1
Hepatitis BCDNA National Guidelines for Public Health UnitsRevision historyVersionDateRevised byChanges1.021 March 2017Katrina Knope and Mark VeitchIncorporated CDNA commentsThe Series of National Guidelines (‘the Guidelines’) have been developed by the Communicable Diseases Network Australia (CDNA) and endorsed by the Australian Health Protection Principal Committee (AHPPC). Their purpose is to provide nationally consistent guidance to public health units (PHUs) in responding to a notifiable disease event. These guidelines capture the knowledge of experienced professionals and provide guidance on best practice based upon the best available evidence at the time of completion.Readers should not rely solely on the information contained within these guidelines. Guideline information is not intended to be a substitute for advice from other relevant sources including, but not limited to, the advice from a health professional. Clinical judgement and discretion may be required in the interpretation and application of these guidelines.The membership of CDNA and AHPPC, and the Commonwealth of Australia as represented by the Department of Health (‘Health’), do not warrant or represent that the information contained in the Guidelines is accurate, current or complete. CDNA, AHPPC and Health do not accept any legal liability or responsibility for any loss, damages, costs or expenses incurred by the use of, or reliance on, or interpretation of, the information contained in the guidelines.Endorsed by CDNA: 25 October 2017Noted by AHPPC: 9 January 2018Released by Health: 21 February 2018 Table of contents TOC \o "1-2" \h \z \u 1.Summary PAGEREF _Toc477871915 \h 32.The disease PAGEREF _Toc477871916 \h 33.Routine prevention activities PAGEREF _Toc477871917 \h 84.Surveillance objectives PAGEREF _Toc477871918 \h 95.Data management PAGEREF _Toc477871919 \h munications PAGEREF _Toc477871920 \h 107.Case definition PAGEREF _Toc477871921 \h 108.Laboratory testing PAGEREF _Toc477871922 \h 119.Case management PAGEREF _Toc477871923 \h 13Response times PAGEREF _Toc477871924 \h 13Response procedure PAGEREF _Toc477871925 \h 13Case investigation PAGEREF _Toc477871926 \h 13Education PAGEREF _Toc477871927 \h 16Isolation and restriction PAGEREF _Toc477871928 \h 1610.Environmental investigation PAGEREF _Toc477871929 \h 1711.Contact management PAGEREF _Toc477871930 \h 17Contact definition PAGEREF _Toc477871931 \h 18Prophylaxis PAGEREF _Toc477871932 \h 18Passive immunisation PAGEREF _Toc477871933 \h 18Active immunisation PAGEREF _Toc477871934 \h 18Education PAGEREF _Toc477871935 \h 19Isolation and restriction PAGEREF _Toc477871936 \h 1912.Special situations PAGEREF _Toc477871937 \h 2013.References and additional sources of information PAGEREF _Toc477871938 \h 22Further information14.Appendices HYPERLINK \l "_Toc477871941" Appendix 1: PHU Checklist for hepatitis B casesAppendix 2: Sample hepatitis B sample case report formAppendix 3: Hepatitis B Information sheetAppendix 4: Jurisdictional laboratoriesAppendix 5: Template letter for unspecified hepatitis BHepatitis BCDNA National Guidelines for Public Health UnitsSummaryPublic health priorityHigh for newly acquired cases; routine for those with chronic infection and unspecified cases. Note: The terms acute and chronic refer to the two typical clinical presentations of hepatitis?B virus (HBV) infection. The National Notifiable Disease Surveillance System?(NNDSS) case definitions refer to newly acquired cases, which is largely synonymous with acute infections; and unspecified cases. Unspecified cases are likely to be mostly chronic infections but a small proportion may be acute.Case managementIndividual clinical case management is the responsibility of the treating clinician. Public?health units (PHUs) should determine if the case is newly acquired and where possible, identify potential source/s of exposure.Contact managementThe jurisdictional or regional PHU will engage with the treating clinician, to identify contacts of both newly acquired and unspecified infections; and to support the treating clinician to minimise the public health consequences of HBV infection through counselling, additional testing, post-exposure prophylaxis and/or vaccination of non-immune contacts. The diseaseInfectious agentsHBV is comprised of a number of clinically and diagnostically important viral proteins. These include the envelope protein hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg), and a soluble nucleocapsid protein, hepatitis B e antigen (HBeAg). Eight?genotypes of HBV have been identified (A to H) that have different geographical distributions and clinical outcomes. The more common genotypes in Asia are B and C; and in Europe, the Middle East, and India, A and D. The distribution of genotypes in Australia is less well defined, but the range of genotypes present is likely to reflect the migration patterns from high prevalence countries. Genotype C4 is prevalent among Aboriginal communities in Northern Australia PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EYXZpZXM8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
ZWNOdW0+MTYxMDwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oMSwgMik8L0Rpc3BsYXlUZXh0PjxyZWNv
cmQ+PHJlYy1udW1iZXI+MTYxMDwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJF
TiIgZGItaWQ9IjB2cnM5ZWY1Y3p3ejk2ZTVhemZwcHRmdDJmZHZwZmE1enZ4dyI+MTYxMDwva2V5
PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYt
dHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+RGF2aWVzLCBKLjwvYXV0aG9yPjxh
dXRob3I+TGl0dGxlam9obiwgTS48L2F1dGhvcj48YXV0aG9yPkxvY2FybmluaSwgUy4gQS48L2F1
dGhvcj48YXV0aG9yPldoaXRpbmcsIFMuPC9hdXRob3I+PGF1dGhvcj5IYWprb3dpY3osIEsuPC9h
dXRob3I+PGF1dGhvcj5Db3dpZSwgQi4gQy48L2F1dGhvcj48YXV0aG9yPkJvd2RlbiwgRC4gUy48
L2F1dGhvcj48YXV0aG9yPlRvbmcsIFMuIFkuPC9hdXRob3I+PGF1dGhvcj5EYXZpcywgSi4gUy48
L2F1dGhvcj48L2F1dGhvcnM+PC9jb250cmlidXRvcnM+PGF1dGgtYWRkcmVzcz5NZW56aWVzIFNj
aG9vbCBvZiBIZWFsdGggUmVzZWFyY2ggYW5kIENoYXJsZXMgRGFyd2luIFVuaXZlcnNpdHksIERh
cndpbiwgTm9ydGhlcm4gVGVycml0b3J5LCBBdXN0cmFsaWEuPC9hdXRoLWFkZHJlc3M+PHRpdGxl
cz48dGl0bGU+TW9sZWN1bGFyIGVwaWRlbWlvbG9neSBvZiBoZXBhdGl0aXMgQiBpbiB0aGUgSW5k
aWdlbm91cyBwZW9wbGUgb2Ygbm9ydGhlcm4gQXVzdHJhbGlhPC90aXRsZT48c2Vjb25kYXJ5LXRp
dGxlPkogR2FzdHJvZW50ZXJvbCBIZXBhdG9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5K
b3VybmFsIG9mIGdhc3Ryb2VudGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3k8L2FsdC10aXRsZT48L3Rp
dGxlcz48cGVyaW9kaWNhbD48ZnVsbC10aXRsZT5KIEdhc3Ryb2VudGVyb2wgSGVwYXRvbDwvZnVs
bC10aXRsZT48YWJici0xPkpvdXJuYWwgb2YgZ2FzdHJvZW50ZXJvbG9neSBhbmQgaGVwYXRvbG9n
eTwvYWJici0xPjwvcGVyaW9kaWNhbD48YWx0LXBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBHYXN0
cm9lbnRlcm9sIEhlcGF0b2w8L2Z1bGwtdGl0bGU+PGFiYnItMT5Kb3VybmFsIG9mIGdhc3Ryb2Vu
dGVyb2xvZ3kgYW5kIGhlcGF0b2xvZ3k8L2FiYnItMT48L2FsdC1wZXJpb2RpY2FsPjxwYWdlcz4x
MjM0LTQxPC9wYWdlcz48dm9sdW1lPjI4PC92b2x1bWU+PG51bWJlcj43PC9udW1iZXI+PGVkaXRp
b24+MjAxMy8wMi8yNjwvZWRpdGlvbj48a2V5d29yZHM+PGtleXdvcmQ+QWR1bHQ8L2tleXdvcmQ+
PGtleXdvcmQ+QXVzdHJhbGlhL2VwaWRlbWlvbG9neTwva2V5d29yZD48a2V5d29yZD5ETkEsIFZp
cmFsL2dlbmV0aWNzPC9rZXl3b3JkPjxrZXl3b3JkPkZlbWFsZTwva2V5d29yZD48a2V5d29yZD5H
ZW5vdHlwZTwva2V5d29yZD48a2V5d29yZD5IZXBhdGl0aXMgQi8qZXBpZGVtaW9sb2d5LypnZW5l
dGljczwva2V5d29yZD48a2V5d29yZD5IZXBhdGl0aXMgQiBlIEFudGlnZW5zPC9rZXl3b3JkPjxr
ZXl3b3JkPkhlcGF0aXRpcyBCIHZpcnVzLypnZW5ldGljczwva2V5d29yZD48a2V5d29yZD5IdW1h
bnM8L2tleXdvcmQ+PGtleXdvcmQ+SW5jaWRlbmNlPC9rZXl3b3JkPjxrZXl3b3JkPk1hbGU8L2tl
eXdvcmQ+PGtleXdvcmQ+TWlkZGxlIEFnZWQ8L2tleXdvcmQ+PGtleXdvcmQ+UG9seW1lcmFzZSBD
aGFpbiBSZWFjdGlvbjwva2V5d29yZD48a2V5d29yZD4qUG9wdWxhdGlvbiBHcm91cHM8L2tleXdv
cmQ+PGtleXdvcmQ+WW91bmcgQWR1bHQ8L2tleXdvcmQ+PC9rZXl3b3Jkcz48ZGF0ZXM+PHllYXI+
MjAxMzwveWVhcj48cHViLWRhdGVzPjxkYXRlPkp1bDwvZGF0ZT48L3B1Yi1kYXRlcz48L2RhdGVz
Pjxpc2JuPjE0NDAtMTc0NiAoRWxlY3Ryb25pYykmI3hEOzA4MTUtOTMxOSAoTGlua2luZyk8L2lz
Ym4+PGFjY2Vzc2lvbi1udW0+MjM0MzI1NDU8L2FjY2Vzc2lvbi1udW0+PHdvcmstdHlwZT5SZXNl
YXJjaCBTdXBwb3J0LCBOb24tVS5TLiBHb3YmYXBvczt0PC93b3JrLXR5cGU+PHVybHM+PHJlbGF0
ZWQtdXJscz48dXJsPmh0dHA6Ly93d3cubmNiaS5ubG0ubmloLmdvdi9wdWJtZWQvMjM0MzI1NDU8
L3VybD48L3JlbGF0ZWQtdXJscz48L3VybHM+PGVsZWN0cm9uaWMtcmVzb3VyY2UtbnVtPjEwLjEx
MTEvamdoLjEyMTc3PC9lbGVjdHJvbmljLXJlc291cmNlLW51bT48bGFuZ3VhZ2U+ZW5nPC9sYW5n
dWFnZT48L3JlY29yZD48L0NpdGU+PENpdGU+PEF1dGhvcj5TdWdhdWNoaTwvQXV0aG9yPjxZZWFy
PjIwMDE8L1llYXI+PFJlY051bT4xNjgxPC9SZWNOdW0+PHJlY29yZD48cmVjLW51bWJlcj4xNjgx
PC9yZWMtbnVtYmVyPjxmb3JlaWduLWtleXM+PGtleSBhcHA9IkVOIiBkYi1pZD0iMHZyczllZjVj
end6OTZlNWF6ZnBwdGZ0MmZkdnBmYTV6dnh3Ij4xNjgxPC9rZXk+PC9mb3JlaWduLWtleXM+PHJl
Zi10eXBlIG5hbWU9IkpvdXJuYWwgQXJ0aWNsZSI+MTc8L3JlZi10eXBlPjxjb250cmlidXRvcnM+
PGF1dGhvcnM+PGF1dGhvcj5TdWdhdWNoaSwgRi48L2F1dGhvcj48YXV0aG9yPk1pem9rYW1pLCBN
LjwvYXV0aG9yPjxhdXRob3I+T3JpdG8sIEUuPC9hdXRob3I+PGF1dGhvcj5PaG5vLCBULjwvYXV0
aG9yPjxhdXRob3I+S2F0bywgSC48L2F1dGhvcj48YXV0aG9yPlN1enVraSwgUy48L2F1dGhvcj48
YXV0aG9yPktpbXVyYSwgWS48L2F1dGhvcj48YXV0aG9yPlVlZGEsIFIuPC9hdXRob3I+PGF1dGhv
cj5CdXR0ZXJ3b3J0aCwgTC4gQS48L2F1dGhvcj48YXV0aG9yPkNvb2tzbGV5LCBXLiBHLjwvYXV0
aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48YXV0aC1hZGRyZXNzPlNlY29uZCBEZXBhcnRt
ZW50IG9mIEludGVybmFsIE1lZGljaW5lIGFuZCBMYWJvcmF0b3J5IE1lZGljaW5lLCBOYWdveWEg
Q2l0eSBVbml2ZXJzaXR5IE1lZGljYWwgU2Nob29sLCBLYXdhc3VtaSwgTWl6dWhvLCA0NjctODYw
MSBOYWdveWEsIEphcGFuLjwvYXV0aC1hZGRyZXNzPjx0aXRsZXM+PHRpdGxlPkEgbm92ZWwgdmFy
aWFudCBnZW5vdHlwZSBDIG9mIGhlcGF0aXRpcyBCIHZpcnVzIGlkZW50aWZpZWQgaW4gaXNvbGF0
ZXMgZnJvbSBBdXN0cmFsaWFuIEFib3JpZ2luZXM6IGNvbXBsZXRlIGdlbm9tZSBzZXF1ZW5jZSBh
bmQgcGh5bG9nZW5ldGljIHJlbGF0ZWRuZXNzPC90aXRsZT48c2Vjb25kYXJ5LXRpdGxlPkogR2Vu
IFZpcm9sPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5UaGUgSm91cm5hbCBvZiBnZW5lcmFs
IHZpcm9sb2d5PC9hbHQtdGl0bGU+PC90aXRsZXM+PHBlcmlvZGljYWw+PGZ1bGwtdGl0bGU+SiBH
ZW4gVmlyb2w8L2Z1bGwtdGl0bGU+PC9wZXJpb2RpY2FsPjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10
aXRsZT5UaGUgSm91cm5hbCBPZiBHZW5lcmFsIFZpcm9sb2d5PC9mdWxsLXRpdGxlPjwvYWx0LXBl
cmlvZGljYWw+PHBhZ2VzPjg4My05MjwvcGFnZXM+PHZvbHVtZT44Mjwvdm9sdW1lPjxudW1iZXI+
UHQgNDwvbnVtYmVyPjxlZGl0aW9uPjIwMDEvMDMvMjE8L2VkaXRpb24+PGtleXdvcmRzPjxrZXl3
b3JkPkFtaW5vIEFjaWQgU2VxdWVuY2U8L2tleXdvcmQ+PGtleXdvcmQ+QW5pbWFsczwva2V5d29y
ZD48a2V5d29yZD5BdXN0cmFsaWE8L2tleXdvcmQ+PGtleXdvcmQ+R2Vub3R5cGU8L2tleXdvcmQ+
PGtleXdvcmQ+SGVwYXRpdGlzIEIgU3VyZmFjZSBBbnRpZ2Vucy9hbmFseXNpczwva2V5d29yZD48
a2V5d29yZD5IZXBhdGl0aXMgQiB2aXJ1cy8qY2xhc3NpZmljYXRpb24vZ2VuZXRpY3M8L2tleXdv
cmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPk1vbGVjdWxhciBTZXF1ZW5jZSBE
YXRhPC9rZXl3b3JkPjxrZXl3b3JkPipPY2VhbmljIEFuY2VzdHJ5IEdyb3VwPC9rZXl3b3JkPjxr
ZXl3b3JkPlBoeWxvZ2VueTwva2V5d29yZD48a2V5d29yZD5TZXJvdHlwaW5nPC9rZXl3b3JkPjwv
a2V5d29yZHM+PGRhdGVzPjx5ZWFyPjIwMDE8L3llYXI+PHB1Yi1kYXRlcz48ZGF0ZT5BcHI8L2Rh
dGU+PC9wdWItZGF0ZXM+PC9kYXRlcz48aXNibj4wMDIyLTEzMTcgKFByaW50KSYjeEQ7MDAyMi0x
MzE3IChMaW5raW5nKTwvaXNibj48YWNjZXNzaW9uLW51bT4xMTI1NzE5NDwvYWNjZXNzaW9uLW51
bT48d29yay10eXBlPlJlc2VhcmNoIFN1cHBvcnQsIE5vbi1VLlMuIEdvdiZhcG9zO3Q8L3dvcmst
dHlwZT48dXJscz48cmVsYXRlZC11cmxzPjx1cmw+aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292
L3B1Ym1lZC8xMTI1NzE5NDwvdXJsPjwvcmVsYXRlZC11cmxzPjwvdXJscz48bGFuZ3VhZ2U+ZW5n
PC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPgB=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EYXZpZXM8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS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ADDIN EN.CITE.DATA (1,2).ReservoirHumans are the only known natural host. People with chronic infections are the major reservoir of infection. Mode of transmissionHBV is transmitted via parenteral, percutaneous (broken or penetrated skin) or mucosal exposure to infectious body fluids (blood, vaginal fluids, semen and saliva if contaminated with blood) of an infected person. An extremely small volume of blood may be sufficient to transmit infection because of the high concentration of virus in blood in some individuals. Viral concentrations in blood can exceed 10 billion HBV DNA international units per ml (IU/mL) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2xsaW5nZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFy
