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Hepatitis B VirusHepatitis B Virus
Hepatitis B - Clinical
FeaturesHepatitis B - Clinical
Features• Incubation period: Average 60-90 days
Range 45-180 days• Clinical illness (jaundice):<5 yrs, <10%
5 yrs, 30%-50%
• Acute case-fatality rate: 0.5%-1%• Chronic infection: <5 yrs, 30%-90%
5 yrs, 2%-10% • Premature mortality from
chronic liver disease: 15%-25%
Acute Hepatitis B Virus Infection with Recovery
Acute Hepatitis B Virus Infection with RecoveryTypical Serologic CourseTypical Serologic Course
Weeks after ExposureWeeks after Exposure
TiterTiter
Symptoms
HBeAg anti-HBe
Total anti-HBc
IgM anti-HBc anti-HBsHBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Progression to Chronic Hepatitis B Virus Infection
Progression to Chronic Hepatitis B Virus InfectionTypical Serologic CourseTypical Serologic Course
Weeks after ExposureWeeks after Exposure
TiterTiter
IgM anti-HBc
Total anti-HBc
HBsAg
Acute(6 months)
HBeAg
Chronic(Years)
anti-HBe
0 4 8 12 16 20 24 28 32 36 52 Years
Rate of Reported Hepatitis B by Age Group
United States, 1990
Rate of Reported Hepatitis B by Age Group
United States, 1990
Age Group (Years)Age Group (Years)
Ra
te (
pe
r 1
00,0
00
)R
ate
(p
er
100
,00
0)
Source: CDC Viral Hepatitis Surveillance Program
0-14 15-19 20-29 30-39 40+0
5
10
15
20
25
Age at Aquisition of Acute and Chronic HBV Infection
United States, 1989 Estimates
Age at Aquisition of Acute and Chronic HBV Infection
United States, 1989 Estimates
Acute HBV Infections Chronic HBV Infections
(4% ) Perinatal (24%)(4%) Children (12%)
(1-10 yrs)(8%) Adolescent (6%)
Adult(83%)
Adult(59%)
Outcome of Hepatitis B Virus Infectionby Age at Infection
Outcome of Hepatitis B Virus Infectionby Age at Infection
Symptomatic Infection
Chronic Infection
Age at Infection
Ch
ron
ic In
fect
ion
(%
)
Sym
pto
mat
ic In
fect
ion
(%
)
Birth 1-6 months 7-12 months 1-4 years Older Childrenand Adults
0
20
40
60
80
100100
80
60
40
20
0
• High (8%): 45% of global population– lifetime risk of infection >60%– early childhood infections common
• Intermediate (2%-7%): 43% of global population– lifetime risk of infection 20%-60%– infections occur in all age groups
• Low (<2%): 12% of global population– lifetime risk of infection <20%– most infections occur in adult risk groups
Global Patterns of Chronic HBV Infection
Global Patterns of Chronic HBV Infection
Geographic Distribution of Chronic HBV Infection
Geographic Distribution of Chronic HBV Infection
HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
Concentration of Hepatitis B Virus
in Various Body Fluids
Concentration of Hepatitis B Virus
in Various Body Fluids
High ModerateLow/Not
Detectable
blood semen urineserum vaginal fluid feces
wound exudates saliva sweat
tearsbreastmilk
•Sexual
•Parenteral
•Perinatal
Hepatitis B Virus
Modes of TransmissionHepatitis B Virus
Modes of Transmission
Risk Factors for Acute Hepatitis B
United States, 1992-1993
Risk Factors for Acute Hepatitis B
United States, 1992-1993
* Includes sexual contact with acute cases, carriers, and multiple partners. Source: CDC Sentinel Counties Study of Viral Hepatitis
Heterosexual* (41%)
Homosexual Activity (9%)Household Contact (2%)
Health Care Employment (1%)
Other (1%)Unknown (31%)
InjectingDrug Use
(15%)
• Prevent chronic HBV Infection• Prevent chronic liver disease• Prevent primary hepatocellular
carcinoma• Prevent acute symptomatic HBV
infection
Elimination of Hepatitis B Virus Transmission United States
Elimination of Hepatitis B Virus Transmission United States
Objectives
• Prevent perinatal HBV transmission• Routine vaccination of all infants• Vaccination of children in high-risk groups• Vaccination of adolescents
– all unvaccinated children at 11-12 years of age
– “high-risk” adolescents at all ages• Vaccination of adults in high-risk groups
Elimination of Hepatitis B Virus Transmission United States
Elimination of Hepatitis B Virus Transmission United States
Strategy
Estimated Incidence of Acute Hepatitis B
United States, 1978-1995
Estimated Incidence of Acute Hepatitis B
United States, 1978-1995Vaccinelicensed
HBsAg screening
of pregnant women
recommended
Infantimmunizati
onrecommend
ed
OSHA Ruleenacted
Adolescent immunizati
on recommend
ed
*Decline among
homosexual men & HCWs
Decline among
injectingdrug users
80
70
60
50
40
30
20
10
0
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95
Year
Ca
ses
per
10
0,0
00 P
op
ula
tio
n
* Provisional date