The rules about whom to screen and vaccinate for hepatitis B are now more clinician-friendly.
Clinical Assistant Professor, Department of Medicine, Perelman School of Medicine at University of Pennsylvania ; Internist, Department of Medicine, Hospital Medicine Section, Pennsylvania Hospital, Philadelphia, Pennsylvania Associate Professor of Clinical Medicine, Department of General Internal Medicine, Lewis Katz School of Medicine; Staff Physician, Department of General Internal Medicine, Temple Internal Medicine Associates, Philadelphia, Pennsylvania The Curbsiders.
I'm Dr Matthew Frank Watto, here with my great friend and America's primary care physician, Dr Paul Nelson Williams. We're going to talk about hepatitis B virus . This is a topic that I was very weak on. I will say I feel much better now. It's an exciting time. We've actually changed who we screen for HBV and who we offer vaccinations to. Once upon a time, for our younger listeners, there were very specific criteria for who would be immunized for HBV. You had to look it up on a list, and you were always kind of guessing, It was awful. Now there are updated recommendations that everyone should be offered HBV vaccination, which makes things much easier. But with that comes the question of, how do I know if someone has been vaccinated or needs vaccination, or has an infection or not? So, we're also doing universal screening. Everyone should be screened for HBV at least one time, and then again if their risk factors change. It has been simplified in a lot of ways, although it does give us a chance to look at HBV serologies a lot more frequently, which can be confounding if you're not familiar with them. Which test should we send? We talked about the triple screen. Why do we need to send a triple screen? For hepatitis C, we just send one antibody. Why is HBV different?It's the dream. We can cure hep C too. So hep B aspires to be hep C. The triple screen is a way for you to suss out whether someone has a past exposure, current infection or prior immunization, or active immunity to HBV. The triple screen includes the HBV surface antigen. If this is present, it suggests an ongoing infection. There is the HBV surface antibody and the HBV core antibody. The core antibody is positive only if you've had prior exposure to HBV. The HBV surface antibody can be positive if you have been immunized or if you had past exposure. By putting those three things together, you can figure out if someone has a prior exposure that has now cleared and immune, if they have ongoing infection, or if they've had prior immunization. Nowadays a lot of labs will provide a way to interpret the results when they come back, with a graph or table to tell you which category your patient fits into. Paul, if we find somebody who has not been vaccinated and we want to vaccinate them, we have the traditional three-vaccine series. We also have a combined hepatitis A and B vaccine which can be given. Now there are two newer ones, one of which is a CpG-adjuvanted vaccine for people with a suppressed immune system or who haven't responded to the initial traditional vaccine. It's only two doses and tends to achieve a little bit more robust immune response. This is one of those vaccines where we sometimes check surface antibody titers, because some people may not have a positive titer even after they have gone through the original vaccine series. Now, Paul, there is the counseling. I thought this was interesting to talk about because if someone has HBV, they should basically live alone and not interact with others, right? No sports, no sharing. If they go to Buca di Beppo, they should not be eating family style. Is all this true? Of course, none of that is accurate. A lot of counseling can be done if someone has HBV infection, but the things you mentioned — playing sports, sharing food, casual contact — all those things are perfectly fine. The person with HBV infection should not become an instant hermit. There are some commonsense precautions that they should take to prevent transmission. They should not be sharing razorblades, and for many reasons, they shouldn't be sharing toothbrushes. If blood was spilled for whatever reason, it should be cleaned up with bleach. If a sexual partner is not immune, they should be screened and vaccinated. For patients with ongoing injection drug use, harm reduction is key. You obviously want to vaccinate them right away and make sure they have immunity because their risk is so high. That might be a time to use one of the fancier vaccines. It's also important to counsel that breastfeeding is also fine in the setting of chronic HBV infections. You also want to do some counseling about how to keep their liver from getting sicker because HBV can cause longstanding impact on the liver. When you are counseling patients, what kind of advice do you give them? I'm probably going to want to tell them not to drink alcohol. And our astute guest pointed out that steatotic liver disease is a big problem and can definitely add fuel to the fire. He said a heart-healthy diet is a liver-healthy diet. Any of the things we talk about on the show to keep you metabolically healthy — exercise, eating right, keeping a healthy weight — will protect the liver, too. Of course, caffeine is wonderful for the liver. That's right. Coffee is wonderful for the liver. And vaccinate them for hepatitis A if they haven't had that vaccine. In the podcast, we delved into the management and when to treat HBV. Essentially, you're treating people when they're in the active phases of chronic HBV infection when they have active liver inflammation, a high ALT level, and high levels of HBV DNA. But most primary care clinicians are not going to be doing that treatment on their own. We go into so much detail about this on the podcast. Click here to listen to the full podcast,
HBV - Hepatitis B Virus HBV Liver Preventive Screening Screening Fatty Liver Steatorrhoeic Hepatosis Steatosis Hepatis Liver Disease Hepatic Impairment Immunizations Vaccination Pennsylvania Vaccine Vaccines Biliary Disease Gallbladder Disease Nonalcoholic Fatty Liver Disease NAFLD Non-Alcoholic Fatty Liver Disease Non-Alcoholic Fatty Liver Disease (NAFLD) Fellowship
United States Latest News, United States Headlines
Similar News:You can also read news stories similar to this one that we have collected from other news sources.
Hepatitis C falling in San Diego, but eliminating disease will take more workA big part of driving down the number of hepatitis C infections in San Diego County has been more aggressive outreach to those at increased risk.
Read more »
New Illinois law automatically sets up expungement hearings for juvenilesGov. J.B. Pritzker signed a new law on Friday aimed at simplifying juvenile expungement in Illinois.
Read more »
LA County Public Health detects hepatitis A case at Little Tokyo restaurantPublic Health recommends that anyone who consumes food or beverages at Azay Little Tokyo between July 26 and 30 get a hepatitis A vaccine.
Read more »
Skin infections, hepatitis spread in Gaza due to contaminated waterDiseases like polio and hepatitis are impacting many Gazans, including the elderly and children. NBC News' Richard Engel reports on the humanitarian crisis that is worrying the World Health Organization and the United Nations.
Read more »
Skin infections and hepatitis spread as Gazans resort to drinking and bathing in contaminated waterMuch of Gaza’s water infrastructure has been damaged or destroyed, leaving a lack of clean water — a crisis that’s particularly dire for young children.
Read more »
Finding new targets for blocking chronic hepatitisResearchers revealed how certain liver cells contribute to inflammatory responses underlying chronic hepatitis. Using mouse and cell culture models, they observed increased levels of inflammatory genes, including signaling molecules called chemokines, when hepatic stellate cells did not express a protein known as A20.
Read more »