Hepatitis B Carrier
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Transcript of Hepatitis B Carrier
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Hepatitis B Carrier
By Ruby Lai
21/7/2006
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1. Who to screen
2. Clarify whether a true HB carrier
3. Counsel on contact tracing for thoseHBsAg+& HBsAb + w/o vaccination
4. Hep B Vaccination
5. Surveillance of hepatitis, cirrhosis, CA
6. Current treatment available &management guideline
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Cases discussion
1. M/21 no Hx of blood test on Hep Bstatus
2. M/35, Hep B vaccine 5 years ago,request check Hepatitis B status.
3. F/34 , husband Hep B carrier 4. F/40 detected HBsAg 3 months ago as
first time, request repeat Hepatitis B
Status 5. M/45, Known Hep B carrier, moderate
drinker,
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Who to screen
Health Care worker
Family history of Hep B carrier
Adolescent or Adult no hx of vaccination,esp. high risk group e.g. multiple sexualpartner, frequent blood transfusion,injecting drug, sexual partner Hep B
carrier. People with compromised immunity post-vacc serology need for the above group
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True Hep B carrier
The risk of carrier rate:
90-95% perinatal transmission
30% children age 1-5
5-10% older children, adolescent, adult
Route of transmission: perinatal, paternal,sexual
China & South East Asia high prevalence>8% Carriers
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True Hep B carrier
Once HBsAg detected, it should berepeated at least 6 months later to confirmthe true Hep. B Carrier Status
So usually advise repeat HBsAg & HBsAbone year later
Persist HBsAg confirm Carrier status.
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Contact Tracing
Sexual partner
Children
Parent Sibling
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Hepatitis B vaccination
Regimen 0, 1, 6 is widely used
Efficacy >95% seroconversion rate
Post vaccination serology usually not needexact some special group of people
Routine boostering not recommended
after 3 doses
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Hepatitis B vaccination
1st & 2nd dose not 12weeks
3rd dose not evidence of efficacy after 10months
More tight schedule earilar protection
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Hypo-responder-anti-HBs titre 0-10mIU/ml
Non-responder -anti-HBs titre
Factor: Obesity, male sex,smoker, olderage, immunocompromised status.
Suggest repeat 3 standard dose
18-25% respond in 2nd course
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When to start Surveillance
To increase the chance of intervention andimprove survival,
Early detection of subclinical HCC
By AFP (Alpha-fetal protein)
By USG Liver
Sensitivity for AFP alone(74.2%), USGLiver Alone (81.9%)
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How frequent
A single tumour
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Case 1
M/21 no Hx of blood test on Hep B status
Management:
1. Born in HK?
2. Vaccination program completed
3. If vaccine before, low risk, no need tocheck
4. If vaccine before high risk, check
5. If no vaccine, check
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Case 2
M/35, Hep B vaccine 5 years ago, requestcheck Hepatitis B status.
Management:
1. Check if only high risk group
2. Boostering usually not required because
of natural boostering
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Case 3
F/34 , husband Hep B carrier
Management:
1. Suggest check Hep B status
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Case 4
F/40 detected HBsAg 3 months ago as first time,request repeat Hepatitis B Status
Management:
1. Suggest recheck HBsAg and HBsAb 6 to Iyear after the last blood test
2. Advise husband and sibling, parent to check
HBsAg status 3. Advise healthy life style and regular liver
assessment if Hep B carrier confirmed
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Case 5
5. M/45, Known Hep B carrier, moderatedrinker,
Management:
1. Advise quit alcohol
2. Advise family member to check Hep B
status 3. Regular liver assessment including ALT,
AFP, USG liver in 4-6 months interval
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Current Management for Chronic
Hepatitis
Antiviral Treatment
- Lamivudine
- Adefovir- Interferon Alfa (IFN-)
? Traditional Chinese Herbal Medicine
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Lamivudine
Benefit:
1. HBeAg seroconversion durability of respond aftercessation of treatment is 38%-77%
Problem:1. Lamivudine resistent Mutant(14%, 38%, 49%,66%, 69% in first, 2nd, 3rd, 4th & 5th
yrs of treatment )2. Relapsing rate 36-54% in 3 years, most occur in first
year3. Duration of treatment 1 year or more
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Adefovir
Benefit:1. low resistent2.
Problem:1. Cost high2. HBeAg seroconversion rate on 12%3. ALT raise again after stop the treatment
4. Duration of treatment 1 year or more
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Interferon Alfa
Benefit:1. Short duration 4-6 months2. Lack of resistent mutants
Problem:1. High cost2. Side effect (Early Flu like symptom: chill,
headache, fever, malaise, tachycardia, myalgia,arthralgia
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When to start Tx
a) HBeAg+ CHB with ALT >2x ULN &compensated liver should be observed for3-6 months for spontaneous
seroconversion from HBeAg toHBeAb(HKP7/04, AA)
if after 3-6 months ALT remains >2xULN & HBV DNA >10^5 copies/ml
consider Tx (HKP7/04)
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When to start Tx
b) HBeAg- CHB with HBV DNA >10^5 copies/ml& ALT >2x ULN on repeated testing (HKP7/04),at least 1 month between observations (AP)
c) HBV cirrhosis with HBV DNA >10^4 (HKP7/04,AA)
d) ALT in a rising trend or with ALT> 5xULN (AP)
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When to start Tx
ALT >2x ULN & HBV DNA
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Thank You