Prevention and Treatment of hepatitis B
المؤلف:
Mary Louise Turgeon
المصدر:
Immunology & Serology in Laboratory Medicine
الجزء والصفحة:
5th E, P299
2025-09-03
240
Routine hepatitis B vaccination of U.S. children began in 1991. Since then, the reported incidence of acute hepatitis B among children and adolescents (<15 years) has decreased by more than 98% and by 93% in those aged 15 to 24 years. Although not as large as the declines in younger age groups, substantial decreases also have occurred among older persons. The rates are a decrease of 78% in adults aged 25 to 44 years and 61% in adults 45 years of age or older.
The most important factors in preventing transfusion acquired HBV are donor interviewing, screening of donor blood, use of hepatitis-free products when possible, and appropriate use of blood and blood components. In addition, the avoidance of high-risk blood components such as untreated factor VIII pre pared from multiple-donor pools reduces the incidence of HBV.
Elimination of high-risk donors has accounted for at least a 50% reduction in the incidence of hepatitis; routine testing of donated blood for HBsAg has further reduced the incidence by another 20% to 30%. Testing for anti-HBc will detect almost 100% of HBsAg-positive persons, the rare asymptomatic donor in the core window, and the large number of donors who have had subclinical hepatitis B infections and are now immune.
The use of recombinant vaccine against hepatitis B, licensed in 1982, is warranted for high-risk persons, including medical personnel. HBV vaccine is administered in three doses over 7 months and is about 80% to 95% effective. The vaccine is now included in the childhood vaccination schedule. Hepatitis B vaccine is also a vaccine against cancer (hepatocellular carcinoma). Vaccination offers a new approach to preventing transfusion-acquired HBV and the dependent hepatitis D virus (HDV) in patients who are likely to need ongoing trans fusion therapy, such as nonimmune patients with hemophilia, sickle cell anemia, or aplastic anemia.
In cases of accidental needlestick exposure or exposure of mucous membranes or open cuts to HBsAg-positive blood, hepatitis B immune globulin (HBIG) should be administered within 24 hours of exposure and again 25 to 30 days later to nonimmunized patients. Infants born to mothers with acute hepatitis B in the third trimester, or with HBsAg at delivery, should be given HBIG as soon as possible and no later than 24 hours after birth. Persons who are HBsAg-positive or who have anti-HBs need not be given HBIG unless the HBV titer is shown to be low or unknown.
Seven drugs have been licensed in the United States for the treatment of HBV infection. Treatment for about 1 year usually results in the reduction of serum HBV DNA levels and a serum level of HBV DNA that is undetectable by PCR assay.
Liver transplantation is also used for some severe cases of liver disease caused by HBV, although the new organ usually becomes infected with HBV.
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