PjxSZWNOdW0+MTY3MDwvUmVjTnVtPjxEaXNwbGF5VGV4dD4oMyk8L0Rpc3BsYXlUZXh0PjxyZWNv
cmQ+PHJlYy1udW1iZXI+MTY3MDwvcmVjLW51bWJlcj48Zm9yZWlnbi1rZXlzPjxrZXkgYXBwPSJF
TiIgZGItaWQ9IjB2cnM5ZWY1Y3p3ejk2ZTVhemZwcHRmdDJmZHZwZmE1enZ4dyI+MTY3MDwva2V5
PjwvZm9yZWlnbi1rZXlzPjxyZWYtdHlwZSBuYW1lPSJKb3VybmFsIEFydGljbGUiPjE3PC9yZWYt
dHlwZT48Y29udHJpYnV0b3JzPjxhdXRob3JzPjxhdXRob3I+SG9sbGluZ2VyLCBGLiBCLjwvYXV0
aG9yPjxhdXRob3I+TGF1LCBELiBULjwvYXV0aG9yPjwvYXV0aG9ycz48L2NvbnRyaWJ1dG9ycz48
YXV0aC1hZGRyZXNzPkRlcGFydG1lbnQgb2YgTWVkaWNpbmUsIEV1Z2VuZSBCLiBDYXNleSBIZXBh
dGl0aXMgUmVzZWFyY2ggQ2VudGVyIGFuZCBEaWFnbm9zdGljIExhYm9yYXRvcnksIEJheWxvciBD
b2xsZWdlIG9mIE1lZGljaW5lLCBPbmUgQmF5bG9yIFBsYXphLCBCQ00tMzg1LCBIb3VzdG9uLCBU
WCA3NzAzMC0zNDk4LCBVU0EuIGJsYWluZWhAYmNtLnRtYy5lZHU8L2F1dGgtYWRkcmVzcz48dGl0
bGVzPjx0aXRsZT5IZXBhdGl0aXMgQjogdGhlIHBhdGh3YXkgdG8gcmVjb3ZlcnkgdGhyb3VnaCB0
cmVhdG1lbnQ8L3RpdGxlPjxzZWNvbmRhcnktdGl0bGU+R2FzdHJvZW50ZXJvbCBDbGluIE5vcnRo
IEFtPC9zZWNvbmRhcnktdGl0bGU+PGFsdC10aXRsZT5HYXN0cm9lbnRlcm9sb2d5IGNsaW5pY3Mg
b2YgTm9ydGggQW1lcmljYTwvYWx0LXRpdGxlPjwvdGl0bGVzPjxwZXJpb2RpY2FsPjxmdWxsLXRp
dGxlPkdhc3Ryb2VudGVyb2wgQ2xpbiBOb3J0aCBBbTwvZnVsbC10aXRsZT48YWJici0xPkdhc3Ry
b2VudGVyb2xvZ3kgY2xpbmljcyBvZiBOb3J0aCBBbWVyaWNhPC9hYmJyLTE+PC9wZXJpb2RpY2Fs
PjxhbHQtcGVyaW9kaWNhbD48ZnVsbC10aXRsZT5HYXN0cm9lbnRlcm9sIENsaW4gTm9ydGggQW08
L2Z1bGwtdGl0bGU+PGFiYnItMT5HYXN0cm9lbnRlcm9sb2d5IGNsaW5pY3Mgb2YgTm9ydGggQW1l
cmljYTwvYWJici0xPjwvYWx0LXBlcmlvZGljYWw+PHBhZ2VzPjg5NS05MzE8L3BhZ2VzPjx2b2x1
bWU+MzU8L3ZvbHVtZT48bnVtYmVyPjQ8L251bWJlcj48ZWRpdGlvbj4yMDA2LzExLzMwPC9lZGl0
aW9uPjxrZXl3b3Jkcz48a2V5d29yZD5BbnRpdmlyYWwgQWdlbnRzL3RoZXJhcGV1dGljIHVzZTwv
a2V5d29yZD48a2V5d29yZD5ETkEsIFZpcmFsL2Jsb29kL2RydWcgZWZmZWN0czwva2V5d29yZD48
a2V5d29yZD5EcnVnIFJlc2lzdGFuY2UsIFZpcmFsL2RydWcgZWZmZWN0czwva2V5d29yZD48a2V5
d29yZD5IZXBhdGl0aXMgQiBlIEFudGlnZW5zL2Jsb29kL2RydWcgZWZmZWN0czwva2V5d29yZD48
a2V5d29yZD5IZXBhdGl0aXMgQiB2aXJ1cy9kcnVnIGVmZmVjdHM8L2tleXdvcmQ+PGtleXdvcmQ+
SGVwYXRpdGlzIEIsIENocm9uaWMvZGlhZ25vc2lzLypkcnVnIHRoZXJhcHkvZXBpZGVtaW9sb2d5
LypwYXRob2xvZ3k8L2tleXdvcmQ+PGtleXdvcmQ+SHVtYW5zPC9rZXl3b3JkPjxrZXl3b3JkPklu
Y2lkZW5jZTwva2V5d29yZD48a2V5d29yZD5Vbml0ZWQgU3RhdGVzL2VwaWRlbWlvbG9neTwva2V5
d29yZD48L2tleXdvcmRzPjxkYXRlcz48eWVhcj4yMDA2PC95ZWFyPjxwdWItZGF0ZXM+PGRhdGU+
RGVjPC9kYXRlPjwvcHViLWRhdGVzPjwvZGF0ZXM+PGlzYm4+MDg4OS04NTUzIChQcmludCkmI3hE
OzA4ODktODU1MyAoTGlua2luZyk8L2lzYm4+PGFjY2Vzc2lvbi1udW0+MTcxMjk4MjA8L2FjY2Vz
c2lvbi1udW0+PHdvcmstdHlwZT5Db3JyZWN0ZWQgYW5kIFJlcHVibGlzaGVkIEFydGljbGUmI3hE
O1Jlc2VhcmNoIFN1cHBvcnQsIE5vbi1VLlMuIEdvdiZhcG9zO3QmI3hEO1Jldmlldzwvd29yay10
eXBlPjx1cmxzPjxyZWxhdGVkLXVybHM+PHVybD5odHRwOi8vd3d3Lm5jYmkubmxtLm5paC5nb3Yv
cHVibWVkLzE3MTI5ODIwPC91cmw+PC9yZWxhdGVkLXVybHM+PC91cmxzPjxlbGVjdHJvbmljLXJl
c291cmNlLW51bT4xMC4xMDE2L2ouZ3RjLjIwMDYuMTAuMDAyPC9lbGVjdHJvbmljLXJlc291cmNl
LW51bT48bGFuZ3VhZ2U+ZW5nPC9sYW5ndWFnZT48L3JlY29yZD48L0NpdGU+PC9FbmROb3RlPn==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2xsaW5nZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFy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==
ADDIN EN.CITE.DATA (3). The minimum infectious dose in experimental conditions has been estimated to be approximately 10 HBV DNA copies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb21peWE8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS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 EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Lb21peWE8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS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 EN.CITE.DATA (4). Historically, the risk of HBV transmission from a patient to an uninfected person has been linked to the hepatitis?B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) status of the source patient. In studies of health care workers (HCWs) who sustained needle stick injuries (NSIs) from sharps contaminated with blood containing HBV, the risk of seroconversion for HBV infection ranged from 37?per?cent to 62 per cent if the source patient was both HBsAg-positive and HBeAg?positive, and 23 per cent to 37 per cent if the source was HBsAg-positive but HBeAg-negative [9, HYPERLINK \l "_ENREF_12" \o "Werner, 1982 #49" 12]. The risk of developing clinical hepatitis after exposure ranged from 22 per cent to 31 per cent if the source patient was both HBsAg-positive and HBeAg?positive, and from 1 per cent to 6 per cent if the source was HBsAg-positive but HBeAg-negative ADDIN EN.CITE <EndNote><Cite><Author>Schillie</Author><Year>2013</Year><RecNum>1751</RecNum><DisplayText>(5, 6)</DisplayText><record><rec-number>1751</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1751</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schillie, Sarah</author><author>Murphy, Trudy V</author><author>Sawyer, Mark</author><author>Ly, Kathleen</author><author>Hughes, Elizabeth</author><author>Jiles, Ruth</author><author>de Perio, Marie A</author><author>Reilly, Meredith</author><author>Byrd, Kathy</author><author>Ward, John W</author></authors></contributors><titles><title>CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management</title><secondary-title>MMWR Recomm Rep</secondary-title></titles><periodical><full-title>MMWR Recomm Rep</full-title><abbr-1>MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control</abbr-1></periodical><pages>1-19</pages><volume>62</volume><number>10</number><dates><year>2013</year></dates><urls></urls></record></Cite><Cite><Author>Werner</Author><Year>1982</Year><RecNum>1752</RecNum><record><rec-number>1752</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1752</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Werner, Barbara G</author><author>Grady, George F</author></authors></contributors><titles><title>Accidental Hepatitis-B-Surface-Antigen-Positive InoculationsUse of e Antigen to Estimate Infectivity</title><secondary-title>Ann Intern Med</secondary-title></titles><periodical><full-title>Ann Intern Med</full-title><abbr-1>Annals of internal medicine</abbr-1></periodical><pages>367-369</pages><volume>97</volume><number>3</number><dates><year>1982</year></dates><isbn>0003-4819</isbn><urls></urls></record></Cite></EndNote>(5, 6).As viral load monitoring becomes more common, these risks will be re-evaluated using new data. In general, higher viral loads in a source patient have been associated with increased probability of seroconversion in a recipient ADDIN EN.CITE <EndNote><Cite><Author>Wiseman</Author><Year>2009</Year><RecNum>1753</RecNum><DisplayText>(7)</DisplayText><record><rec-number>1753</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1753</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiseman, Elke</author><author>Fraser, Melissa A</author><author>Holden, Sally</author><author>Glass, Anne</author><author>Kidson, Bronwynne L</author><author>Heron, Leon G</author><author>Maley, Michael W</author><author>Ayres, Anna</author><author>Locarnini, Stephen A</author><author>Levy, Miriam T</author></authors></contributors><titles><title>Perinatal transmission of hepatitis B virus: an Australian experience</title><secondary-title>Medical Journal of Australia</secondary-title></titles><periodical><full-title>Medical Journal of Australia</full-title></periodical><pages>489</pages><volume>190</volume><number>9</number><dates><year>2009</year></dates><isbn>0025-729X</isbn><urls></urls></record></Cite></EndNote>(7). Modes of transmission include:Perinatal transmission from an infected mother to her infant. Percutaneous or parenteral exposure to infected blood and other bodily fluids in scenarios including:sharing and reusing contaminated objects that pierce the skin or mucous membranes, such as needles, syringes, injecting fluids and other equipment associated with injecting drug use (IDU), tattoo equipment, body-piercing equipment, acupuncture equipment, razor blades, toothbrushes and manicure/pedicure instruments such as nail clippersneedle-stick injuries transfusion of infected blood or blood products. The Australian Red Cross Blood Service commenced screening for HBsAg in July 1971 and have used HBV DNA screening since 2010invasive medical or dental procedures if there has been inadequate infection controlhuman bitesdirect contact through non-intact skin with the blood or open sores of an infected person. Mucosal exposure to infected blood and other bodily fluids in scenarios including:sexual contactcontact between infectious body fluid and mucous membranes, such as a splash of blood into eyes or mouth.Transmission occasionally occurs in settings, such as households, through non-sexual contact with an infected person, but where the precise mode of transmission is unclear. Overcrowded homes increase this risk where there are more people and hence more chances of contact and exposure with an infected person. The risk of transmission of hepatitis B may also be increased in settings where there is a high prevalence of violence and injury, or where cultural practices involve exposure to blood.There is no evidence for HBV transmission by:breast feeding ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2013</Year><RecNum>1688</RecNum><DisplayText>(8)</DisplayText><record><rec-number>1688</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1688</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, X.</author><author>Chen, J.</author><author>Wen, J.</author><author>Xu, C.</author><author>Zhang, S.</author><author>Zhou, Y. H.</author><author>Hu, Y.</author></authors></contributors><auth-address>Faculty of Nursing, Nanjing Drum Tower Hospital, Nanjing Medical University, Jiangsu, China.</auth-address><titles><title>Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus</title><secondary-title>PLoS One</secondary-title><alt-title>PloS one</alt-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><alt-periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></alt-periodical><pages>e55303</pages><volume>8</volume><number>1</number><edition>2013/02/06</edition><keywords><keyword>*Breast Feeding</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>China/epidemiology</keyword><keyword>Hepatitis B/*epidemiology/*transmission</keyword><keyword>Hepatitis B Antigens/blood</keyword><keyword>Humans</keyword><keyword>Immunoenzyme Techniques</keyword><keyword>Infant</keyword><keyword>*Infectious Disease Transmission, Vertical</keyword><keyword>Logistic Models</keyword><keyword>Prevalence</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2013</year></dates><isbn>1932-6203 (Electronic)
1932-6203 (Linking)</isbn><accession-num>23383145</accession-num><work-type>Comparative Study
Research Support, Non-U.S. Gov't</work-type><urls><related-urls><url>;(8)faecal-oral transmissioninsect vectorskissing coughing or sneezing sharing food or eating utensils skin to skin contact, provided skin is intactsaliva, unless visibly contaminated by blood or inoculated directly into tissues PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY290dDwvQXV0aG9yPjxZZWFyPjE5ODA8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY290dDwvQXV0aG9yPjxZZWFyPjE5ODA8L1llYXI+PFJl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ADDIN EN.CITE.DATA (9-13).Incubation periodThe incubation period varies from 45 to 180 days ADDIN EN.CITE <EndNote><Cite><Author>Heymann</Author><Year>2015</Year><RecNum>1578</RecNum><DisplayText>(14)</DisplayText><record><rec-number>1578</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1578</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Heymann, D.L.</author></authors></contributors><titles><title>Control of Communicable Diseases Manual</title></titles><edition>20th</edition><dates><year>2015</year></dates><publisher>American Public Health Association</publisher><urls></urls></record></Cite></EndNote>(14) and most commonly is 60 to 90 days. The incubation period depends on the amount of virus in the inoculum, mode of transmission, and host factors.Infectious periodInfectivity during acute infections in adults commences several weeks before the onset of symptoms and usually lasts four to five months while HBsAg is present in blood and other secretions PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2xsaW5nZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFy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==
