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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
Public awareness campaign launched in SF in September 2008
    • Kickoff with gala fundraising dinner and press conference unveiling first ever screening guidelines for hepatitis B
    • Ran for 3 consecutive months
    • Billboard, Muni, Print, Radio, and TV Ads
  • My contact information
    • Erin Bachus, Adult Immunization Coordinator

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

[email protected]