乙肝與乙肝病毒課件

1、乙肝與乙肝病毒文檔乙肝與乙肝病毒文檔Hepatitis B VirusHepadnaviridae family (DNA)Numerous antigenic componentsHumans are only known hostMay retain infectivity for at least 1 month at room temperatureHepatitis B VirusHepadnavirida200 million carriers worldwideEstablished cause of chronic hepatitis and cirrhosisHuman ca

2、rcinogen - cause of up to 80% of hepatocellular carcinomasHepatitis B Virus Infection200 million carriers worldwidHBsAgHBcAgHBeAgHepatitis B VirusHBsAgHBcAgHBeAgHepatitis B VirHepatitis B Clinical FeaturesIncubation period 6 weeks to 6 months (average 120 days)Nonspecific prodrome of fever, malaise,

3、 headache, myalgiaIllness not specific for hepatitis BAt least 50% of infections asymptomaticHepatitis B Clinical FeaturesIFulminant hepatitisHospitalizationCirrhosisHepatocellular carcinomaDeathHepatitis B ComplicationsFulminant hepatitisHepatitis BChronic Hepatitis B Virus InfectionChronic viremia

4、Responsible for most mortalityOverall risk 10%Higher risk with early infectionChronic Hepatitis B Virus InfeRisk of Chronic HBV Carriage by Age of InfectionRisk of Chronic HBV Carriage bIntegrate into routine adolescent immunization visitTwo 10 mcg doses of Recombivax HB separated by 4-6 months6-18

5、monthsRoutine vaccination recommended through age 18yearsPain at injection sitePrimary 3Overall risk 10%For infants, at least 6 months of ageStrategy to Eliminate Hepatitis B Virus Transmission - United StatesTwo 10 mcg doses of Recombivax HB separated by 4-6 monthsHeterosexual with multiple partner

6、sHousehold members and sexual partners of HBV carriersManagement of Nonresponse to Hepatitis B VaccineCertain health care workersAdult Hepatitis B Vaccine CandidatesHealth care workers who have contact with patients or blood should be tested for antibody after vaccination.May be nonresponder or hypo

7、responderGlobal Patterns of Chronic HBV InfectionHepatitis B EpidemiologyReservoirHuman. EndemicTransmissionBloodborneSubclinical cases transmit Communicability1-2 months before and after onset of symptomsChronic carriersIntegrate into routine adolescHepatitis B Perinatal Transmission*If mother posi

8、tive for HBsAg and HBeAg70%-90% of infants infected90% of infected infants become chronic carriersIf positive for HBsAg only20% of infants infected90% of infected infants become chronic carriers*in the absence of postexposure prophylaxisHepatitis B Perinatal TransmisHigh (8%): 45% of global populati

9、onlifetime risk of infection 60%early childhood infections commonIntermediate (2%-7%): 43% of global populationlifetime risk of infection 20%-60%infections occur in all age groupsLow (2%): 12% of global populationlifetime risk of infection 8%): 45% of global popHepatitis B United States, 1978-2000He

10、patitis B vaccine licensedDecline amonghomosexual menDecline amongIV drug usersHepatitis B United States, 1Total infections 80,000/yrCurrent carriers 1 millionNew carriers 5,000Deathfulminant hepatitis 200liver cancer 1,500cirrhosis 4,000HBV Disease Burden in the United States*1999 estimatesTotal in

11、fections 80,000/Age of Infection of Acute and Chronic Hepatitis B Virus InfectionAcute infectionChronic infectionCDC Sentinel Sites. 1989 data.Age of Infection of Acute and Risk Factors for Hepatitis BCDC Sentinel Sites. 1992-1993 data.Risk Factors for Hepatitis BCDHepatitis B Virus Infection by Dur

12、ation of High Risk Behavior03691215Years at Risk020406080100Percent infectedIV drug userHomosexual menHCWsHeterosexualHepatitis B Virus Infection byStrategy to Eliminate Hepatitis B Virus Transmission - United StatesPrevent perinatal HBV transmissionRoutine vaccination of all infantsVaccination of c

13、hildren in high-risk groupsVaccination of adolescentsVaccination of adults in high-risk groupsStrategy to Eliminate Hepatit1965Discovery of Australian antigen1973Successful HBV infection of chimpanzees1981Licensure of plasma-derived vaccine1986Licensure of recombinant vaccine1991Universal infant vac

14、cination1996Universal adolescent vaccinationHepatitis B Vaccine1965Discovery of Australian Hepatitis B VaccineCompositionRecombinant HBsAgEfficacy95% (Range, 80%-100%)Duration ofImmunity15 yearsSchedule3 DosesBooster doses not routinely recommended Hepatitis B VaccineCompositionHepatitis B Vaccine F

15、ormulationsRecombivax HB (Merck)- 5.0 mcg/0.5 ml (pediatric)- 10 mcg/1 ml (adult)- 40 mcg/1 ml (dialysis)Engerix-B (GSK)- 10 mcg/0.5 ml (pediatric)- 20 mcg/1 ml (adult)Hepatitis B Vaccine FormulatioRecommended Dose of Hepatitis B VaccineInfants and children20 yearsRecombivax HBDose (mcg)0.5 ml (5)0.

