Hepatitis B - Coggle Diagram
Immunoglobulin prophylaxis for those without proven hepatitis B immunity, following exposure to potentially infected blood or body fluids.
Prevention through immunisation. Offer to those at risk as per Hep A
Referral to hepatologist, gastroenterologist or infectious disease specialist
Notify Health Protection Unit
Prescribe anti-emetic, analgesia, treatment of itch as appropriate
Referral to GUM, drug/alcohol rehab where appropriate.
How to test
Anti-HBc - suggests current or previous HBV infection, usually detectable for life following initial infection.
Anti-HBe - indicates control of HBV and resolution predicted.
anti-HBc IgM - suggests recent (within last 6m) infection.
HBeAg - detectable in acute and some chronic cases. Tendency to be more infective if detected, if cleared, anti- HBeAg usually detected and infectivity lowered.
anti-HBc IgG - generally persists for life and is indicative of past infection.
HBsAg - suggestive of infectious period
anti-HBs - indicates recovery from and immunity to HBV. Anti-HBs without anti-HBc is a marker of immunisation. Anti-HBs is quantified to measure vaccination response.
Test Hep B serology when:
Clinical features - Fever, fatigue, rash 2 weeks before jaundice, malaise, abdo pain, extrahepatic manifestations such as glomerulonephritis, vasculitis, and polyarteritis
At risk patients - immigrants from areas of high prevalence, sex workers, MSM, IVDU, needlestick injury, sexual assault victim, HIV+ve.
Chronic infection may be displayed as spider naevi, finger clubbing, jaundice, hepatosplenomegaly,
Abnormal LFTs inc raised AST, ALT and bilirubin, possibly raised Alk phos and prolonged PTT.
High levels of HBV DNA are associated with a greater risk of progression to cirrhosis and hepatocellular cancer.
Core avidity testing can differentiate between acute and chronic core IgM infection
As Hep A but also includes NAFLD