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Hepatitis B Facts: Testing and Vaccination

Title: Hepatitis B Facts: Testing and Vaccination Keywords: hepatitis B facts, testing, vaccination, routine vaccination, newborns, birth, sexual exposure, blood ...

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Text of Hepatitis B Facts: Testing and Vaccination

Who Should Be VaccinatedThe following people should receive routine hepatitis B vaccination, according to the Centers for Disease Control and Prevention (CDC):Routine vaccination All newborns within 24 hours of birth All children and teens ages 0 through 18 years All people who wish to be protected from hepatitis B virus (HBV) infection. ACIP and CDC state it is not necessary for the patient to disclose a risk factor to receive hepatitis B who are at risk for sexual exposure Sexually active people who are not in long-term, mutually monog-amous relationships Sex partners of HBsAg-positive people People seeking evaluation or treatment for an STD Men who have sex with menPeople at risk for infection by percutaneous or mucosal expo-sure to blood: People with diabetes (type 1 and type 2): Vaccinate those <60 yrs. For those >60 yrs, vaccinate at discretion of physician. Injection-drug users, current or past Household contacts of HBsAg-positive people Residents and staff of facilities for developmentally challenged people Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids People with end-stage renal disease and those receiving dialysisOthers: Travelers to areas with moderate or high rates of HBV infection People with chronic (life-long) liver disease People with HIV infectionRefugees, immigrants, and adoptees from countries where HBV infection is endemic should have hepatitis B testing. Based on their test results, they should discuss their need for hepatitis B vaccination with their healthcare providers. For certain people at risk, postvaccination testing is recommended. Consult ACIP recommendations for details (see references).Hepatitis B Lab NomenclatureHBsAg: Hepatitis B surface antigen is a marker of current infection. Its presence indicates either acute or chronic HBV : Antibody to hepatitis B surface antigen is a marker of immu-nity. Its presence indicates an immune response to HBV infection, an immune response to vaccination, or the presence of passively acquired antibody. (It is also known as HBsAb, but this abbreviation is best avoided since it is often confused with abbreviations such as HBsAg.)Anti-HBc (total): Antibody to hepatitis B core antigen is a nonspecific marker of acute, chronic, or resolved HBV infection. It is not a marker of vaccine-induced immunity. It may be used in prevaccination test-ing to determine previous exposure to HBV infection. (It is also known as HBcAb, but this abbreviation is best avoided since it is often confused with other abbreviations.)IgM anti-HBc: IgM antibody subclass of anti-HBc. Positivity indicates recent infection with HBV (within the past 6 mos). Its presence indicates acute : Hepatitis B e antigen is a marker of a high degree of HBV infectivity, and it correlates with a high level of HBV replication. It is primarily used to help determine the clinical management of patients with chronic HBV : Antibody to hepatitis B e antigen may be present in an infected or immune person. In persons with chronic HBV infection, its presence suggests a low viral titer and a low degree of : HBV deoxyribonucleic acid is a measure of viral load and reflects viral Hepatitis B Serologic TestingSerologic testing prior to vaccination may be done based on your assess-ment of your patient s level of risk and your or your patient s need for definitive information (see information in the left column). If you decide to test, draw the blood first, and then give the first dose of vaccine at the same office visit. Vaccination can then be continued, if needed, based on the results of the tests. If you are not sure who needs hepa-titis B testing, consult your state or local health department (see ).Immunization Action Coalition Saint Paul, Minnesota 651-647-9009 content reviewed by the Centers for Disease Control and Item #P2110 (5/18)Hepatitis B Facts: Testing and Vaccinationtest results interpretation vaccinate?HBsAg negativeanti-HBc negative susceptibleanti-HBs negativeHBsAg negativeanti-HBc negative immune dueanti-HBs positive with to vaccination >10mlU/mLHBsAg negative immune dueanti-HBc positive to naturalanti-HBs positive infectionHBsAg positiveanti-HBc positive acutelyIgM anti-HBc positive infectedanti-HBs negativeHBsAg positiveanti-HBc positive chronicallyIgM anti-HBc negative infectedanti-HBs negativeHBsAg negative fiveanti-HBc positive interpretationsanti-HBs negative possible*1 May be distantly immune, but the test may not be sensitive enough to detect a very low level of anti-HBs in serum2 May be susceptible with a false positive anti-HBc3 May be chronically infected and have an undetectable level of HBsAg present in the serum4 May be passive transfer of anti-HBc to infant born to HBsAg-positive mother5 May be recovering from acute HBV infection and detectable anti-HBs has not yet appeared*vaccinate if indicatedno vaccination necessaryno vaccination necessaryno vaccination necessaryno vaccination necessary (may need treatment)use clinical judgmentManaging Chronic HBV InfectionWhen you identify a patient who is chronically infected with HBV, make sure you consult a specialist knowledgeable in the treatment of liver disease so your patient s care is optimized. Chronically infected per-sons need medical evaluation every 6 12 months to assess the status of their liver health and their need for antiviral therapy, as well as to screen for liver cancer. In addition, people with chronic HBV infection should be educated about their disease and how to protect members and sex partners of HBsAg-positive people should be tested for HBV infection (HBsAg and anti-HBs or anti-HBc) and should be given the first dose of hepatitis B vaccine at the same visit. (Vaccinating a patient who has already been infected will do no harm). If testing indicates HBV susceptibility, complete the hepatitis B vaccination series. If testing indicates the presence of HBV infec-tion, consultation and further care with a physician knowledgeable about chronic hepatitis B is 1 Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Com-mittee on Immunization Practices. MMWR 2018;67(RR-1):1-302 Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. MMWR 2008;57(RR-8):1-20.(continued in next column)

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