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ib2xsaW5nZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFy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==
ADDIN EN.CITE.DATA (3). People with chronic infection usually remain infectious for life ADDIN EN.CITE <EndNote><Cite><Author>branch</Author><Year>2013</Year><RecNum>1666</RecNum><DisplayText>(15)</DisplayText><record><rec-number>1666</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1666</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>Manitoba Public Health Branch,</author></authors></contributors><titles><title>Communicable disease management protocol, hepatitis B</title></titles><dates><year>2013</year></dates><urls><related-urls><url>;(15).Clinical presentation and outcomeOnly 30 to 50 per cent of adults and less than 10 per cent of children with acute HBV infection have symptoms. In neonates and young children, particularly those less than one?year of age, initial infection is usually asymptomatic. When symptoms are present, they can have an insidious onset and include:anorexia feverjaundice dark-coloured urinelight-coloured stoolsvague abdominal discomfort malaise nausea and vomiting.In 1-10 per cent of acute HBV infections, jaundice may be preceded by an acute fever, arthralgia or arthritis and skin rash. Fulminant hepatitis causing acute liver failure occurs in?<1 per cent of acute HBV infections ADDIN EN.CITE <EndNote><Cite><Author>Mahoney</Author><Year>1999</Year><RecNum>1698</RecNum><DisplayText>(16)</DisplayText><record><rec-number>1698</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1698</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mahoney, F. J.</author></authors></contributors><auth-address>Office of the Director, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Naval Medical Research Unit no. 3, Cairo, Egypt.MahoneyF@namru3.navy.mil</auth-address><titles><title>Update on diagnosis, management, and prevention of hepatitis B virus infection</title><secondary-title>Clin Microbiol Rev</secondary-title><alt-title>Clinical microbiology reviews</alt-title></titles><periodical><full-title>Clin Microbiol Rev</full-title><abbr-1>Clinical microbiology reviews</abbr-1></periodical><alt-periodical><full-title>Clin Microbiol Rev</full-title><abbr-1>Clinical microbiology reviews</abbr-1></alt-periodical><pages>351-66</pages><volume>12</volume><number>2</number><edition>1999/04/09</edition><keywords><keyword>Hepatitis B/diagnosis/prevention & control/*therapy</keyword><keyword>Hepatitis B Vaccines/immunology</keyword><keyword>Hepatitis B virus/genetics/physiology</keyword><keyword>Humans</keyword><keyword>Public Health</keyword><keyword>Vaccination</keyword></keywords><dates><year>1999</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0893-8512 (Print)
0893-8512 (Linking)</isbn><accession-num>10194463</accession-num><work-type>Review</work-type><urls><related-urls><url>;(16). Survival rates for acute liver failure depend on the nature and reversibility of the cause of liver failure, the likelihood of spontaneous hepatic recovery, and access to specialist care in tertiary health services. Studies of patients managed in specialist liver clinics in the USA show more than half of all-cause acute liver failure cases survive PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SZXViZW48L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SZXViZW48L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS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ADDIN EN.CITE.DATA (17, 18). During recovery from HBV infection malaise and fatigue may persist for many weeks. Following acute infection, approximately five per cent of people infected in adulthood, but up to 95 per cent of neonates and 20-30 per cent of children aged one to five years, become chronically infected with HBV?PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWFzbGV5PC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZWFzbGV5PC9BdXRob3I+PFllYXI+MjAwOTwvWWVhcj48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ADDIN EN.CITE.DATA (19, 20). Chronic HBV infection is defined as detection of HBsAg more than six months after prior evidence of infection. Chronic HBV infection is generally asymptomatic until clinical signs of complicated liver diseases such as cirrhosis, portal hypertension or hepatocellular carcinoma become evident. Four successive phases of variable duration have been described for chronic infection: immune tolerance, immune clearance, immune control and immune escape ADDIN EN.CITE <EndNote><Cite><Author>Australia</Author><Year>2009</Year><RecNum>1664</RecNum><DisplayText>(21)</DisplayText><record><rec-number>1664</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1664</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Gastroenterological Society of Australia,</author></authors><secondary-authors><author>Digestive Health Foundation</author></secondary-authors></contributors><titles><title>Australian and New Zealand chronic hepatitis B (CHB) Recommendations</title></titles><reprint-edition>2nd</reprint-edition><dates><year>2009</year></dates><urls><related-urls><url>;(21). The Gastroenterological Society of Australia website (note that the urls for hyperlinked resources are provided in the section Further information) provides a recent clinical update on chronic hepatitis B (CHB). Progression of liver disease due to chronic HBV infection may be:promoted by co-infection with human immunodeficiency virus (HIV), or other forms of immunocompromisepromoted by co-existing chronic liver disease due to alcohol and/or hepatitis C or D PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaWF3PC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48UmVj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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaWF3PC9BdXRob3I+PFllYXI+MjAwNDwvWWVhcj48UmVj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ADDIN EN.CITE.DATA (22).delayed (and reversed) by treatment PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb21tZWph4oCQTWFyaW48L0F1dGhvcj48WWVhcj4yMDAz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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb21tZWph4oCQTWFyaW48L0F1dGhvcj48WWVhcj4yMDAz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ADDIN EN.CITE.DATA (23-25).Premature mortality due to cirrhosis and/or hepatocellular carcinoma is associated with up to 25 per cent of cases of long-term chronic infection ADDIN EN.CITE <EndNote><Cite><Author>ATAGI</Author><Year>2013</Year><RecNum>1663</RecNum><DisplayText>(26)</DisplayText><record><rec-number>1663</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1663</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>ATAGI</author></authors><tertiary-authors><author> </author></tertiary-authors></contributors><titles><title>The Australian Immunisation Handbook</title></titles><edition>10th</edition><dates><year>2013</year></dates><pub-location>Canberra</pub-location><publisher>Commonwealth of Australia</publisher><urls></urls></record></Cite></EndNote>(26). Most people diagnosed with liver cancer in Australia die within one to two years ADDIN EN.CITE <EndNote><Cite><Author>MacLachlan</Author><Year>2012</Year><RecNum>1674</RecNum><DisplayText>(27)</DisplayText><record><rec-number>1674</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1674</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>MacLachlan, J. H.</author><author>Cowie, B. C.</author></authors></contributors><titles><title>Liver cancer is the fastest increasing cause of cancer death in Australians</title><secondary-title>Med J Aust</secondary-title><alt-title>The Medical journal of Australia</alt-title></titles><periodical><full-title>Med J Aust</full-title></periodical><alt-periodical><full-title>The Medical Journal Of Australia</full-title></alt-periodical><pages>492-3</pages><volume>197</volume><number>9</number><edition>2012/11/06</edition><keywords><keyword>Australia/epidemiology</keyword><keyword>Cause of Death</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/*mortality</keyword><keyword>Mortality/trends</keyword></keywords><dates><year>2012</year><pub-dates><date>Nov 5</date></pub-dates></dates><isbn>1326-5377 (Electronic)
0025-729X (Linking)</isbn><accession-num>23121582</accession-num><work-type>Letter</work-type><urls><related-urls><url>;(27). People at increased risk of infectionIn Australia, the following populations are most at risk of acute hepatitis B:Infants born to mothers with CHB, especially if not immunised at birthHousehold contacts of people infected with HBV Sexual contacts of people infected with HBV, including men who have sex with men (MSM) ADDIN EN.CITE <EndNote><Cite><Author>Allard</Author><Year>2014</Year><RecNum>1662</RecNum><DisplayText>(28)</DisplayText><record><rec-number>1662</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1662</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Allard, N.</author><author>Cowie, B.</author></authors></contributors><auth-address>Department of Medicine, Royal Melbourne Hospital, Royal Parade, Parkville, Vic. 3050, Australia.</auth-address><titles><title>Hepatitis B in men who have sex with men and HIV-infected individuals: missed opportunities and future challenges</title><secondary-title>Sex Health</secondary-title><alt-title>Sexual health</alt-title></titles><periodical><full-title>Sex Health</full-title><abbr-1>Sexual health</abbr-1></periodical><alt-periodical><full-title>Sex Health</full-title><abbr-1>Sexual health</abbr-1></alt-periodical><pages>1-4</pages><volume>11</volume><number>1</number><edition>2014/03/29</edition><dates><year>2014</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1448-5028 (Print)
