Persons born in geographic regions with HBsAg prevalence of >2%.

        • Persons with behavioral exposures to HBV

          • Men who have sex with men

          • Users of illegal drugs

        • Persons receiving cytotoxic or immunosuppressive therapy

        • Persons with liver disease of unknown etiology

Sf hep b free
SF Hep B Free

  • Campaign goals

    • To create public and healthcare provider awareness about the importance of testing and vaccinating API for hepatitis B

    • To promote routine hepatitis B testing and vaccination within the primary care medical community

    • To ensure access to treatment for chronically infected individuals

  • Strategies

    • Public Awareness

    • Screening

    • Vaccination

    • Treatment / Follow-up


Sf hep b free1
SF Hep B Free

  • An innovative collaboration of public/private partners

  • Unmatched across the country

  • Galvanized multiple constituents for sustainability

  • Effective response to major local public health concern

  • Partners encompass entire health care sector, universities, legislators, foundations, CBOs, and news agencies


Provider education
Provider Education

  • Study population

    • 196 PCP attendees of a university-based CME primary care Internal Medicine conferences (spring 2007)

  • 78% response rate

  • Only 45% of clinicians correctly chose HBsAg as the screening test of choice for CHB

  • 46% were unaware that HBV can be controlled by medications

  • Overestimated the relative prevalence of CHB: said other at risk groups have a higher prevalence than Chinese

    • HIV (40%), MSM (41%), IVDU (60%)

Hep b free highlights
Hep B Free Highlights

  • 2007

    • Board of Supervisors passes Fiona Ma’s resolution to test & vaccinate all API residents

    • Resolution endorsed by Health Commission. No funds allocated

    • Interagency Steering group established to create SF Hep B Free campaign

    • Planning Group with all key stakeholders established

    • Bus ads featuring Mayor Newsom & Assemblywoman Ma run throughout city

    • SFSU and CCSF commit to on campus testing & vaccination campaigns

    • Eight CME events reach 230 primary care providers

    • Seven new, low cost, public access testing & vaccination sites available

  • 2008

    • Be a Hero public awareness campaign runs for 3 consecutive months

    • Co-sponsored four clinician education events

    • 32 organizations continue to actively participate in campaign

    • Five working groups contribute to success of campaign

    • Educated 220 staff at 15 API Health Parity Coalition agencies about hepatitis B

    • Screened over 4000 people for chronic hepatitis B

    • Raised over $400,000 in grant funds from for public awareness, evaluation, and staff support

    • Replication of Hep B Free begun in multiple communities

    • Diagnostic flowchart developed and distributed


  • My contact information

    • Erin Bachus, Adult Immunization Coordinator

      San Francisco Dept of Public Health (415) 554-2830

      [email protected]