Statistics
Transmission
Prevention Diagnosis Treatment Grab Bag
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What is one of the top 5
causes of death by cancer?
Liver cancer
How many people worldwide
have been infected
with HBV?
Nearly 2 BILLION people
How many people are living
with chronic HBV worldwide?
350 – 400 million people
Compare to the 40 million people
worldwide that are living with HIV
What percentage of Asians in the
US have chronic HBV?
10% of Asian Americans
Which is about 0.3% of the US population
How many people worldwide die
each year from HBV-related
complications?
600,000
True or False
Hepatitis B is hereditary.
Nahttttttttt
How is HBV transmitted?
List 3 major transmission
methods
1. VERTICAL TRANSMISSION – mother to child at birth
2. BLOOD – reusing contaminated medical devices,
sharing IV needles or razors, open wound contact
3. SEX– unprotected sex with someone that has HBV
True or False
HBV can be transmitted from person
to person by mosquitoes.
Actually, we duno  There are no
documented cases of this happening.
However, it is known that different strains
of mosquitoes are able to carry and
transmit different viruses.
Can a non-symptomatic person with
HBV still transmit it to someone else?
Hell yeah they can.
An infected individual’s blood will still have the virus even if
no symptoms are present.
It’s important to remember that for the most part, symptoms
do not show until it’s too late.
The patient is pregnant and has
chronic HBV. Can transmission of
HBV to the child be prevented by
getting a C-section at birth?
NO. A C-section will NOT prevent vertical transmission of
HBV!
Also, a C-section is unnecessary as long as the child gets the
birth dose of HBIg (HBV immunoglobulin) and finishes the
HBV vaccination series
While tabling, someone asks you, “I
want to protect myself from both
Hepatitis A and B. What can I do?”
“You should be vaccinated for Hepatitis A and B (if surface antigen
test is negative). The Hepatitis A vaccine is a 2-shot series. The
Hepatitis B vaccine is a 3-shot series.
There is also a combination Hepatitis A and B vaccine on the market
called Twinrix; the shot schedule for Twinrix is the same as that for
the HBV vaccine.”
Then give em a fancy Twinrix pen.
Why does the WHO call the HBV
vaccine the 1st “anti-cancer”
vaccine?
HBV causes 80% of all liver cancer – preventing and
eliminating HBV infection can essentially eliminate 80%
of all liver cancer.
I received my 1st HBV shot a year
ago, but never completed the
series. What should I do?
You should complete the 2nd and 3rd shots asap
You do not need to repeat the 1st dose.
The recommended schedule for the HBV vaccine is only a series
of MINIMUM time requirements between each shot. (1st shot -1
month – 2nd shot – 5 months – 3rd shot)
Why? The 3rd does is essentially like a booster shot; after the 1st
2 doses, 80% of people have already developed immunity to HBV.
True or False
Current CDC guidelines recommend
getting your blood tested ten years after
being vaccinated, and then getting a
booster shot.
False!
The CDC currently has no recommendations
for
HBV booster shots
Does the HBV vaccine series
work for everyone?
NOT 100%!
Some individuals need to be vaccinated multiple times for any sort of
immunity to develop.
About 5% of people are immunologically non-responsive to the vaccine.
It is recommended that these individuals avoid high-risk activities, such
as sharing IV needles or engaging in unprotected sex, etc.
* * * * *
Drunk driving doesn’t count as a high-risk activity in this case,
but you should probably avoid that anyway 
What should I do to find out if
I have HBV?
Ask your physician for the hepatitis B surface antigen
(HBsAg) blood test.
This is the ONLY blood test that can positively identify
whether or not you’re infected.
At a recent physical my doctor said that my
liver function blood tests are normal, and I feel
completely healthy. Does this mean I am
HBV-free? Why or why not?
Not necessarily.
The HBsAg test is the only blood test that can definitively
determine whether or not you are an HBV carrier.
Also, not all HBV carriers show abnormal liver enzyme
levels. In many carriers, these levels stay normal until they
reach the end stages of liver damage or liver cancer.
Daily
Double!
Explain these test results:
1) HBsAg- / anti-HBs+ / HBcAb+
2) HBsAg- / anti-HBs+ / HBcAb1) The core antibody test (HBcAB) is +, indicating that immunity
was developed during a prior infection. The surface antibody test
(anti-HBs) is also +, so the person is protected from chronic HBV
infection.