1448-5028 (Linking)</isbn><accession-num>24670300</accession-num><urls><related-urls><url>;(28)People who share needles, syringes, injecting fluids and other injecting equipmentSexual contacts of a person who is an injecting drug userPeople who work in high-risk occupational settings such as healthcare, correctional facilities, laboratories, mortuaries, ambulance or police work, or employment in facilities for the intellectually impaired.Uncommonly in Australia, acute HBV infection can be identified as linked to the following settings:HaemodialysisTattooing, body-piercing or acupuncture without adequate infection controlNeedle stick injuryAccidental exposure of the eyes, mucous membranes or a wound to the blood of another personBlood transfusion - now rare, but risk may occur due to the pre-seroconversion window period, infection with immunovariant viruses or occult HBVReceiving blood transfusions or other blood products, dental or surgical care in overseas settings with poor infection control, especially in areas with high hepatitis B prevalence.In Australia, the following populations (with historical and/or current high prevalence of infection) are most at risk of CHB:People born in an intermediate or high hepatitis B prevalence country (largely through perinatal or early childhood infection)Aboriginal and Torres Strait Islander people (particularly adults infected perinatally or in early childhood before universal vaccination)Infants born to mothers with CHB, especially if not immunised at birthPeople with developmental disabilities PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DdW5uaW5naGFtPC9BdXRob3I+PFllYXI+MTk5NDwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DdW5uaW5naGFtPC9BdXRob3I+PFllYXI+MTk5NDwvWWVh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ADDIN EN.CITE.DATA (29, 30) People living with human immunodeficiency virus (HIV) or hepatitis C virus (HCV) People who have ever been incarcerated in a custodial setting.Disease occurrence and public health significanceBetween 2010 and 2015, the notification rate of newly acquired hepatitis B in Australia ranged from 0.6 to 1.1 per 100,000 population. Since 2006, the rate of diagnosis of newly acquired infections has declined across all age groups, with the greatest declines observed among people aged 15-24 years ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>The Kirby Institute for infection and immunity in society</Author><RecNum>1697</RecNum><DisplayText>(31)</DisplayText><record><rec-number>1697</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1697</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>The Kirby Institute for infection and immunity in society,</author></authors></contributors><titles><title>HIV, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2016</title></titles><number>13 December 2016</number><dates></dates><urls><related-urls><url>;(31). This age-specific decline in hepatitis B notifications is attributable to the HBV vaccination programs introduced nationally from 1997 in adolescents, and infants from 2000. Notified newly acquired cases of HBV infection in Australia occur mostly in adults aged 25?to 39 years of age, and are most often attributed to injecting drug use, sexual contact and occasionally skin penetrating procedures ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>The Kirby Institute for infection and immunity in society</Author><RecNum>1697</RecNum><DisplayText>(31)</DisplayText><record><rec-number>1697</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1697</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>The Kirby Institute for infection and immunity in society,</author></authors></contributors><titles><title>HIV, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2016</title></titles><number>13 December 2016</number><dates></dates><urls><related-urls><url>;(31).The reliability of notification data for informing estimates of incidence and prevalence, newly acquired and chronic infections is limited due to the nature of the disease. Most new HBV infections are asymptomatic and go undetected. Detection of chronic infections relies on regular screening in at risk populations. Higher rates of hospitalisation, mortality and morbidity from HBV infection have been reported among Aboriginal and Torres Strait Islander people compared with the general Australian population. In 2015 the notification rate of newly acquired HBV infection in the Aboriginal and Torres Strait Islander population was more than three times that in the non-Indigenous population ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>The Kirby Institute for infection and immunity in society</Author><RecNum>1697</RecNum><DisplayText>(31)</DisplayText><record><rec-number>1697</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1697</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>The Kirby Institute for infection and immunity in society,</author></authors></contributors><titles><title>HIV, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2016</title></titles><number>13 December 2016</number><dates></dates><urls><related-urls><url>;(31). The overall prevalence of CHB in the Australian population is relatively low for our region, but the number of people living with CHB continues to increase. Between 2006 and 2015 the annual rate of unspecified hepatitis B notifications remained relatively stable ranging between 26.8 and 32.1 per 100,000. It is estimated that 239,200 people (approximately 1?per cent of the population) were living with chronic HBV in 2015, of whom approximately 38 per cent remained undiagnosed and only 6.1 per cent were receiving antiviral treatment? ADDIN EN.CITE <EndNote><Cite><Author>MacLachlan</Author><Year>2016</Year><RecNum>1743</RecNum><DisplayText>(32)</DisplayText><record><rec-number>1743</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1743</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>MacLachlan, J., Cowie, B., </author></authors></contributors><titles><title>Hepatitis B Mapping Project: Estimates of chronic hepatitis B prevalence, diagnosis, monitoring and treatment by Primary Health Network, 2014/15 - National Report, published by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), available from ;(32).Most primary liver cancer is attributable to chronic viral hepatitis. The annual number of new cases of liver cancer recorded in Australian cancer registries almost tripled between 1982?and 2007?(from 1.8?to 5.2?cases per 100?000?population), and while the notification rate of unspecified hepatitis B is currently stable, the burden of CHB is expected to increase.Given current access to treatment and care (with low rates of antiviral administration) the number of cases of hepatitis B related liver cancer is expected to continue to grow ADDIN EN.CITE <EndNote><Cite><Author>MacLachlan</Author><Year>2012</Year><RecNum>1674</RecNum><DisplayText>(27)</DisplayText><record><rec-number>1674</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1674</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>MacLachlan, J. H.</author><author>Cowie, B. C.</author></authors></contributors><titles><title>Liver cancer is the fastest increasing cause of cancer death in Australians</title><secondary-title>Med J Aust</secondary-title><alt-title>The Medical journal of Australia</alt-title></titles><periodical><full-title>Med J Aust</full-title></periodical><alt-periodical><full-title>The Medical Journal Of Australia</full-title></alt-periodical><pages>492-3</pages><volume>197</volume><number>9</number><edition>2012/11/06</edition><keywords><keyword>Australia/epidemiology</keyword><keyword>Cause of Death</keyword><keyword>Humans</keyword><keyword>Liver Neoplasms/*mortality</keyword><keyword>Mortality/trends</keyword></keywords><dates><year>2012</year><pub-dates><date>Nov 5</date></pub-dates></dates><isbn>1326-5377 (Electronic)
0025-729X (Linking)</isbn><accession-num>23121582</accession-num><work-type>Letter</work-type><urls><related-urls><url>;(27). Of people living with chronic hepatitis B in Australia, an estimated 56 per cent are people born overseas, 9 per cent are Aboriginal and Torres Strait Islander people, 5 per cent people who inject drugs (PWID) and 4 per cent men who have sex with men (MSM) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWNMYWNobGFuPC9BdXRob3I+PFllYXI+MjAxMzwvWWVh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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWNMYWNobGFuPC9BdXRob3I+PFllYXI+MjAxMzwvWWVh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ADDIN EN.CITE.DATA (33).Higher prevalence of chronic HBV infection occurs in Mediterranean countries, parts of eastern Europe, Africa, Central and South America (one to five per cent of population chronically infected), and in many sub-Saharan African, East and Southeast Asian and Pacific island populations (around 10 per cent population chronically infected). In regions of intermediate (two to seven per cent of the population is HBsAg-positive) to high prevalence of HBsAg (>8 per cent of the population is HBsAg-positive) infections are mainly acquired perinatally or in early childhood. Australia is within the WHO Western Pacific Region (WPRO), which has the highest burden of HBV related cirrhosis and liver cancer in the world; many countries have >8% prevalence of HBsAg in their adult population, although in a number of countries (including China) very high levels of infant hepatitis B vaccination have been achieved, resulting in a profound reduction in hepatitis B prevalence among those born in recent decades. Reliable epidemiological estimates for hepatitis B are not available for many countries in the region, however WPRO maintains hepatitis data and statistics summarising prevalence of HBsAg and HCV RNA in selected countries. Routine prevention activitiesVaccinationSerum derived HBV vaccines and the recombinant HBV vaccines became available during the 1980s. Some vaccination of infants and high-risk people commenced in Australia in the 1980s. Universal infant vaccination commenced in the Northern Territory in 1990. The adolescent program commenced in states and territories in the mid to late 1990s and the universal infant program, which includes a dose given at birth, began nationally in May?2000. For details of the introduction of hepatitis B vaccination in Australia, refer to the National Centre for Immunisation Research and Surveillance (NCIRS) website. The Australian infant schedule consists of a dose of monovalent hepatitis B vaccine given at birth, followed by hepatitis B-containing combination vaccine given at 2, 4 and 6 months of age. For information on hepatitis B vaccination refer to The Australian Immunisation Handbook. Risk mitigationThe risk of transmission of HBV is reduced by:Screening donated blood and tissuesRoutine antenatal screening of pregnant women for HBsAg, which enables:management to prevent newborn infants developing HBV infection (Table 2,?below);follow-up and management of mothers who have chronic HBV infection; andidentification of the HBV status of other family and household members, protection of those who are susceptible to HBV infection.Universal infant hepatitis B vaccination, including the birth doseVaccination of people at increased risk of infection because of lifestyle, country of birth, Aboriginal and Torres Strait Islander status, medical history, occupation, or sexual, household or household-like or other ongoing intimate contacts with a HBV infected person. This includes household members of the adoptive family if the adopted child is known to have CHB infection Infection control in all healthcare settings and in regulated premises where skin penetrating activities occur, refer to the NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010).Promotion of safer sex practises Promotion of safer injecting drug use practises, provision of sterile injecting equipment (via needle and syringe programmes) and opioid substitution treatment programmesEducation of the case or care-giver about the nature of the infection and the mode of transmission (refer to Education in 9. Case management, below)Cleaning up blood spills, refer to Staying Healthy: Preventing infectious diseases in early childhood education and care services, 5th Edition Avoiding contact with blood or other body fluids and not sharing items potentially contaminated with blood (such as toothbrushes and razors)Access to guideline-based primary healthcare, and specialist care where required, including provision of treatment. Appropriate management improves individual health outcomes, engages the individual with the healthcare system and facilitates testing and vaccination of contacts, allows consideration of expanded approaches to prevention of mother to child transmission in pregnant women, and reduces infectivity among those receiving antiviral therapy. 