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Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic.
In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at infection: approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is 15%–25%. HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood. The primary risk factors that have been associated with infection are unprotected sex with an infected partner, birth to an infected mother, unprotected sex with more than one partner, men who have sex with other men (MSM), history of other STDs, and illegal injection drug use.
CDC's national strategy to eliminate transmission of HBV infection includes
- Prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers and infants born to mothers with unknown HBsAg status
- Routine infant vaccination
- Vaccination of previously unvaccinated children and adolescents through age 18 years
- Vaccination of previously unvaccinated adults at increased risk for infection
High vaccination coverage rates, with subsequent declines in acute Hepatitis B incidence, have been achieved among infants and adolescents. In contrast, vaccination coverage among the majority of high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and injection drug users) have remained low, and the majority of new infections occur in these high-risk groups. STD clinics and other settings that provide services targeted to high-risk adults are ideal sites in which to provide Hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for Hepatitis B and should receive Hepatitis B vaccination.
After exposure to Hepatitis B virus (HBV), appropriate and timely prophylaxis can prevent HBV infection and subsequent development of chronic infection or liver disease. The mainstay of postexposure prophylaxis (PEP) is Hepatitis B vaccine, but, in certain circumstances, Hepatitis B immune globulin is recommended in addition to vaccine for added protection. Click here for more information and a page that provides links to PEP guidelines and resources by type of exposure.
Rare case of Patient-to-Patient Transmission of Hepatitis B Virus
In 2007, researchers have documented a case if hepatitis B transmisison between two patients at a dentist's office in the US. Click here to read the article press release from The Journal of Infectious Diseases.
Article: Patient-to-Patient Transmission of Hepatitis B Virus Associated with Oral Surgery
Editorial: Transmission of Hepatitis B in the Health Care Setting: The Elephant in the Room … or the Mouse?
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