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{{Hepatitis B}}
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==Overview==
Common risk factors in the development of HBV infection include sexual contact with infected individuals, sharing a household with a carrier, [[intravenous drug use]], travel to [[endemic]] regions, [[perinatal]] transmission from infected mothers to infants, and certain occupations.
 
==Risk Factors==
==Risk Factors==
Individuals are at increased risk of HBV infection if they
Individuals who are at increased risk of [[hepatitis B infection]] include:<ref name="WHO-Hepatitis-B_2003">World Health Organization. Department of Cummunicable Disease Surveillance and Response http://apps.who.int/iris/bitstream/10665/67746/1/WHO_CDS_CSR_LYO_2002.2_HEPATITIS_B.pdf</ref><ref name="USPTF-Hepatitis-B">US. Preventive Services Task Force. Screening for Hepatitis B infection. (2014) https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014?ds=1&s=hepatitis%20b Accessed on October 4th, 2016</ref>
*Have sex with someone infected with HBV
* Infants born to [[infected]] mothers
*Have sex with more than one partner
* Young children in day-care or residential settings with other children in [[endemic]] areas
*Inject drugs
* Sexual/household contacts of [[infected]] persons
*Are a man who has sex with men
*Patients and employees in [[hemodialysis]] centers
*Live in the same house with someone who has chronic (long-term) HBV infection  
* Injection drug users sharing unsterilized needles
*Have a job that involves contact with human blood
* People sharing unsterilized medical or dental equipment
*Are a client in a home for the developmentally disabled
* People providing or receiving acupuncture and/or tattooing with unsterilized medical devices
*Have hemophilia
* Persons living in regions or travelling to regions with [[endemic]] hepatitis B
*Travel to areas where hepatitis B is common (country listing)
**Country of origin is the major risk factor for HBV infection (prevalence threshold of 2% or greater to define countries with high risk for HBV infection)
* Sexually active heterosexuals
* Lack of [[vaccination]] in infancy
* Men who have sex with men
* [[Hemophilia]] patients
* Travel to areas where hepatitis B is common
 
Frequent and routine exposure to [[blood]] or [[serum]] is the common denominator of healthcare occupational exposure.<ref name="WHO">{{cite web | title = Hepatitis B | url = http://www.who.int/csr/disease/hepatitis/HepatitisB_whocdscsrlyo2002_2.pdf }}</ref>
{|
|[[image:Hbvrisk.png|700px|thumb|center|Source: https://www.cdc.gov/]]
|[[image:Hbvperinatal.png|700px|thumb|center|Source: https://www.cdc.gov/]]
 
|}


One out of 20 people in the United States will get infected with HBV some time during their lives.  
===Hepatitis B Reactivation===
Hepatitis B virus presents in all patients with infection. Patients who are either HBsAg-positive or anti HBc-positive are at the risk of hepatitis B reactivation.


Their risk is higher if their parents were born in Southeast Asia, Africa, the Amazon basin in South America, the Pacific Islands, or the Middle East.
Patients are at risk for HBV reactivation in the following conditions:<ref name="pmid23111095">{{cite journal| author=Lee YH, Bae SC, Song GG| title=Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy. | journal=Clin Exp Rheumatol | year= 2013 | volume= 31 | issue= 1 | pages= 118-21 | pmid=23111095 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23111095  }} </ref><ref name="pmid22392695">{{cite journal| author=Kim PS, Ho GY, Prete PE, Furst DE| title=Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B. | journal=Arthritis Care Res (Hoboken) | year= 2012 | volume= 64 | issue= 8 | pages= 1265-8 | pmid=22392695 | doi=10.1002/acr.21654 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22392695  }} </ref><ref name="pmid6105519">{{cite journal| author=Sagnelli E, Manzillo G, Maio G, Pasquale G, Felaco FM, Filippini P et al.| title=Serum levels of hepatitis B surface and core antigens during immunosuppressive treatment of HBsAg-positive chronic active hepatitis. | journal=Lancet | year= 1980 | volume= 2 | issue= 8191 | pages= 395-7 | pmid=6105519 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6105519  }} </ref><ref name="pmid3884951">{{cite journal| author=Nair PV, Tong MJ, Stevenson D, Roskamp D, Boone C| title=Effects of short-term, high-dose prednisone treatment of patients with HBsAg-positive chronic active hepatitis. | journal=Liver | year= 1985 | volume= 5 | issue= 1 | pages= 8-12 | pmid=3884951 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3884951  }} </ref><ref>Europian Medicines Agency. reviews direct-acting antivirals for hepatitis C. (2016) http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Direct-acting_antivirals_for_hepatitis_C_20/Procedure_started/WC500203479.pdf </ref><ref name="FDA">U.S Food and Drug Adminestration. Drug Safety Communication: FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C http://www.fda.gov/downloads/Drugs/DrugSafety/UCM523499.pdf</ref>
*Receive immunosuppressive therapy
**[[Chemotherapy agents]]
**[[Tumor necrosis factor inhibitor|Tumor necrosis factor (TNF) inhibitor]] ([[Infliximab]])
**[[Methotrexate]] (particularly following its withdrawal)
**[[Abatacept]]
**[[Ustekinumab]]
**Anti-CD 20 agents ([[Rituximab]] and [[Ofatumumab]])
**High to moderate dose [[glucocorticoids]]
*Patients treated with direct-acting antivirals for hepatitis C
**Daklinza
**Epclusa
**Exviera
**Harvoni
**Olysio
**Sovaldi
**Viekira Pak/ Viekira Pak XR
**Technivie
**Zepatier