2) The core antibody test is negative but the surface antibody is
positive, indicating that immunity was developed by getting the
HBV vaccine.
Explain these test results:
HBsAG+ / anti-HBs+
Patient has the antibodies for HBV, but is still
infected. He/She should follow the same
monitoring recommendations for those with
chronic HBV.
FYI: this is a rare occurrence
Don’t forget! This person can still transmit HBV along to someone else.

Couldn’t think of a question
True or False
Everyone with chronic HBV
needs treatment.
FALSE!
Treatment is costly and harsh on the body.
If no symptoms occur, regular monitoring (ALT, AFP,
ultrasound) is the best course.
What are your recommendations for monitoring of
people with chronic HBV?
With appropriate monitoring, it is completely possible to lead a
normal and healthy life. There are a few tests you should do
regularly to screen your liver for early signs of damage or cancer.
Every 6 months:
- alanine transferase (ALT) test: screens for liver damage.
- alpha-fetoprotein (AFP) test: screens for liver cancer
Also, get an ultrasound of the liver once a year to scan for
tumors.
The combination of all 3 of these tests is essential, as either one by
itself is not 100% effective in detecting liver damage or cancer.
We also recommend getting the hepatitis A vaccine to prevent any
further damage to your liver. Also avoid drinking alcohol.
How many FDA-approved treatments
(not vaccines) for HBV exist today?
There are currently only 5 FDA-approved medications for HBV.
None of these medications can completely eliminate the virus
from your body, but they can help control the viral load.
There have been no other proven treatments found to get rid of
the virus.
3 Oral Antiviral meds – Adefovir, Entecavir, Lamivudine
2 Infection meds – alpha-Interferon, Pegylated interferon shots
Patient: HBsAG + / anti-HBs +
How long should this patient take
the 3 oral medications?
(Adefovir, Entecavir, Lamivudine)
Long-term / For life
I have chronic hepatitis B. I also have cirrhosis, and my
family has a history of liver cancer. What changes, if
any, would you make to the normal recommendations
for monitoring my disease?
Increase the frequency of AFP screening
(for liver cancer) to once every 3-4 months, and
increase the frequency of ultrasounds to once every 6
months.
What are the differences
between Hepatitis A, B, and C?
Hepatitis A is a food-borne virus, Hepatitis B and C are blood-borne.
The main mode of transmission for Hepatitis A is food and water, for
Hepatitis B is mother to child, and for Hepatitis C is blood transfusion.
Hepatitis A is acute infection only; Hepatitis B and C are usually chronic
infections.
Hepatitis A and B have vaccines.
Hepatitis C does not.
Why are HBV rates so much
higher in Asians than in any
other ethnic group?
HBV is endemic to Asia in the same way that
HIV is endemic to Africa.
Main mode of transmission for Asians is vertical transmission.
Non-Asian HBV transmission occurs later in life, usually through
IV drug use or unprotected sex.
Since HBV is passed generation to generation in Asians,
education and awareness are especially crucial.
Daily
Double!
China carries the biggest burden of HBV
in the world. How many people in China
are living with chronic HBV?
130 million people
True or False
A majority of liver cancer is caused by
alcohol abuse.
FALSE!
80% of liver cancer is due to chronic HBV.
and yes this question is too easy for a 400 point question
I completed all three shots of my hepatitis B vaccine
series, but I still do not have immunity. What are some
possible reasons for this? What do you recommend
that I do?
1. The vaccine was not stored properly (an environment that is too hot or cold can
render the vaccine ineffective)
2. The vaccine was administered incorrectly
3. You are immunologically nonresponsive to the vaccine – this is the case in
about 5% of all people.
You can try the vaccine series again, perhaps using a different brand of
vaccine. Get the blood test afterwards to confirm whether or not the vaccine
worked. If the vaccine doesn’t work after multiple tries, you are likely in the 5% of
those unresponsive to the vaccine. In this case, avoid engaging in high-risk
activities like sharing needles, having multiple sexual partners, etc.
Final Jeopardy
Is it true that the HBV vaccine
is equally effective if
administered in the arm or the
butt? Explain.
NOPE
The vaccine does not work if injected in fat, so
it must be given in muscular tissue such as the
arm or thigh. It also does not work
subcutaneously.