4. Surveillance objectivesSurveillance of hepatitis B aims to collect data to monitor epidemiological trends in hepatitis B, with particular regard to time, place, population groups, and risk factors. These data are used to identify and characterise clusters of cases; inform and evaluate policies, interventions and services to reduce the transmission and consequences of HBV infections; and contribute to reporting on the progress of national strategies.Data managementConfirmed cases should be entered into notifiable diseases database within five working days of notification. Core data and (for newly acquired cases) enhanced data sought from clinicians and laboratories should be entered as soon as information becomes available. Core and enhanced data from jurisdictions are collated in the NNDSS and by the Kirby Institute. These data are defined in the national core and enhanced hepatitis B datasets. Appendix 2 has a sample case report form based on these specifications for use by PHUs. This data form allows the collection and entry of data additional to that captured by the NNDSS core and enhanced datasets, providing an opportunity to further classify cases and gather additional data on unspecified cases. The extent to which jurisdictions collect data beyond the minimum core and enhanced datasets will depend on resource availability. CommunicationsLaboratories and/or clinicians diagnosing cases of hepatitis B are required to notify the relevant state and territory health authorities in accordance with the relevant legislation or regulations.Case definitionOnly confirmed cases of HBV infection are notifiable. Hepatitis B – newly acquired ReportingOnly con?rmed cases should be noti?ed. Con?rmed case A con?rmed case requires laboratory de?nitive evidence only. Laboratory de?nitive evidence Detection of hepatitis B surface antigen (HBsAg) in a patient shown to be negative within the last 24 months OR Detection of HBsAg and IgM to hepatitis B core antigen, except where there is prior evidence of hepatitis B infection OR Detection of hepatitis B virus by nucleic acid testing, and IgM to hepatitis B core antigen, except where there is prior evidence of hepatitis B infection. Note: Transient HBsAg positivity can occur in patients following HBV vaccination. This occurs more commonly in dialysis patients and is unlikely to persist beyond 14 days post-vaccination.Hepatitis B – unspeci?ed ReportingOnly con?rmed cases should be noti?ed. Con?rmed case A con?rmed case requires laboratory de?nitive evidence AND that the case does not meet any of the criteria for a newly acquired case. Laboratory de?nitive evidence Detection of hepatitis B surface antigen (HBsAg), or hepatitis B virus by nucleic acid testing, except where there is prior evidence of hepatitis B virus infection. Note: Transient HBsAg positivity can occur in patients following HBV vaccination. This occurs more commonly in dialysis patients and is unlikely to persist beyond 14 days post-vaccination.Case definitions can be found on the Department of Health’s case definitions website.The Public Health Laboratory Network of Australia (PHLN) has developed laboratory case definitions for recent, chronic and unspecified hepatitis B infection. Refer to the Department of Health PHLN web page.Laboratory testingTesting GuidelinesThe National Hepatitis B Testing Policy provides information about indications for HBV testing, informed consent and conveying test results, refer to the ASHM website. It addresses testing in particular settings (Healthcare Workers, Antenatal and Perinatal Testing, People from Culturally and Linguistically Diverse Backgrounds, and Aboriginal and Torres Strait Islander Peoples) where barriers (such as poor access to primary healthcare, stigma/discrimination, non-English language and inadequate health literacy) have the potential to impede testing of higher risk populations.Participation in testing is voluntary except in circumstances when testing is mandatory for participation in certain activities or to have access to certain services (such as blood, tissue and organ donation, migration health requirements, entering training or service in the armed forces).Who to testRecommend testing based on an individual’s risk of HBV infection, refer to People at increased risk of infection (Section 2, above) and the National Hepatitis B Testing Policy.Note also the recommendation for universal screening of pregnant women, refer to the RANZCOG statement. Testing is also recommended in other situations, such as:Health care workers who perform or may be expected to perform exposure prone proceduresDiagnosis of another infection which shares a mode of acquisition with HBVA person who reports a positive result from an HBV test not licensed in AustraliaOn the diagnosis of other conditions that may be caused by HBV infection e.g.?glomerulonephritis, vasculitisPatients undergoing chemotherapy or immunosuppressive therapy or treatment for hepatitis?C.When a person requests an HBV test but does not disclose risk factors, their choice should be recognised and HBV testing provided.Test interpretationTwo classes of assays are used in the diagnosis of HBV infection: serologic assays that detect specific HBV antigens and antibodies; and molecular assays that detect viral nucleic acid. For further details of testing contact the pathology provider or jurisdictional laboratory (refer to Appendix 4). Hepatitis B surface antigen (HBsAg) can be detected in serum from several weeks before the onset of any illness. Other detectable markers of current (as opposed to resolved) HBV infection include HBV DNA and hepatitis B e antigen (HBeAg). Persistence of HBsAg denotes infectivity, which is generally greater if HBeAg is present and/or the HBV DNA viral load is high ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>1986</Year><RecNum>1668</RecNum><DisplayText>(34)</DisplayText><record><rec-number>1668</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1668</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, D. S.</author><author>Lai, M. Y.</author><author>Lee, S. C.</author><author>Yang, P. M.</author><author>Sheu, J. C.</author><author>Sung, J. L.</author></authors></contributors><titles><title>Serum HBsAg, HBeAg, anti-HBe, and hepatitis B viral DNA in asymptomatic carriers in Taiwan</title><secondary-title>J Med Virol</secondary-title><alt-title>Journal of medical virology</alt-title></titles><periodical><full-title>J Med Virol</full-title></periodical><pages>87-94</pages><volume>19</volume><number>1</number><edition>1986/05/01</edition><keywords><keyword>Adult</keyword><keyword>Carrier State/epidemiology/*immunology/microbiology</keyword><keyword>DNA, Viral/*analysis</keyword><keyword>Female</keyword><keyword>Hepatitis B/epidemiology/*immunology/microbiology</keyword><keyword>Hepatitis B Antibodies/*analysis/immunology</keyword><keyword>Hepatitis B Antigens/*analysis</keyword><keyword>Hepatitis B Surface Antigens/analysis/immunology</keyword><keyword>Hepatitis B e Antigens/analysis/immunology</keyword><keyword>Hepatitis B virus/genetics/immunology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Nucleic Acid Hybridization</keyword><keyword>Radioimmunoassay</keyword><keyword>Taiwan</keyword></keywords><dates><year>1986</year><pub-dates><date>May</date></pub-dates></dates><isbn>0146-6615 (Print)
0146-6615 (Linking)</isbn><accession-num>3701304</accession-num><work-type>Research Support, Non-U.S. Gov't</work-type><urls><related-urls><url>;(34).The presence of HBeAg and/or high hepatitis B DNA are markers of high infectivity. A falling concentration of HBeAg and rising anti-HBe correlates with reduced infectivity.Anti-HBc IgM is present in high titre during acute infection and usually disappears within six?months. However, anti-HBc IgM may also be detectable intermittently in those with chronic infection, such as during a hepatitis flare.In the case of an acute infection that does not progress to chronic hepatitis B, seroconversion to anti-HBs may occur days, weeks or months after infection. Antibodies against HBsAg (anti-HBs) indicate immunity, which may result from either natural infection or immunisation. When immunity results from immunisation, there are no markers of current or past HBV infection such as anti-HBc.People with chronic HBV infection are identified by the long-term presence (longer than six?months) of HBsAg.Table 1.Tests used for Hepatitis B infectionMarker Abbreviations Purpose or uses Hepatitis B surface antigen (qualitative) HBsAg Donor testing – screening of blood and tissue donations Hepatitis B surface antigen (qualitative)Diagnostic testing - marker of current infectionHepatitis B surface antigen neutralisation ?Confirmation of the presence of HBsAgHepatitis B surface antigen (quantitative) HBsAg Monitoring of therapy, particularly with regard to interferon-based treatment – currently in a research context, not standard of care nationallyHepatitis B surface antibodyanti-HBs or HBsAbUsually indicates immunity, either from past infection or immunisation. Anti-HBs levels may decline to undetectable levelsover years, especially if resulting from immunisation.Hepatitis B coretotal antibody anti-HBc or Evidence of infection with HBVHBcAb Marker of past or present infection. Generally remains detectable for life even if infection clears. Vaccination does not produce anti-HBc IgM to hepatitis B core antigenIgM anti-HBc orHBcIgMSuggestive of acute infection in the recent past (usually less than six months). Can also be detected during a flare of chronichepatitis B.Hepatitis B e antigenHBeAg Determining infectivity of a person with HBV infection and phase of the infection for clinical management Marker of enhanced infectivity. Seen transiently in most infections,and persists in some with chronic infection for many years.Absence of HBeAg does not exclude a high level of infectivity or disease activity, however (e.g. in the presence of pre-coremutants).Hepatitis B e antibodyAnti-HBe or HBeAbMarker of seroconversion from HBeAg, and stage of infection forclinical managementHepatitis B DNA (qualitative)HBV DNA Donor testing – screening of blood and tissue donationsConfirm the presence of circulating HBVHepatitis B DNA HBV DNA VL A quantitative measure of viral load and infectivity. An important investigation to establish phase of infection, monitor disease activity, and assess ongoing response to treatment and treatment adherence.Hepatitis B sequencing – genotyping and resistance testing ?Characterisation of virus for clinical management. Used to assess presence of mutations conferring antiviral resistance. Genotyping also occasionally used to determine likelihood of responding tointerferon-based therapy but this is not standard of care nationally.Other public health uses e.g. transmission investigations.Further information is available in the National Hepatitis B Testing Policy, refer to the Testing Portal, and also from the Australasian Society for HIV Medicine resource, Interpreting hepatitis B serology: Recommended wording for national laboratories to report hepatitis B diagnostic test results, refer to the ASHM website. Case managementResponse timesPublic health action should commence within three working days of notification of a confirmed case of newly acquired HBV infection. The timing of the public health response to cases of unspecified HBV infection is at the discretion of the public health unit.Response procedureDetermining the source of infection for newly acquired cases may permit identification of other cases and interrupt infection transmission. Case investigationThe response to a notification will usually be carried out in collaboration with the case’s clinical team. PHU staff should assist by investigating the likely source of infection, and determining whether the case is newly acquired or unspecified for surveillance purposes. This will require engagement with the clinical team and sometimes the case or caregiver.Public health staff should confirm that action has been taken to:Confirm that the case