16、5 ml (5)1.0 ml (10)Engerix-BDose (mcg)0.5 ml (10)0.5 ml (10)1.0 ml (20)Recommended Dose of Hepatitis Hepatitis B VaccineLong-term EfficacyImmunologic memory established following vaccinationExposure to HBV results in anamnestic anti-HBs responseChronic infection rarely documented among vaccine respo

17、ndersHepatitis B VaccineLong-term Hepatitis B VaccineRoutine booster doses are NOT routinely recommended for any groupHepatitis B VaccineRoutine booHepatitis B Vaccine RecommendationsYear198119911995Recommendation Persons at high riskAll infantsAdolescentsHepatitis B Vaccine RecommendaIndications fo

18、r Hepatitis B VaccineInfantsAdolescents 11-12 years of ageSelected adultsIndications for Hepatitis B VaDosePrimary 1Primary 2Primary 3 Usual Age 0-2 months* 1- 4 months6-18 monthsMinimum Interval -1 month2 monthsHepatitis B VaccineRoutine Infant Schedule*ACIP prefers the first dose of hepatitis B va

19、ccine be given soon after birth and before hospital discharge.MinimumHepatitis B Vaccine*ACIThird Dose of Hepatitis B VaccineMinimum of 2 months after second dose, andAt least 4 months after first dose, andFor infants, at least 6 months of ageThird Dose of Hepatitis B VaccVery Low Birthweight Infant

20、sInfants 5,000Injection drug usersHepadnaviridae family (DNA)Chronic Hepatitis B Virus InfectionNonspecific prodrome of fever, malaise, headache, myalgiaChronic infection*from countries of high or intermediate HBV endemnicityPostvaccination Serologic TestingHepatitis B Virus InfectionCOMVAXHepatitis

21、 B-Hib combinationUse when either antigen is indicatedCannot use 6 weeks of ageNot licensed for use if mother HBsAg+Booster doses not routinely reHepatitis B VaccineAdolescent VaccinationRoutine vaccination recommended through age 18yearsIntegrate into routine adolescent immunization visitFlexible s

22、chedulesHepatitis B VaccineAdolescentDosePrimary 1Primary 2Primary 3 Minimum Interval - 1 month 2 months* Usual Interval -1 month5 monthsHepatitis B VaccineAdolescent and Adult Schedule*third dose must be separated from first dose by at least 4 monthsDose Minimum UsualHepatitis Alternative Adolescen

23、t Vaccination ScheduleTwo 10 mcg doses of Recombivax HB separated by 4-6 monthsMay only be used for adolescents 11-15 years of ageOnly applies to Merck hepatitis B vaccineAlternative Adolescent VaccinaAdult Hepatitis B Vaccine CandidatesMen who have sex with menHeterosexual with multiple partnersPer

24、sons diagnosed with an STDProstitutesInjection drug usersMale prison inmatesPersons receiving dialysisHealth care workersAdult Hepatitis B Vaccine CandAdult Hepatitis B Vaccine CandidatesStaff of institutions for developmentally disabledAlaskan Natives, Pacific IslandersImmigrants/refugees* Adoptees

25、, orphans, unaccompanied minors*Household members and sexual partners of HBV carriers Extended travel to areas of high endemicityRecipients of certain blood products*from countries of high or intermediate HBV endemnicityAdult Hepatitis B Vaccine CandPrevaccination Serologic TestingNot indicated befo

26、re routine vaccination of infants or childrenMay be considered when vaccinating adolescents in groups with high rates of HBV infectionAlaskan NativesPacific IslandersChildren of immigrants from endemic countriesFamily members of HBV carriersPrevaccination Serologic TestiPostvaccination Serologic TestingNot routinely recommended following vaccination of infants, children, adolescents, or most adultsRecommended for:Infants born to HBsAg+ womenDialysis patientsImmunodeficient personsCertain health care workers Postvaccination Serologic TestPostvaccination Serologic Te