Hepatitis B

Cause: Hepatitis B virus.

Illness and treatment: Acute infection may be asymptomatic or have abrupt onset with fever, abdominal pain, and jaundice. Chronic infection is typically asymptomatic until complications such as liver damage or cancer develop after decades. Surface antigen positivity (contagious) during pregnancy from acute or more typically chronic infection gives a risk of transmitting the virus during delivery. Perinatal infection is typically asymptomatic, but infants infected at birth carry a high risk for later complications. A specialist can determine treatment options for hepatitis B virus infections.

Sources: Transmission is through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen and vaginal fluids), including sex with a partner who has HBV infection; injection drug use that involves sharing needles, syringes, or drug-preparation equipment; and birth to a person who has HBV infection.

Additional risks: After acute infection, about 25-50% of children aged 1-5 years will become chronically infected compared to about 5% of adults. Infants infected at birth are at extremely high risk (90%) of becoming chronically infected, and for developing later complications including liver cancer.

Prevention: To prevent infection, routine Hepatitis B immunization of all infants and children is recommended starting at birth. People 59 years or younger and adults aged 60 years and older with certain risk factors should also be vaccinated for hepatitis B. Risk factors include household and sexual contacts of a person infected with hepatitis B, healthcare workers, men who have sex with men, persons with HIV infection and persons with hepatitis C infection. Adults aged 60 years and older without known risk factors for hepatitis B may receive hepatitis B vaccination. The vaccine can also be administered during pregnancy to those at risk. Routine testing is recommended for those born in Asia, Africa, and other regions with ≥2% prevalence of chronic infections. For infants born to hepatitis B positive women, hepatitis B vaccine and one dose of hepatitis B immune globulin (HBIG) administered within 12 hours after birth are 85-95% effective in preventing infection.

Recent Washington trends: In 1987 there were 1,126 hepatitis B acute cases reported in Washington. However, since the implementation of strong vaccination efforts of children and people at risk for infection, hepatitis B incidence has decreased to fewer than 50 acute cases reported annually in recent years. On average, 900-1,900 cases of chronic hepatitis B were reported in Washington residents per year between 2010 and 2021. Additionally, local health jurisdictions follow between 200-330 infants born from pregnant persons living with hepatitis B each year, with reports of 0-3 cases of perinatal hepatitis B virus infections per year.

Purpose of Reporting and Surveillance

To identify sources of infection and prevent further transmission from such sources
To identify new groups at risk and reduce further cases
To inform cases about treatment options
To educate cases about transmission of hepatitis B and how to reduce the risk of transmission
To identify contacts and recommend appropriate preventive measures
To better understand the epidemiology of hepatitis B virus infection and the burden of morbidity from chronic infection

Legal Reporting Requirements

Acute Hepatitis B

Health care providers and Health care facilities: notifiable to local health jurisdiction within 24 hours.
- Providers must also report pregnancy status for patients 12-50 years of age
Laboratories: hepatitis B virus (acute) by IgM positivity notifiable within 24 hours. Specimen submission is on request only in outbreak settings, specimen submission within 2 days of request by DOH or LHJ
- When available and associated with a positive result, laboratories must also report pregnancy status and hepatocellular enzyme levels.
Local health jurisdictions: notifiable to Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (OCDE) via the Washington State Disease Reporting System (WDRS) within 7 days of case investigation completion or summary information required within 21 days.

Chronic Hepatitis B (initial diagnosis and previously unreported prevalent cases)

Health care providers and Health care facilities: notifiable to local health jurisdiction within 3 business days
- Providers must also report pregnancy status for patients 12-50 years of age
Laboratories: all hepatitis B virus by HBsAg (surface antigen), HBeAg (e antigen), or HBV DNA notifiable to local health jurisdiction of patient residence (or ordering health care provider if patient residence is unknown) within 24 hours. Specimen submission is on request only in outbreak settings, specimen submission within 2 days of request by DOH or LHJ.
- When available and associated with a positive result indicated above, laboratories must also report pregnancy status, hepatocellular enzyme levels, and negative IgM anti-HBc results.
Local health jurisdictions: notifiable to DOH Office of Communicable Disease Epidemiology (OCDE) via WDRS within 7 days of case investigation completion or summary information required within 21 days of initial notification of local health authorities

Hepatitis B Surface Antigen Positive Pregnant Women (each pregnancy)

Health care providers and Health care facilities: notifiable to local health jurisdiction within 3 business days
Laboratories: all hepatitis B virus by HBsAg (surface antigen), HBeAg (e antigen), or HBV DNA notifiable within 24 hours
Local health jurisdictions: notifiable to DOH Office of Communicable Disease Epidemiology (OCDE) Perinatal Hepatitis B Prevention Program (PHBPP) via the PHBPP module within 7 days of case investigation completion, or summary information required within 21 days of initial notification to local health authorities.

Perinatal Hepatitis B

Health care providers and Health care facilities: notifiable (as acute hepatitis B) to local health jurisdiction within 3 business days of receiving confirming test result
Laboratories: all hepatitis B virus by HBsAg (surface antigen), HBeAg (e antigen), or HBV DNA notifiable within 24 hours.
Local health jurisdictions: notifiable to DOH Office of Communicable Disease (OCDE) via WDRS within 7 days of case investigation completion, or summary information required within 21 days