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 by contact with the blood, semen or vaginal secretions of an infected person, and can occur with minor exposures or during childbirth.

Additional risks: After acute infection, about 30% of children under 5 years will become chronically infected compared to about 5% of adults. Infants born to surface antigen positive women 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 adults with diabetes aged 19-59 years. 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 both acute and chronic hepatitis B infection.

Recent Washington trends: Since 1987 when there were 1,126 acute cases, hepatitis B incidence has recently decreased to fewer than 50 acute cases per year with increased vaccination. On average, 1,122 cases of chronic hepatitis B were reported per year between 2005 and 2014. Between 2005 and 2013 3,060 babies born to HBsAg positive women were reported to local health jurisdictions. Of these (98%) received treatment within one day of birth and only 20 infants receiving all recommended treatment and follow-up testing developed chronic hepatitis B infections.

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: notifiable to local health jurisdiction within 24 hours
  • Health care facilities: notifiable to local health jurisdiction within 24 hours
  • Laboratories: hepatitis B virus (acute) by IgM positivity notifiable within 24 hours. Specimen submission is on request only in outbreak settings.
  • Local health jurisdictions: notifiable to Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (OCDE) 206-418-5500 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: notifiable to local health jurisdiction within one month
  • Health care facilities: notifiable to local health jurisdiction within one month
  • 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) on a monthly basis
  • Local health jurisdictions: notifiable to DOH Office of Infectious Disease 360-236-3440 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: notifiable to local health jurisdiction within 3 business days
  • 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 on a monthly basis
  • Local health jurisdictions: notifiable to DOH Office of Immunization and Child Profile (OICP) 360-236-3595 Perinatal Hepatitis B Prevention Program within 7 days of case investigation completion, or summary information required within 21 days of initial notification to local health authroities

Perinatal Hepatitis B

  • Health care providers: notifiable (as acute hepatitis B) to local health jurisdiction within 3 business days of receiving confirming test result
  • 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 on a monthly basis
  • Local health jurisdictions: notifiable to OCDE 206-418-5500 and OICP 360-236-3595 within 7 days of case investigation completion, or summary information required within 21 days