1、乙肝与乙肝病毒文档乙肝与乙肝病毒文档乙肝与乙肝病毒文档乙肝与乙肝病毒文档Hepatitis B VirusHepadnaviridae family(DNA)Numerous antigenic componentsHumans are only known hostMay retain infectivity for at least 1 month at room temperatureH e p a t i t i s B V i r u s H e p a d n a v i r i d a200 million carriers worldwideEstablished cause
2、of chronic hepatitis and cirrhosisHuman carcinogen-cause of up to 80%of hepatocellular carcinomasHepatitis B Virus Infection 2 0 0 mi l l i o n c a r r i e r s w o r l d w i dHBsAgHBcAgHBeAgHepatitis B VirusH B s A g H B c A g H B e A g H e p a t i t i s B V i rHepatitis B Clinical FeaturesIncubatio
3、n period 6 weeks to 6 months(average 120 days)Nonspecific prodrome of fever,malaise,headache,myalgiaIllness not specific for hepatitis BAt least 50%of infections asymptomaticH e p a t i t i s B C l i n i c a l F e a t u r e s IFulminant hepatitisHospitalizationCirrhosisHepatocellular carcinomaDeathH
4、epatitis B ComplicationsF u l mi n a n t h e p a t i t i s H e p a t i t i s BChronic Hepatitis B Virus InfectionChronic viremiaResponsible for most mortalityOverall risk 10%Higher risk with early infectionC h r o n i c H e p a t i t i s B V i r u s I n f e0102030405060708090100Birth1-6 mo7-12 mo1-4
5、 yrs5+yrsAge of infectionCarrier risk(%)Risk of Chronic HBV Carriage by Age of InfectionR i s k o f C h r o n i c H B V C a r r i a g e bIntegrate into routine adolescent immunization visitTwo 10 mcg doses of Recombivax HB separated by 4-6 months6-18 monthsRoutine vaccination recommended through age
6、 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 partnersHousehold members and sexual partners of HBV carrie
7、rsManagement 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 hyporesponderGlobal Patterns of Chronic HBV InfectionHep
8、atitis B EpidemiologyReservoirHuman.EndemicTransmissionBloodborneSubclinical cases transmit Communicability1-2 months before and after onset of symptomsChronic carriersI n t e g r a t e i n t o r o u t i n e a d o l e s cHepatitis B Perinatal Transmission*If mother positive for HBsAg and HBeAg70%-90
9、%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 prophylaxisH e p a t i t i s B P e r i n a t a l T r a n s mi s High(8%):45%of global populationlifetime ris
10、k of infection 60%early childhood infections common Intermediate(2%-7%):43%of global populationlifetime risk of infection 20%-60%infections occur in all age groups Low(2%):12%of global populationlifetime risk of infection 8%):4 5%o f g l o b a l p o p0500010000150002000025000300001978198219861990199
11、41998CasesHepatitis B United States,1978-2000Hepatitis B vaccine licensedDecline amonghomosexual menDecline amongIV drug usersH e p a t i t i s B U n i t e d S t a t e s,1Total infections 80,000/yrCurrent carriers 1 millionNew carriers 5,000Deathfulminant hepatitis 200liver cancer 1,500cirrhosis 4,0
12、00HBV Disease Burden in the United States*1999 estimatesT o t a l i n f e c t i o n s 8 0,0 0 0/4%4%84%8%Age of Infection of Acute and Chronic Hepatitis B Virus Infection12%24%58%6%AdolescentChildrenPerinatalAdultAcute infectionChronic infectionCDC Sentinel Sites.1989 data.A g e o f I n f e c t i o
13、n o f A c u t e a n d Unknown31%Other1%Inj drug use15%Homosexual9%Heterosexual41%Health care worker1%Household contact2%Risk Factors for Hepatitis BCDC Sentinel Sites.1992-1993 data.R i s k F a c t o r s f o r H e p a t i t i s B C DHepatitis B Virus Infection by Duration of High Risk Behavior036912
14、15Years at Risk020406080100Percent infectedIV drug userHomosexual menHCWsHeterosexualH e p a t i t i s B V i r u s I n f e c t i o n b yStrategy to Eliminate Hepatitis B Virus Transmission-United StatesPrevent perinatal HBV transmissionRoutine vaccination of all infantsVaccination of children in hig
15、h-risk groupsVaccination of adolescentsVaccination of adults in high-risk groupsS t r a t e g y t o E l i mi n a t e H e p a t i t1965Discovery of Australian antigen1973Successful HBV infection of chimpanzees1981Licensure of plasma-derived vaccine1986Licensure of recombinant vaccine1991Universal inf
16、ant vaccination1996Universal adolescent vaccinationHepatitis B Vaccine1 9 6 5D i s c o v e r y o f A u s t r a l i a n Hepatitis B VaccineCompositionRecombinant HBsAgEfficacy95%(Range,80%-100%)Duration ofImmunity15 yearsSchedule3 DosesBooster doses not routinely recommended H e p a t i t i s B V a c
17、 c i n e C o mp o s i t i o nHepatitis B Vaccine FormulationsRecombivax 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)H e p a t i t i s B V a c c i n e F o r mu l a t i oRecommended Dose of Hepatitis B VaccineInf
