Controll and preventive measures on hepatitis B

Hepatitis B Controll and prevention strategy till 2016

1. HEPATITIS-B PREVENTION & CONTROL Presented by: Rajat Chaudhary

2. Objectives: Control Measures Preventive Measures

3. Risk groups Parenteral drug users Homosexual( mens ) Close contact of individual *newborn of infected mother *regular sexual partners Patient on chronic hemodialysis Patient with chronic liver disease Medical n nursing personnel

4. C ontrol measures include: Immunization : most effective & cost saving means of prevention Awareness : a)to high risk group peoples and others b) Health Personnel : are awared of adequate sterilization of all instruments and practice of simple hygienic measures c) Carriers : not to share razors or tooth brushes and use barrier method of contraceptives Screening of blood & blood products: to reduce the chance that blood supply system may contain pathogen

5. PREVENTION OF HEPATITIS B N o specific treatment till now , prevention is the best .. Following measures available 1.Hepatitis B Vaccine: (Active ) a.plasma derived vaccine b.R DNA- Yeast derived vaccine 2.Hepatitis b immunoglobulin(HBIG) (Passive ) 3.Passive-active immunization (Mixed )

6. 1.General prevention STANDARD PRECAUTIONS Uses of gloves Protective garments Mask & eye protective Disposal needle Bleach solution to decontaminate work surface Autoclaving for metal objects

7. 2.Specific Prevention ACTIVE IMMUNIZATION ( hep B vaccine ) Firstly Introduced in 1982 Derived from plasma of healthy human HBsAg carrier In 1987 genetically engineered vaccine Recombinant yeast Nonglycosylated HBsAg -CI in allergic pt with its components(not ci in pregnancy and lactating) -stored at 2-8 degree centigrade ( frezzing must be avoided as it dissociates antigen from alum ajuvant )

8. Source: cdc

9. Pre exposure prophyalxis In Nepal : As included in pentavalent along with dpt,hib at 6 ,10,14 week

10. Some Faqs : can be given with other vaccines administerd at different sites - In case of missed vaccine after 2 nd or 3 rd dose ,no need to restart - Minimum interval : 1 st and 2 nd -4 week : 2 nd and 3 rd - 8 week - Complete vaccine series : Upto 40 yr : 95 % protective antibody level 40- 60 : 90% Above 60 : 65-75 % - The duration of protection is only 20 yrs and based on current scientific evidence , life long .

11. Specific prevention B)Passive immunization HBIG (Hepatitis B Immunoglobin ) -For immediate protection (lasts for approx. 3 months ) 2 Dose:0.05 to 0.007 ml/kg body wt. Given 30 days apart eg . Surgeons, lab workers, new born infant of carrier mother sexual contact with acute hepatits b infected patients after liver transplatation -given ideally within 6hr of inoculation not later than 48 hrs. Reduces frequency of clinical illness but doesn’t prevent infection

12. C. Passive Active Immunization HBIG and Hepatits B vaccine more efficacious than HBIG alone . They don’t interfere each other Ideal for : Post exposure prophylaxis : Carrier state from infected mother to child Dose: HBIG (0.05-0.07 ml/kg ) within 24 hr : Hepatitis B vaccine 1ml formulation (20 microgram / ml)—IM— within 7 days of expoxure (1 st dose) 2 nd and 3 rd dose after 1 and 6 month respectively

13. Serologoical Testing in vaccine recipient 1. prevaccination testing : for - in areas within prevalence (2% or higher) eg asia ,Africa - drug users -person receving cytotoxic and immunosupessants -homosexuals 2.postvaccination testing : for - chronic hemodyalsis pt. -immunocompromised pt.eg hiv - sex partner with Hbs + 3 . Vaccine Non response (5% -even after 6 dose – may be infected already) Include vaccine factors (dose schedule inj site) Includes host factors (old age>40 ,male ,obesity, smoking ,chronic disease.

14. Take home message: Not treated till dated but can be prevented and controlled Hep B vaccine at 0,1,6 month Hep B+HBIG more effective in perinatal transmission and post exposure prophylaxis.

15. REFERENCES Parks textbook of preventive and social medicine Nepal paediatrics society guidelines for childhood immunization. https:// wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b http:// occmed.oxfordjournals.org/content/61/8/531.long#sec-30 Articles from nature, Usc researches

16. When the student in the doctor dies ,the doctor in the student dies…. Thank you:-p