== References ==   
== References ==   
{{Reflist|2}}
{{Reflist|2}}
{{STD/STI}}
[[Category:Needs overview]]
[[Category:Hepatitis|B]]
[[Category:Viruses]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Mature chapter]]
[[Category:Disease]]


{{WH}}
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[[Category:Gastroenterology]]
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[[Category:Emergency mdicine]]
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[[Category:Infectious disease]]
[[Category:Hepatology]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Sara Mehrsefat, M.D. [3]

Overview

Common risk factors in the development of HBV infection include sexual contact with infected individuals, sharing a household with a carrier, intravenous drug use, travel to endemic regions, perinatal transmission from infected mothers to infants, and certain occupations.

Risk Factors

Individuals who are at increased risk of hepatitis B infection include:[1][2]

  • Infants born to infected mothers
  • Young children in day-care or residential settings with other children in endemic areas
  • Sexual/household contacts of infected persons
  • Patients and employees in hemodialysis centers
  • Injection drug users sharing unsterilized needles
  • People sharing unsterilized medical or dental equipment
  • People providing or receiving acupuncture and/or tattooing with unsterilized medical devices
  • Persons living in regions or travelling to regions with endemic hepatitis B
    • Country of origin is the major risk factor for HBV infection (prevalence threshold of 2% or greater to define countries with high risk for HBV infection)
  • Sexually active heterosexuals
  • Lack of vaccination in infancy
  • Men who have sex with men
  • Hemophilia patients
  • Travel to areas where hepatitis B is common

Frequent and routine exposure to blood or serum is the common denominator of healthcare occupational exposure.[3]

Source: https://www.cdc.gov/
Source: https://www.cdc.gov/

Hepatitis B Reactivation

Hepatitis B virus presents in all patients with infection. Patients who are either HBsAg-positive or anti HBc-positive are at the risk of hepatitis B reactivation.

Patients are at risk for HBV reactivation in the following conditions:[4][5][6][7][8][9]

References

  1. ↑ World Health Organization. Department of Cummunicable Disease Surveillance and Response http://apps.who.int/iris/bitstream/10665/67746/1/WHO_CDS_CSR_LYO_2002.2_HEPATITIS_B.pdf
  2. ↑ US. Preventive Services Task Force. Screening for Hepatitis B infection. (2014) https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014?ds=1&s=hepatitis%20b Accessed on October 4th, 2016
  3. ↑ "Hepatitis B" (PDF).
  4. ↑ Lee YH, Bae SC, Song GG (2013). "Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy". Clin Exp Rheumatol. 31 (1): 118–21. PMID 23111095.
  5. ↑ Kim PS, Ho GY, Prete PE, Furst DE (2012). "Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B." Arthritis Care Res (Hoboken). 64 (8): 1265–8. doi:10.1002/acr.21654. PMID 22392695.
  6. ↑ Sagnelli E, Manzillo G, Maio G, Pasquale G, Felaco FM, Filippini P; et al. (1980). "Serum levels of hepatitis B surface and core antigens during immunosuppressive treatment of HBsAg-positive chronic active hepatitis". Lancet. 2 (8191): 395–7. PMID 6105519.
  7. ↑ Nair PV, Tong MJ, Stevenson D, Roskamp D, Boone C (1985). "Effects of short-term, high-dose prednisone treatment of patients with HBsAg-positive chronic active hepatitis". Liver. 5 (1): 8–12. PMID 3884951.
  8. ↑ Europian Medicines Agency. reviews direct-acting antivirals for hepatitis C. (2016) http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Direct-acting_antivirals_for_hepatitis_C_20/Procedure_started/WC500203479.pdf
  9. ↑ U.S Food and Drug Adminestration. Drug Safety Communication: FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C http://www.fda.gov/downloads/Drugs/DrugSafety/UCM523499.pdf

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