18、ants and children20 yearsRecombivax HBDose(mcg)0.5 ml(5)0.5 ml(5)1.0 ml(10)Engerix-BDose(mcg)0.5 ml(10)0.5 ml(10)1.0 ml(20)R e c o mme n d e d D o s e o f H e p a t i t i s Hepatitis B VaccineLong-term EfficacyImmunologic memory established following vaccinationExposure to HBV results in anamnestic
19、anti-HBs responseChronic infection rarely documented among vaccine respondersH e p a t i t i s B V a c c i n eL o n g-t e r m Hepatitis B VaccineRoutine booster doses are NOT routinely recommended for any groupH e p a t i t i s B V a c c i n e R o u t i n e b o oHepatitis B Vaccine RecommendationsYe
20、ar198119911995Recommendation Persons at high riskAll infantsAdolescentsH e p a t i t i s B V a c c i n e R e c o mme n d aIndications for Hepatitis B VaccineInfantsAdolescents 11-12 years of ageSelected adultsI n d i c a t i o n s f o r H e p a t i t i s B V aDosePrimary 1Primary 2Primary 3 Usual Ag
21、e 0-2 months*1-4 months6-18 monthsMinimum Interval -1 month2 monthsHepatitis B VaccineRoutine Infant Schedule*ACIP prefers the first dose of hepatitis B vaccine be given soon after birth and before hospital discharge.Mi n i mu mH e p a t i t i s B V a c c i n e*A C IThird Dose of Hepatitis B Vaccine
22、Minimum of 2 months after second dose,andAt least 4 months after first dose,andFor infants,at least 6 months of ageT h i r d D o s e o f H e p a t i t i s B V a c cVery Low Birthweight InfantsInfants 5,000Injection drug usersHepadnaviridae family(DNA)Chronic Hepatitis B Virus InfectionNonspecific pr
23、odrome of fever,malaise,headache,myalgiaChronic infection*from countries of high or intermediate HBV endemnicityPostvaccination Serologic TestingHepatitis B Virus InfectionCOMVAXHepatitis B-Hib combinationUse when either antigen is indicatedCannot use 6 weeks of ageNot licensed for use if mother HBs
24、Ag+B o o s t e r d o s e s n o t r o u t i n e l y r eHepatitis B VaccineAdolescent VaccinationRoutine vaccination recommended through age 18yearsIntegrate into routine adolescent immunization visitFlexible schedulesH e p a t i t i s B V a c c i n eA d o l e s c e n tDosePrimary 1Primary 2Primary 3
25、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 monthsD o s e Mi n i mu m U s u a l H e p a t i t i s Alternative Adolescent Vaccination ScheduleTwo 10 mcg doses of Recombiva
26、x HB separated by 4-6 monthsMay only be used for adolescents 11-15 years of ageOnly applies to Merck hepatitis B vaccineA l t e r n a t i v e A d o l e s c e n t V a c c i n aAdult Hepatitis B Vaccine CandidatesMen who have sex with menHeterosexual with multiple partnersPersons diagnosed with an STD
27、ProstitutesInjection drug usersMale prison inmatesPersons receiving dialysisHealth care workersA d u l t H e p a t i t i s B V a c c i n e C a n dAdult Hepatitis B Vaccine CandidatesStaff of institutions for developmentally disabledAlaskan Natives,Pacific IslandersImmigrants/refugees*Adoptees,orphan
28、s,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 endemnicityA d u l t H e p a t i t i s B V a c c i n e C a n dPrevaccination Serologic TestingNot in
29、dicated before 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 carriersP r e v a c c i n a t i o n S e r o l o g i c T
30、 e s t iPostvaccination Serologic TestingNot routinely recommended following vaccination of infants,children,adolescents,or most adultsRecommended for:Infants born to HBsAg+womenDialysis patientsImmunodeficient personsCertain health care workers P o s t v a c c i n a t i o n S e r o l o g i c T e s
31、tPostvaccination Serologic TestingHealth care workers who have contact with patients or blood should be tested for antibody after vaccination.P o s t v a c c i n a t i o n S e r o l o g i c T e s tManagement of Nonresponse to Hepatitis B VaccineComplete a second series of three dosesShould be given
32、on the usual schedule of 0,1 and 6 monthsRetest 1 to 2 months after completing the second seriesMa n a g e me n t o f N o n r e s p o n s e t o HPersistent Nonresponse to Hepatitis B Vaccine18 yearsT w i n r i x C o mb i n a t i o n h e p a t i t i s BHepatitis B VaccineAdverse ReactionsPain at inje
33、ction siteMild systemic complaints(fatigue,headache)Temperature 37.7 CSevere systemic reactionsAdults13%-29%11%-17%1%rareInfants and Children3%-9%0%-20%0.4%-6%rareH e p a t i t i s B V a c c i n eA d v e r s e R eHepatitis B VaccineContraindications and PrecautionsSevere allergic reaction to a vaccine component or following a previous doseModerate or severe acute illnessH e p a t i t i s B V a c c i n eC o n t r a i n d i谢谢观看！谢谢观看！谢谢观看！谢谢观看！
