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Hepatitis B

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.

Occupational Exposure

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.

(Source: CDC)

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?


Viral Hepatitis The word "hepatitis" means inflammation of the liverand also refers to a group of viral infections that affect the liver. The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
Hepatitis B Information for Health Professionals Information from the CDC.
What I need to know about Hepatitis B From the American Liver Society.
Information from MedlinePlus.
Hepatitis B and C What's new at the FDA in hepatitis
Hepatitis Information from the WHO about hepatitis.
Bloodborne Infectious Diseases
HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus

Exposures to blood and other body fluids occur across a wide variety of occupations. Health care workers, emergency response and public safety personnel, and other workers can be exposed to blood through needlestick and other sharps injuries, mucous membrane, and skin exposures. The pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Workers and employers are urged to take advantage of available engineering controls and work practices to prevent exposure to blood and other body fluids.

Hepatitis B A JAMA Patient Page.
Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis The Department of Health and Human Services is committed to ensuring that new cases of viral hepatitis are prevented and that persons who are already infected are tested; informed about their infection; and provided with counseling, care, and treatment.
Viral Hepatitis A through E and Beyond

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

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Update on Hepatitis B The hepatitis B virus (HBV) affects more than 1 million people in the United States and between 350 million and 400 million worldwide.1 HBV is transmitted through contact with bodily fluids—including blood, semen, and vaginal secretions—of an HBV-infected individual (Table 1), and causes inflammation of the liver. It is part of the viral hepatitis family that includes hepatitis A, C, D, E, F, and G.2
The Silent Epidemic More than 4 million Americans are infected with viral hepatitis.1 Hepatitis B and hepatitis C are now more common than human immunodeficiency virus (HIV), and deaths from viral hepatitis outnumber those caused by HIV.1Unfortunately, many Americans are unaware they are infected. It is estimated that 30% of those with hepatitis B infection and 75% of those with hepatitis C infection1,2
New HBV subgenotype D9, a novel D/C recombinant, identified in patients with chronic HBeAg-negative infection in Eastern India Genome diversity is a hallmark of hepatitis B virus (HBV), which allowed its classification into 10 genotypes (A–J) and numerous subgenotypes. Among them, Genotype D is currently segregated into eight subgenotypes (D1–D8). Here, we report the identification and characterization of a novel subgenotype within genotype D of HBV from chronic hepatitis B e antigen (HBeAg)-negative patients of Eastern India.
Report: Thousands of VA dental patients should be tested A task force on April 21 recommended thousands of Dayton VA Medical Center patients be tested for exposure to hepatitis B, hepatitis C and HIV.
Exposure to Blood: What Health Care Personnel Need to Know Focuses on human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
Hepatitis B virus infection in dentistry: a forgotten topic More than two billion people have been infected with hepatitis B virus (HBV). Globally, 350–400 million suffer from chronic HBV infection. It is postulated that dentists and dental staff are infected and transmit the virus to their patients more than any other occupation. The aim of this article is to review the HBV incidence in dental society, the points of view of dentists and their patients regarding transmission of the virus during dental procedures, the occurrence of HBV outbreaks in dental clinics and the importance of methods of preventing HBV infection in dentistry.
Dept. of Unintended Consequences: Hepatitis B in West Virginia Hepatitis B is blood-borne, so on the surface, this is a story of the tragic consequences of some failure somewhere in the clinic's infection-control procedures.
(1992) This study shows that the annual cumulative risk of infection from routine treatment of patients whose seropositivity is undisclosed is 57 times greater from HBV than from HIV, and that the risk of dying from HBV infection is 1.7 times greater than the risk of HIV infection, for which mortality is almost certain.
Hepatitis B and dental personnel: transmission to patients and prevention issues (1983) Hepatitis B virus (HBV) infection is considered an occupational risk for dental professionals.

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