meets the case definition. Confirm the onset date, symptoms and signs of illness, and assess whether the clinical evidence is consistent with a diagnosis of hepatitis BDiscuss with the treating clinician the need to interview the case or the relevant care?giver in order to provide information and to seek a contact history; and seek the clinician's permission to do soEstablish what the case or the relevant care-giver has already been told about the diagnosis before beginning the interviewConfirm results of existing relevant laboratory tests, or recommend that the tests be doneReview case and contact management undertaken to dateSeek complete core and enhanced data (where relevant) on the case.Case classification: Among the many cases classified by the NNDSS case definitions as unspecified HBV infection there may be a small proportion which, with further information, may be properly classified as newly acquired HBV infection. Cases notified as HBsAg positive with no other results, and cases notified as HBsAg positive with both anti-HBc and HBcIgM negative may potentially be shown to be newly acquired HBV infection by further tests. Recommended follow-up actions are as follows.If HBsAg positive and no other test results are available:Confirm that anti-HBc and anti-HBc IgM tests have not been done.Check for any previous HBsAg resultsIf none, contact clinician recommending anti-HBc and anti-HBc IgM testingIf HBsAg positive and both anti-HBc and anti-HBc IgM are negative:Contact clinician recommending repeat testing.Electronic laboratory reporting may already have prompted the recommended clarifying tests. If this process is known to be in place in the notifying laboratory, no further action is required.The clinical and public health management of cases of acute or unspecified HBV infection may be facilitated by contact between clinical teams and the jurisdictional or regional PHU. This aims to assist clinicians with exposure investigation and contact tracing, improve testing and vaccination of household and sexual contacts when indicated, and improve completeness and quality of core epidemiological data. Further, in newly diagnosed chronic HBV infections, public health units can support non-specialist clinicians to access information sources on management and referral to improve long-term case outcomes. In jurisdictions with large numbers of hepatitis B notifications, communication with the notifying clinician/s may be done with a standard letter (refer to Appendix 5), case report form, and other supporting information. Exposure investigation Newly acquired hepatitis BDetermining the source of infection of newly acquired cases may permit identification of other co-exposed cases and opportunities to interrupt further transmission.Trace back by seeking information about exposures during the likely acquisition period from six weeks to six months before onset of the illness. A longer risk history may be needed for newly acquired cases identified through the detection of HBsAg within 24 months of a negative result. If the illness onset is unclear consider tracing back to six months before to the most recent negative result. Unspecified hepatitis B infectionsWhen chronic infection is diagnosed in a person who is likely to have been infected vertically, it is important that the mother and household contacts be tested. Other possible sources of cases of CHB infection are rarely useful to pursue.An investigation checklist which includes a list of possible exposures is provided in Appendix?1.Case treatment and monitoringDiscussing, offering and providing treatment for HBV are the responsibility of the case’s clinician. Cases should be tested for other blood borne viruses (HCV, HDV and HIV).Acute hepatitis BFor most patients, treatment for acute hepatitis B is mainly supportive. Patients with clinically severe illness, and those in at greater risk of worse outcomes (e.g. patients who are immunocompromised, also have hepatitis C virus infection, have pre-existing liver disease, or are older adults) should be referred for specialist carePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdW1hcjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJl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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdW1hcjwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJl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ADDIN EN.CITE.DATA (35, 36). For the great majority of cases of acute hepatitis B, routine antiviral therapy is not supported by available evidence; however in some cases of fulminant acute hepatitis B, antiviral therapy may be administered. Rarely, individuals with fulminant acute hepatitis B require liver transplantation for liver failure.Chronic hepatitis BIt is important to ensure that people with CHB establish a sustainable clinical relationship with a trusted primary healthcare provider, for chronic hepatitis monitoring and cancer screening, hepatitis treatment, and management of co-morbidities.Treatment of CHB with pegylated interferon (PEG-IFN), or nucleoside/nucleotide analogues (eg. lamivudine, adefovir dipivoxil, telbivudine, entecavir, tenofovir) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2FnbGlvbmU8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFy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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2FnbGlvbmU8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFy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ADDIN EN.CITE.DATA (37) has been shown to substantially reduce the risk of progressive liver disease, and antivirals can reduce the risk of liver cancer by over 50 per cent over 4-5 years PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhdGhlb2RvcmlkaXM8L0F1dGhvcj48WWVhcj4yMDEw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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QYXBhdGhlb2RvcmlkaXM8L0F1dGhvcj48WWVhcj4yMDEw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ADDIN EN.CITE.DATA (38). Over three quarters of Australians in?2014 were receiving treatment for CHB are receiving either entecavir or tenofovir ADDIN EN.CITE <EndNote><Cite><Author>MacLachlan</Author><Year>2016</Year><RecNum>1743</RecNum><DisplayText>(32)</DisplayText><record><rec-number>1743</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1743</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>MacLachlan, J., Cowie, B., </author></authors></contributors><titles><title>Hepatitis B Mapping Project: Estimates of chronic hepatitis B prevalence, diagnosis, monitoring and treatment by Primary Health Network, 2014/15 - National Report, published by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), available from ;(32). All people living with CHB should have regular monitoring of their disease activity so that specific treatment can be considered when indicated. Further information on the management of CHB is available from the HepBHelp website and from the ASHM B Positive resource. Surveillance for primary liver cancer is part of the management of CHB.People with chronic HBV are at risk of serious and sometimes life-threatening disease flares during cancer chemotherapy, or other prolonged or significant immunosuppressive therapy. In addition, some profound immunosuppressive regimens (such as bone marrow or stem cell transplantation) can lead to reactivation of resolved (anti-HBc positive, HBsAg negative) HBV infection. The National Hepatitis B Testing Policy recommends all patients about to undergo significant immunosuppression should be tested for HBV and referred to a specialist for consideration of close monitoring or antiviral treatment as appropriate, refer to the ASHM B Positive website and the ASHM Testing Portal on National HBV testing policy. Direct-acting antiviral (DAA) medicines used to treat chronic hepatitis C virus (HCV) infection have also been associated with reactivation of HBV in patients with current or past HBV infection. This risk can be mitigated by advising HCV patients of this issue, screening for current or past HBV infection (including HBsAg and anti-HBc), and carefully monitoring liver function during DAA treatment, refer to the TGA website. EducationInform the case or care-giver of measures to prevent HBV transmission, including:Cleaning and disinfection of surfaces contaminated with bloodNot sharing objects potentially contaminated with blood (for example razors and toothbrushes, injecting equipment)Single use of disposable needlesStoring contaminated sharps in an approved sharps containerCovering any wound with an impermeable dressingPractising safe sexNot donating blood or body parts.Immunisation of contacts, including sexual partners, as indicated (refer below).HBsAg-positive people who seek medical or dental care may be encouraged, but are not obliged, to inform involved personnel of their hepatitis B status.Provide the case and (with their permission) their family and other potentially exposed individuals an information sheet on hepatitis B infection. Consider using an interpreter with cases or contacts from a non-English speaking background, or an Aboriginal Health Education Officer for Aboriginal people. The information sheet should provide information about the nature of the infection, the mode of transmission, and preventive measures (refer?to Appendix 3 for an example information sheet) and be written in an appropriate language (information sheets in different languages are available at the HYPERLINK "" ASHM hepatitis B resources page.Isolation and restrictionIsolation of people living with CHB is not required. The infected person should be educated about transmission routes, safe injecting and sexual practices, blood and body fluid precautions, and not donating organs or blood.Child careThere are no restrictions on a child living with hepatitis B from attending childcare. The risk of transmission of HBV in child care settings is very low, given universal vaccination of children in Australia. Sound infection control and environmental cleanliness and appropriate management of blood and body fluid spills, further reduces this risk. Further information is available in?Staying Healthy: Preventing infectious diseases in early childhood education and care services, 5th Edition. Healthcare settingsHospitalised cases of acute or chronic HBV infections do not need to be isolated. The risk of secondary cases from hospitalised cases can be prevented by standard and transmission-based precautions, pre-exposure hepatitis B vaccination of staff, and post-exposure management of potentially exposed healthcare workers For healthcare workers infected with HBV – refer to section 12, Special situations. Environmental investigationDespite the fact HBV is stable on surfaces and infective for at least seven days under experimental conditions ADDIN EN.CITE <EndNote><Cite><Author>Bond</Author><Year>1981</Year><RecNum>1665</RecNum><DisplayText>(39)</DisplayText><record><rec-number>1665</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1665</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bond, W. W.</author><author>Favero, M. S.</author><author>Petersen, N. J.</author><author>Gravelle, C. R.</author><author>Ebert, J. W.</author><author>Maynard, J. E.</author></authors></contributors><titles><title>Survival of hepatitis B virus after drying and storage for one week</title><secondary-title>Lancet</secondary-title><alt-title>Lancet</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet</abbr-1></alt-periodical><pages>550-1</pages><volume>1</volume><number>8219</number><edition>1981/03/07</edition><keywords><keyword>Animals</keyword><keyword>Drug Storage</keyword><keyword>Hepatitis B/transmission</keyword><keyword>Hepatitis B Surface Antigens/*immunology</keyword><keyword>Hepatitis B virus/*growth & development</keyword><keyword>Male</keyword><keyword>Pan troglodytes/immunology</keyword></keywords><dates><year>1981</year><pub-dates><date>Mar 7</date></pub-dates></dates><isbn>0140-6736 (Print)
