Hepatitis B (HBV)

Infectious diseases

disorders that are caused by organisms; microscopic in size (bacteria, viruses, fungi, parasites) passed directly or indirectly from one person to another.

It is the most common serious liver infection in the world caused by hepatitis B virus that attacks and injures the liver

Hepatitis B

Term that been called since most people do not have symptoms when newly infected or chronically infected.

Silent epidemic

For people who are chronically infected but don’t have any symptoms their liver is still being silently damaged which can develop into serious liver disease such as ________

cirrhosis or liver cancer

Mode of transmission

• Percutaneous activities

  • puncture through the skin

• Mucosal contact with infectious blood or body fluids

• Sex with an infected partner

• Injection-drug use; involves sharing needles, syringes or drug-preparation equipment

• Birth to an infected mother

• Contact with blood from or open sores on an infected person

• Exposure to needle sticks or sharp instruments

• Sharing certain items with an infected person that can break the skin or mucous membranes

  • Razors

  • Toothbrushes

  • Glucose monitoring equipment (potentially resulting in exposure to blood)

Asymptomatic

Children below 5 years old and newly infected immunosuppressed adults

Symptoms of HBV (FFLNA DCJJ)

• Fever

• Fatigue

• Loss of appetite

• Nausea and vomiting

• Abdominal pain

• Dark urine

• Clay-colored stool

• Joint pain

• Jaundice

30% - 50% of people above 5 years of age have signs and symptoms

Acute HBV

• last up to 6 months with or without symptoms

• infected persons able to pass the virus to others during this time

A _____________ can let a person know if the hepatitis B virus is in their blood or if they have successfully gotten rid of the virus;

simple blood test

if not infected and not received Hepatitis B vaccine

they should start the vaccine series

Primary goals of medical care for HBV

Rest

Managing Symptoms

Fulminant hepatitis

rare, life-threatening condition

can occur with a new acute infection

requires immediate urgent medical attention as person can go into sudden liver failure

Taking care of liver during new infection

• Avoid alcohol

• Stop or limit smoking

• Eat healthy foods

• Avoid greasy or fatty foods

• Talk to health provider about prescriptions and OTC medications

• use of vitamins and liver health supplements will likely not assist your recovery and may actually cause more harm than good to the liver

• Be sure to follow up with your health care provider for any additional blood tests that are needed to confirm your recovery from an acute infection

Chronic HBV

People who tested positive for HBV for more than six months (after first blood test result)

immune system was not able to get rid of HBV and still remains in their blood and liver

90% of infected ______________ will develop chronic HB infection

newborns and babies

Up to 50% infected ___________________ will develop chronic HB infection

children (1-5 years old)

____________ of infected adults will develop chronic HB infection (90% will recover)

5-10%

Assessment

• Exposure to risk factors for an infected mother during pregnancy

• Past and present medical history; include intimate relationship with infected individual

• S/S of HB physiologically and clinical findings

• Level of understanding with HBV

• Coping ability to maintain healthy lifestyle

• Skin integrity with presence of yellowish discoloration of the eyes and skin

How many parts does a Hepatitis B Panel have and what does it indicate?

it has 3 parts

need to know all three test results in order to fully understand whether you are infected, protected or still at risk for a hepatitis B infection

may ask to check your blood again in ____________ after your first visit to confirm your hepatitis B status

6 (six) months

Hepatitis B surface antigen (HBsAg)

can detect the actual presence of the hepatitis B virus (surface antigen) in your blood

Hepatitis B surface antigen (+) result

“positive” or “reactive” HBsAg test result means; the person is infected with Hepatitis B

need further testing to determine if it’s an acute or chronic HBI

Hepatitis B surface antibody (HBsAb) (+) result

A “positive” or “reactive” anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus and cannot be infected

Hepatitis B core antibody (HBcAb) (+) result

A “positive” or “reactive” anti- HBc (or HBcAb) indicates a past or current hepatitis B infection

Hepatitis B core antibody (HBcAb)

does not provide any protection against the hepatitis B virus

can only be fully understood by knowing the results of the first two tests (HBsAg and anti-HBs)

Current treatments for hepatitis B

Immune modulator drugs

Antiviral drugs

Immune modulator drugs

• interferon-type drugs

• boost immune system to help get rid of HBV

• given as a shot (how insulin is given)

• over 6 months to 1 year

Antiviral drugs

• stop and slow down HBV from reproducing

• reduces inflammation and damage to liver

• taken as a pill

• once a day

• at least 1 year and usually longer

Diet modifications

• small frequent feeding

• dietary supplements

• administering pharmaceutical agents

  • antacids

  • anti-emetics

Discharge considerations

• Review drug regimen

  • Side effects

  • Potential interactions with other medication

• Review medical regimens and provide information/assistance as necessary

• Emphasize necessity of taking antibiotics as directed

• Provide phone number of contact person to answer questions/ validate information post discharge

In dealing with pain

• Use of nonpharmacological methods of pain control such as relaxation

• Assist patient to learn breathing techniques

Assessing contributing factors

• Note risk factors for occurrence of infection such as skin integrity and environmental exposure

• Observe localized signs of infection

• Note signs and symptoms of sepsis

  • Fever

  • Chills

  • Diaphoresis (sweating)

  • Altered level of consciousness (LOC)

  • Positive blood cultures

Readiness to learn

determine patient’s level of knowledge and ability to learn

Facilitate learning

• Provide written information/guidelines for patient to reinforce learning process

• Begin with information the patient already knows and move to what the patient does not know

  • progressing from simple to complex to limit sense of overwhelmed.

• Provide positive feedback

Hepatitis B is a ______________ disease

vaccine-preventable

Dosing schedule

0.1 to 2 months

4 to 6 months

minimum intervals between doses

• At least four weeks between doses # 1 and # 2.

• At least eight weeks between doses # 2 and # 3.

• At least 16 weeks between doses # 1 and # 3.

If your patient falls behind on the hepatitis B vaccination schedule (even if a year or more has elapsed)

• continue vaccinating from where your patient left off

• The series does NOT need to be restarted

Recommended adult dosing volume of monovalent hepatitis B vaccine

• 19 years and younger

  • 0.5ml per dose

  • (Engerix-B pediatric, GlaxoSmithKline; Recombivax HB pediatric, Merck)

• 20 years and older

  • 1.0 ml per dose

  • (Engerix-B adult, GlaxoSmith Kline; Recombivax HB adult, Merck)

Additional Prevention Measures

• Wash your hands thoroughly with soap and water after potential exposure to blood.

• Use condoms with sexual partners.

• Avoid direct contact with blood and bodily fluids.

• Clean up blood spills with a fresh diluted bleach solution (mix 1 part bleach with 9 parts water).

• Cover all cuts carefully.

• Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body rings.

• Discard sanitary napkins and tampons into plastic bags.

• Avoid illegal street drugs (injecting, inhaling, snorting, or popping pills).

• Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture.