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Hepatitis Transmission & Immunization – What Pharmacy Professionals Need To Know

HEPATITIS TRANSMISSION & IMMUNIZATION – WHAT PHARMACY PROFESSIONALS NEED TO KNOW

I don’t have a great fear of many viruses, but this one scares the living daylights out of me! I can’t think of another virus that can be infective seven days later. The fact that a blood spill can remain infective for 7 days, this virus has earned a great deal of respect from me!

Hippocrates described “epidemic jaundice” in the fifth century BC. “Serum hepatitis” was first reported in 1883 when a bunch of German shipyard workers got their smallpox vaccine that contained human lymph.When I got my license to administer injectables 15 years ago I was required to get immunized against Hepatitis-B, so now I have a healthy respect, but not as much fear

Table of Contents

HEPATITIS-B TREATMENT

Hepatitis (HBV) is a small, double-stranded DNA virus in the family Hepadnaviridae. Hepatitis B is spread when blood, semen, or other bodily fluid infected with the virus enters the body of a person who is not infected. The incubation period of HBV is 60-90 days. People can become infected with the virus during activities such as:   

  • Birth via neonatal exposure
  • Sex with an infected partner through exposure to infected blood and body fluids such as saliva and menstrual, vaginal, and seminal fluids
  • Sharing needles, syringes, or other drug-injection equipment
  • Sharing items like razors or toothbrushes with an HBV positive person
  • Direct contact with the blood or open sores of an HBV positive person
  • Exposure to blood from needlesticks or other sharp instruments

Most cases are asymptomatic, however persons with acute HBV may progress to chronic HBV. This is seen in approximately:

  • As many as 90% of infants
  • 30% to 50% of children between age 1 and 5
  • 5% of adults

 

HEPATITIS-B PREVALENCE FROM 2020 – The numbers are in

  • 2,157 new cases of acute hepatitis B reported
  • 14,000 estimated acute hepatitis B infections
  • 11,635 cases of newly reported chronic hepatitis B
  • 5 newly reported cases of chronic hepatitis B per 100,000 people
  • 76% of all acute hepatitis B cases were persons aged 30-59 years

Source: https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-b.htm

 

How long does the Hepatitis B virus survive outside the body?

  • Hepatitis B virus can survive outside the body at least 7 days.During that time, the virus can still cause infection if it enters the body of a person who is not infected.

How should blood spills be cleaned from surfaces to make sure that Hepatitis B virus is gone?

  • All blood spills — including those that have already dried — should be cleaned and disinfected with a mixture of bleach and water (one-part household bleach to 10 parts water). Gloves should always be used when cleaning up any blood spills – even dried blood can present a risk to others!

 

Signs, Symptoms, and Transmission of HBV

  • Caused by a DNA virus, it is one of the most common worldwide infections. There are 8 different genotypes (A-H) and 200-300 million chronic carriers worldwide.
  • Symptoms: malaise, anorexia, weakness, nausea, jaundice, abdominal pain, headache, and dark urine.  Malaise and weakness may last for weeks to months after all other symptoms disappear.  Fulminant hepatitis occurs in 1-2% with a mortality rate of up to 60%. 
  • Complications with chronic infection: chronic hepatitis, cirrhosis, liver failure, hepatocellular carcinoma.  About 25% of all carriers develop chronic hepatitis.  Risk of becoming a carrier following infection is 6%-50%.
  • Incubation period: 7-10 days. 
  • Transmission: human to human by exposure to bodily fluids by parenteral or mucosal contact, or sexual transmission.
    • Perinatal transmission is a significant mode.
  • Prevalence in the USA: 800,000 to 1.4 million affected

 

Now for some Good News!

  • Rates of acute Hepatitis B in the United States have declined by approximately 82% since 1990.

 

Vaccines for Hepatitis-B per ACIP recommendations:
ACIP: The Advisory Committee on Immunization Practices

  • Administration of hepatitis B vaccine and hepatitis B immune globulin (HBIG) for infants born to HBV-positive mother within 12 hours of birth, followed by completion of the vaccine series and postvaccination serologic testing
  • Universal hepatitis B vaccination within 24 hours of birth, followed by completion of the vaccine series; and
  • Vaccination of children and adolescents aged <19 years who have not been vaccinated previously

 

3-Dose Vaccine Series for Infants (Including the “Birth Dose”)

Since 1991, ALL medically stable infants with a birth weight of at least 2,000 g in the U.S. are recommended to receive the first dose of hepatitis B vaccine within 24 hours of birth.  The additional 2 doses are given at 1 month and 6 months of age.

  • There are four, 3-dose vaccine brands approved in the U.S.;each dose should be administered Day-0, then one month after first dose; then six months after first dose.
    • Recombivax HB (Merck) [FDA approved 1986]
      • 5 mL (5 mcg) Pediatric/Adolescent Formulation single-dose vials and prefilled syringes
      • 1 mL (10 mcg) Adult Formulation single-dose vials and prefilled syringes
      • RECOMBIVAX HB Dialysis Formulation is a sterile suspension as 1 mL (40 mcg) single-dose vials
    • Engerix-B (GlaxoSmithKline) [FDA approved-1989]
    • Twinrix (GlaxoSmithKline) (Hep-A and HepB)[FDA approved 2001]
    • PreHevbrio (VBI Vaccines) [Approved November 2021]
      • PreHevbrio is only approved for adults aged 18 and over.  
      • Study results indicate that PreHevbrio might provide increased antibody protection compared to other three-dose vaccines, and may be a better option for those with well-managed chronic conditions

 

2-Dose Vaccine Series (Adults >18 Only)

  • Heplisav-B (Dynavax) [FDA approved 2017]
    • 2-dose vaccine recommended in the U.S. for use in adults aged 18 and older. The vaccine is administered as two doses given one-month apart Seroconversion rate was higher for Heplisav-B (91.6%) than Engerix-B 72.6% for the 60-70-year-old age group.

 

Hepatitis-B vaccine for workers:

  • Employers MUST provide at risk workers Hep-B vaccine within 10 days of job assignment
  • Employers must pay for the vaccine
  • Must offer opportunity to get the vaccine while on company time, that is to reimburse patient for time going to get vaccine administered
  • Exceptions:
    • Employee has contraindication
    • Employee proves immunity with antibody testing
    • Employees have been previously vaccinated
    • Employees opting the right to decline vaccine

 

Hepatitis-B immune globulin (HBIG) (BayHep B & Nabi-HB)

HBIG needs to be given as soon as possible after exposure, otherwise it might not be effective. Post-exposure prophylaxis exposure in the following situations:

  • Acute exposure to blood containing HBsAg: needle sticks, mucus membrane contact
  • Perinatal exposure of infants to mother with HBsAg positive mothers
  • Sexual exposure to an HBsAg-positive person
  • Household exposure to people with acute HBV infection

Have a great day on the bench!!

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