0140-6736 (Linking)</isbn><accession-num>6111645</accession-num><work-type>Letter</work-type><urls><related-urls><url>;(39), it is readily inactivated by most disinfectants. Environmental sources are rarely, if ever, the source of infection, and therefore environmental investigation is generally not indicated, except when a cluster of cases is reported that raise the possibility of an environmental source.Contact managementContacts may be the source of infection for the case, or may be at risk of infection from the case.The aim of contact management is to prevent or minimise illness among contacts, and to prevent ongoing transmission from existing or potential new sources of infection.The clinician managing the patient is usually responsible for initiating the tracing and management of contacts. PHU staff may contact the clinician directly or by letter to emphasise the need for testing and vaccination of household and sexual contacts, and advise on the availability of state-funded vaccine. The clinician may be assisted by PHU staff and others, such as sexual health service staff, in accordance with local processes. The Australian Contact Tracing Manual provides guidance , refer to the ASHM website and the Northern Territory hepatitis B vaccination and public health guidelines.Contact tracing must be done with regard to legal, ethical and confidentiality considerations. This includes the requirement to seek permission from a case if it is deemed necessary to disclose their identity to manage the risk to contacts.Management of contacts includes:Noting the requirement to obtain consent from the case to disclose their identity (as?above), clarify the timing and nature of their contact with the case and their risk of infectionAlert them to the possibility that they could already be, or may become, infected, and recommend testingArrange tests including HBsAg, anti-HBs, anti-HBc (total) and, if suspecting acute infection, anti-HBc IgM. Refer to Table 1 (above)If no evidence of immunity from previous infection (positive anti-HBc) or vaccination (anti-HBs level ≥10 mIU/mL documented at any time after previous vaccination), and depending on circumstances and timing, recommend active immunisation with or without passive immunisation (refer to Table 2)Provide contacts with information about hepatitis B infection and their level of risk, aiming to allay unnecessary concern, ensure appropriate prophylaxis, and ensure appropriate action if they develop symptoms.Contact definitionContacts include:household members of a casesexual partners of a casenewborn or infant of a HBsAg positive motherchildren of casespeople who have shared injecting equipment with the caserecipients of the blood or organs of the case which were collected while the case was potentially infectiouspeople with exposure to blood or body fluids of the case (mucosal contact, sharps injury etc).ProphylaxisFor immunisation details, refer to current the Australian Immunisation Handbook .Passive immunisationPassive immunisation with Hepatitis B Immune Globulin (HBIG) is used, along with active immunisation with hepatitis B vaccine, to provide post-exposure protection against HBV. HBIG should be given as soon as possible after exposure, and can be given up to 72 hours after the exposure. The exposed person's prior history of HBV infection, vaccination, and vaccine response status (if known) should always be considered, but treatment should not be unduly delayed whilst awaiting test results.Post-exposure prophylaxis with HBIG is recommended for non-immune people in the following situations (refer to Table 2):Perinatal exposure to an HBsAg-positive motherPercutaneous, parenteral or permucosal exposure to infectious bloodSexual exposure to an HBsAg-positive individual. Active immunisationActive vaccination reduces the risk of perinatal HBV transmission (by 50 to 72%) if given very soon after birth PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxSZWNO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=
ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MZWU8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxSZWNO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=
ADDIN EN.CITE.DATA (40-42). Active vaccination is also recommended for all non-immune people at risk who are identified in the course of a HBV case investigation. Post-vaccination serological testing 4-8 weeks after vaccination is recommended for sexual and household contacts and healthcare workers to assess their immunity. HIV-positive adults, and other immunocompromised adults including those with renal failure, may be at increased risk of acquiring HBV infection and also respond less well to vaccination. The Australian Immunisation Handbook outlines options to improve the serological response in immunocompromised adults and non-responders ADDIN EN.CITE <EndNote><Cite><Author>ATAGI</Author><Year>2013</Year><RecNum>1663</RecNum><DisplayText>(26)</DisplayText><record><rec-number>1663</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1663</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>ATAGI</author></authors><tertiary-authors><author> </author></tertiary-authors></contributors><titles><title>The Australian Immunisation Handbook</title></titles><edition>10th</edition><dates><year>2013</year></dates><pub-location>Canberra</pub-location><publisher>Commonwealth of Australia</publisher><urls></urls></record></Cite></EndNote>(26). For children born to mothers living with CHB, serological testing is recommended at least 3 months after the final dose of hepatitis B vaccine (refer to Table 2). Note that timelines in this table are considered ideal but if a longer period has elapsed, then vaccination is still protective for future contact.Table 2: Public health management of contacts of hepatitis B cases (sourced from the Australian Immunisation Handbook 10th Edition) Contact categoryHepatitis B immunoglobulin (HBIG)VaccinePost-treatment testingTimingDoseTimingDosePerinatal (exposure of babies during andafter birth)Single doseimmediately afterbirth (preferably within 12 hours of birth and certainlywithin 48 hours)100 IU by IM injectionImmediately afterbirth (preferablywithin 24 hours,no later than 7 days), then at2, 4 and 6months of age 0.5 mL, byIM injectionAt least 3 months after final dose of vaccineHousehold, mucosal orpercutaneous (includes health care workers, after needle-stickinjury, sharing injecting equipment, etc.)Single dose within 72 hours of exposure 400 IU byIM injection;100IU if BodyWeight <30 kgWithin 7 days of exposure and at1 and 6 months after 1st dose1 0.5 mL or 1 mL(depending on age), by IM injection4-8 weeks after vaccinationSexual Single dose within 72 hours of last sexual contact (There islimited evidencefor efficacy if given within14 days ofcontact; however, administration as soon as possible after exposure is preferred. 100 IU if body weight <30 kg).400 IU byIMinjection;Within 14 daysand at 1 and6 months after1st dose1 0.5 mL or1 mL(depending on age), by IMinjection4-8 weeks after vaccination The first dose can be given at the same time as HBIG, but should be administered at a separate site. Administration as soon as possible after exposure is preferredEducationAdvise susceptible contacts (or their parents/guardians) of the risk of infection, the need for immunisation; and to watch for symptoms of hepatitis occurring within six months of exposure.Isolation and restrictionRemind contacts of the need to practise safe sex and/or safe injecting practices to minimise the risk of acquiring or transmitting infection, particularly until laboratory testing clarifies their immunity or infectious status. If they are found to be infected with HBV, refer to advice in Case management (Section 9). Special situationsPregnant women and their childrenAdvise women with CHB who are pregnant or of reproductive age about the risk of transmitting hepatitis B to a newborn child, and of the importance and effectiveness of immunisation to prevent transmission and infection.Appropriate follow-up of a woman diagnosed antenatally is essential to ensure adequate clinical care of the mother, testing and vaccination of household contacts, and protection of the infant from vertical transmission. Women with a positive HBsAg test on antenatal screening should be referred to specialist services to assist in their management, including consideration of antiviral therapy to further reduce the risk of vertical transmission in the setting of a high HBV DNA viral load (e.g. over 1 million IU/mL). Infants born to HBsAg-positive mothers should be given HBIG and a dose of monovalent hepatitis B vaccine as soon as possible on the day of birth, concurrently but in separate thighs. Mothers delivering outside of institutions (e.g. home delivery) must have arrangements made for this to be provided, such as through a general practitioner (GP). Three subsequent doses of a hepatitis B-containing vaccine should be given, at 2, 4 and 6?months of age. Anti-HBs antibody and HBsAg levels should be measured in infants born to mothers with CHB infection 3 to 12 months after completing the primary vaccine course. If anti-HBs antibody levels are adequate (≥10 mIU/mL) and HBsAg is negative, then the infant is protected. If the anti-HBs level is <10 mIU/mL, then the possibility of HBV infection should be investigated. Refer to section 4.5.7 of?The Australian Immunisation Handbook?10th Edition for details.Healthcare workersHealthcare workers known to be infected with blood-borne viruses should be assessed and monitored in accordance with the Australian National Guidelines for the Management of Health Care Workers known to be Infected with Blood-Borne Viruses. Referral to a specialist is recommended for ongoing assessment and monitoring of healthcare workers with chronic HBV infection. Healthcare workers should be provided with a fact sheet on Hepatitis B and advised of their obligations with regard to exposure prone procedures (EPP) as detailed in the Australian National Guidelines for the Management of Health Care Workers known to be Infected with Blood-Borne Viruses.If a person with newly diagnosed acute or chronic HBV infection is a healthcare worker who performs exposure-prone procedures, the need for a look-back investigation should be considered by the relevant jurisdictional agency with reference to the Australian National Guidelines for the Management of Health Care Workers known to be Infected with Blood-Borne Viruses.Non-immune healthcare workers who perform exposure-prone procedures and who experience a percutaneous or mucosal exposure to an infectious source of HBV should have their exposure assessed and management initiated urgently by an expert clinician. The exposure may take place in or out of work setting. This may involve advice regarding the need to modify work practices involving exposure prone procedures, in accordance with national, jurisdictional and organisational guidelines, during the period of possible seroconversion and infection. Non-immune healthcare workers who perform exposure prone procedures should be tested according to the Australian National Guidelines for the Management of Health Care Workers known to be Infected with Blood-Borne Viruses. ADDIN EN.CITE <EndNote><Cite><Author>CDNA</Author><RecNum>1667</RecNum><DisplayText>(43)</DisplayText><record><rec-number>1667</rec-number><foreign-keys><key app="EN" db-id="0vrs9ef5czwz96e5azfpptft2fdvpfa5zvxw">1667</key></foreign-keys><ref-type name="Standard">58</ref-type><contributors><authors><author>CDNA</author></authors></contributors><titles><title>Australian national guidelines for the management of health care workers known to be infected with blood-borne viruses</title></titles><dates><pub-dates><date>2012</date></pub-dates></dates><urls></urls></record></Cite></EndNote>(43).Suspected healthcare acquired infectionIf acute hepatitis B is diagnosed in a person, particularly with no identified risk factors for HBV infection, and the initial investigation suggests the possibility of healthcare acquired infection, initiate an investigation and notify the relevant jurisdictional agency. Keep in mind the possibility of other undisclosed sources of infection.Blood transfusion and transplantationThe Australian Red Cross Blood Service (ARCBS) should be notified immediately if a case of acute of CHB has donated blood or plasma while possibly infectious, or if transfused blood or blood products are suspected as the possible source of infection. If a case occurs in a recipient of a tissue or organ transplant, the relevant transplant unit should be immediately informed.Cluster of casesIf cases of acute HBV infection are found to be clustered in place or time, or have common exposures, an investigation should seek to identify the source of infection to inform preventive public health action. Early laboratory characterisation (including genotyping) may assist in assessing the relatedness of cases.References and additional sources of information ADDIN EN.REFLIST 1.Davies J, Littlejohn M, Locarnini SA, Whiting S, Hajkowicz K, Cowie BC, et al. Molecular epidemiology of hepatitis B in the Indigenous people of northern Australia. Journal of gastroenterology and hepatology. 