Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, December, 2005)

Hepatitis B Fact Sheet, December 2005

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An illness with insidious onset of symptoms including anorexia, vague abdominal discomfort, nausea, vomiting, sometimes arthralgias and rash, often progressing to jaundice. Only a small portion of infections are clinically recognized: less than 10% of children and 30-50% of adults with acute infection will have icteric disease.

B. REPORTING CRITERIA: Laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Positive test for hepatitis B surface antigen (HBsAg).

D. WISCONSIN CASE DEFINITION: Laboratory confirmation.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

1. Acute and Communicable Diseases Report (DPH 4151).

2. Viral Hepatitis Case Record (CDC 53.1) - Acute disease only (anti-HBc IgM+ test result or HBsAg+ test result with symptoms of hepatitis).

C. PREVENTION MEASURES:

• Hepatitis B vaccine recommended for all children 0, 1-2 and 6-18 months of age or, if not previously received, at 11-12 years of age.
• Hepatitis B vaccine is recommended for persons in the following high risk groups: Persons with occupational risk, clients and staff of institutions for the developmentally disabled; hemodialysis patients; recipients of certain blood products; household and sexual partners of HBsAg carriers; certain international travelers; injecting drug users; sexually active persons with multiple partners; and inmates of long-term facilities.

D. PUBLIC HEALTH INTERVENTIONS:

• Educate patient on how to protect others from exposure to the hepatitis B virus (HBV).
• Refer patient to a medical provider to monitor outcome or progress of infection.
• Determine pregnancy status if patient is a woman of child-bearing age. Refer pregnant patient to the Perinatal Hepatitis B Prevention Program. See Perinatal Hepatitis B Prevention Program Manual for detailed follow-up recommendations.
• Persons who are not immune to HAV and who have liver disease should be vaccinated against Hepatitis A.
• Identify sexual contacts. Recommend testing for susceptibility if testing does not delay treatment beyond 14 days of the last sexual exposure. If contact is susceptible, recommend:

1) Hepatitis B immune globulin (HBIG), if it can be given within 14 days of the last sexual exposure, AND

2) Hepatitis B vaccine and post-vaccination serologic testing for all exposed sexual contacts of persons with acute and chronic HBV infection.

• Identify household contacts.
• 1) Recommend HBIG if the contact is an infant <12 months of age and if patient is the primary care giver.
• 2) Prophylaxis with HBIG is not indicated for other household contacts of persons with acute HBV infection unless they have had an identifiable blood exposure to the case within the last 14 days. Individuals with identifiable blood exposures should be treated like sexual exposures.
• 3) Recommend Hep B vaccine for all household contacts of chronic HbsAg carriers.
  

III. CONTACTS FOR CONSULTATION

A. BCDP / IMMUNIZATION PROGRAM: (608) 266-8621

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / HEPATITIS SEROLOGY: (608) 262-2303.

IV. RELATED REFERENCES

1. "Hepatitis B (serum hepatitis)" DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Heymann DL, ed. HEPATITIS VIRAL. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:253-261.

3. Pickering LK, ed. Hepatitis B. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:318-336.

4. Perinatal Hepatitis B Prevention in Wisconsin . Wisconsin Epidemiology Bulletin (WEB), 1994;15(2).

5. Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991; 40 (No. RR-13):1-25.

 

VI. DISEASE TRENDS