2013;28(7):1234-41. Epub 2013/02/26.2.Sugauchi F, Mizokami M, Orito E, Ohno T, Kato H, Suzuki S, et al. A novel variant genotype C of hepatitis B virus identified in isolates from Australian Aborigines: complete genome sequence and phylogenetic relatedness. J Gen Virol. 2001;82(Pt 4):883-92. Epub 2001/03/21.3.Hollinger FB, Lau DT. Hepatitis B: the pathway to recovery through treatment. Gastroenterology clinics of North America. 2006;35(4):895-931. Epub 2006/11/30.4.Komiya Y, Katayama K, Yugi H, Mizui M, Matsukura H, Tomoguri T, et al. Minimum infectious dose of hepatitis B virus in chimpanzees and difference in the dynamics of viremia between genotype A and genotype C. Transfusion. 2008;48(2):286-94. Epub 2007/11/22.5.Schillie S, Murphy TV, Sawyer M, Ly K, Hughes E, Jiles R, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. 2013;62(10):1-19.6.Werner BG, Grady GF. Accidental Hepatitis-B-Surface-Antigen-Positive InoculationsUse of e Antigen to Estimate Infectivity. Annals of internal medicine. 1982;97(3):367-9.7.Wiseman E, Fraser MA, Holden S, Glass A, Kidson BL, Heron LG, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Medical Journal of Australia. 2009;190(9):489.8.Chen X, Chen J, Wen J, Xu C, Zhang S, Zhou YH, et al. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus. PloS one. 2013;8(1):e55303. Epub 2013/02/06.9.Scott RM, Snitbhan R, Bancroft WH, Alter HJ, Tingpalapong M. Experimental transmission of hepatitis B virus by semen and saliva. J Infect Dis. 1980;142(1):67-71. Epub 1980/07/01.10.Villarejos VM, Visona KA, Gutierrez A, Rodriguez A. Role of saliva, urine and feces in the transmission of type B hepatitis. The New England journal of medicine. 1974;291(26):1375-8. Epub 1974/12/26.11.Marie-Cardine A, Mouterde O, Dubuisson S, Buffet-Janvresse C, Mallet E. Salivary transmission in an intrafamilial cluster of hepatitis B. Journal of pediatric gastroenterology and nutrition. 2002;34(2):227-30. Epub 2002/02/13.12.Powell E, Duke M, Cooksley WG. Hepatitis B transmission within families: potential importance of saliva as a vehicle of spread. Aust N Z J Med. 1985;15(6):717-20. Epub 1985/12/01.13.van der Eijk AA, Niesters HG, Hansen BE, Pas SD, Richardus JH, Mostert M, et al. Paired, quantitative measurements of hepatitis B virus DNA in saliva, urine and serum of chronic hepatitis B patients. European journal of gastroenterology & hepatology. 2005;17(11):1173-9. Epub 2005/10/11.14.Heymann DL. Control of Communicable Diseases Manual. 20th ed: American Public Health Association; 2015.15.Manitoba Public Health Branch. Communicable disease management protocol, hepatitis B. 2013.16.Mahoney FJ. Update on diagnosis, management, and prevention of hepatitis B virus infection. Clinical microbiology reviews. 1999;12(2):351-66. Epub 1999/04/09.17.Reuben A, Tillman H, Fontana RJ, Davern T, McGuire B, Stravitz RT, et al. Outcomes in Adults With Acute Liver Failure Between 1998 and 2013: An Observational Cohort Study. Annals of internal medicine. 2016;doi:10.18.Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Annals of internal medicine. 2002;137(12):947-54. Epub 2002/12/18.19.Beasley RP. Rocks along the road to the control of HBV and HCC. Annals of epidemiology. 2009;19(4):231-4. Epub 2009/04/07.20.Trepo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet. 2014;384(9959):2053-63. Epub 2014/06/24.21.Gastroenterological Society of Australia. Australian and New Zealand chronic hepatitis B (CHB) Recommendations. Foundation DH, editor2009.22.Liaw YF, Chen YC, Sheen IS, Chien RN, Yeh CT, Chu CM. Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection. Gastroenterology. 2004;126(4):1024-9. Epub 2004/04/02.23.Mommeja‐Marin H, Mondou E, Blum MR, Rousseau F. Serum HBV DNA as a marker of efficacy during therapy for chronic HBV infection: analysis and review of the literature. Hepatology. 2003;37(6):1309-19.24.Liaw Y-F, Sung JJ, Chow WC, Farrell G, Lee C-Z, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. New England Journal of Medicine. 2004;351(15):1521-31.25.Liaw Y-F, Chang T-T, Wu S-S, Schiff ER, Han K-H, Lai C-L, et al. Long-term entecavir therapy results in reversal of fibrosis/cirrhosis and continued histologic improvement in patients with HBeAg (+) and (-) chronic hepatitis B: results from studies ETV-022,-027 and-901. Hepatology. 2008.26.ATAGI. The Australian Immunisation Handbook. 10th ed. Canberra: Commonwealth of Australia; 2013.27.MacLachlan JH, Cowie BC. Liver cancer is the fastest increasing cause of cancer death in Australians. Med J Aust. 2012;197(9):492-3. Epub 2012/11/06.28.Allard N, Cowie B. Hepatitis B in men who have sex with men and HIV-infected individuals: missed opportunities and future challenges. Sexual health. 2014;11(1):1-4. Epub 2014/03/29.29.Cunningham SJ, Cunningham R, Izmeth MG, Baker B, Hart CA. Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped. Epidemiol Infect. 1994;112(1):195-200. Epub 1994/02/01.30.Sullivan WF, Berg JM, Bradley E, Cheetham T, Denton R, Heng J, et al. Primary care of adults with developmental disabilities: Canadian consensus guidelines. Canadian family physician Medecin de famille canadien. 2011;57(5):541-53, e154-68. Epub 2011/05/17.31.The Kirby Institute for infection and immunity in society. HIV, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2016. [13 December 2016]; Available from: J, Cowie, B., . Hepatitis B Mapping Project: Estimates of chronic hepatitis B prevalence, diagnosis, monitoring and treatment by Primary Health Network, 2014/15 - National Report, published by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), available from: Hepatitis B Mapping Project. 2016.33.MacLachlan JH, Allard N, Towell V, Cowie BC. The burden of chronic hepatitis B virus infection in Australia, 2011. Aust N Z J Public Health. 2013;37(5):416-22. Epub 2013/10/05.34.Chen DS, Lai MY, Lee SC, Yang PM, Sheu JC, Sung JL. Serum HBsAg, HBeAg, anti-HBe, and hepatitis B viral DNA in asymptomatic carriers in Taiwan. J Med Virol. 1986;19(1):87-94. Epub 1986/05/01.35.Kumar M, Satapathy S, Monga R, Das K, Hissar S, Pande C, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology. 2007;45(1):97-101.36.Coppola N, Sagnelli C, Pisaturo M, Minichini C, Messina V, Alessio L, et al. Clinical and virological characteristics associated with severe acute hepatitis B. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2014;20(12):1469-0691.37.Scaglione SJ, Lok AS. Effectiveness of hepatitis B treatment in clinical practice. Gastroenterology. 2012;142(6):1360-8 e1. Epub 2012/04/28.38.Papatheodoridis GV, Lampertico P, Manolakopoulos S, Lok A. Incidence of hepatocellular carcinoma in chronic hepatitis B patients receiving nucleos(t)ide therapy: a systematic review. Journal of hepatology. 2010;53(2):348-56. Epub 2010/05/21.39.Bond WW, Favero MS, Petersen NJ, Gravelle CR, Ebert JW, Maynard JE. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981;1(8219):550-1. Epub 1981/03/07.40.Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. The Cochrane database of systematic reviews. 2006(2):CD004790. Epub 2006/04/21.41.Margolis HS, Coleman PJ, Brown RE, Mast EE, Sheingold SH, Arevalo JA. Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations. JAMA. 1995;274(15):1201-8. Epub 1995/10/18.42.Wong VC, Ip HM, Reesink HW, Lelie PN, Reerink-Brongers EE, Yeung CY, et al. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study. Lancet. 1984;1(8383):921-6. Epub 1984/04/28.43.CDNA. Australian national guidelines for the management of health care workers known to be infected with blood-borne viruses.Further informationThe Gastroenterological Society of Australia website National Hepatitis B Testing Policy C, Chan HL, Lok A. Hepatitis B virus infection. Lancet 2014;384 (9959):2053-2063.Australasian Society for HIV Medicine (ASHM). HIV, VIRAL HEPATITIS AND STIS: A GUIDE FOR PRIMARY CARE. 2014. (4th%20Edition)_9CD85381FC74E41182EAD89D67763804/HIV_Viral_Hepatitis_and_STIs_a_Guide_for_Clinical_Care_(4th_Edition).pdfHepatitis Australia. Transmission of hepatitis B. 2015. Available from: B Positive – All you wanted to know about hepatitis B– A guide for primary care providers. HIV, viral hepatitis and STIs: a guide for primary care (particularly Chapter 12) Health and Medical Research Council, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010) Healthy: Preventing infectious diseases in early childhood education and care services, 5th Edition B Help .org.au – Providing information and advice to GPs on the further investigation and management of patients with hepatitis B. ASHM hepatitis B resources page WPRO hepatitis data and Statistics Centre for Immunisation Research & Surveillance (NCIRS) The Australian Immunisation Handbook of Health PHLN web page of Health case definitions statement on the management of hepatitis B in pregnancy (C-Obs-50)-Review-July-2016.pdf?ext=.pdfInterpreting hepatitis B serology: Recommended wording for national laboratories to report hepatitis B diagnostic test results. Goods Administration Safety advisory – risk of hepatitis B reactivation Territory hepatitis B vaccination and public health guidelines National Guidelines for the Management of Health Care Workers known to be Infected with Blood-Borne Viruses ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- 1 or 2 374 374 1 0 0 0 1 168 1 1 default username and password
- 1 or 3 374 374 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 711 711 1 0 0 0 1 168 1 1 default username and password
- 1 or 3 711 711 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 693 693 1 0 0 0 1 168 1 1 default username and password
- 1 or 3 693 693 1 0 0 0 1 168 1 1 default username and password
- 1 or 2 593 593 1 0 0 0 1 or 2dvchrbu 168 1 1 default username and password
- 1 or 3 593 593 1 0 0 0 1 or 2dvchrbu 168 1 1 default username and password
- 1 or 2 910 910 1 0 0 0 1 168 1 1 default username and password
- 1 or 3 910 910 1 0 0 0 1 168 1 1 default username and password
- 192 1 or 2 33 33 1 0 0 0 1 1 1 default username and password
- 1 or 2 364 364 1 0 0 0 1 168 1 1 admin username and password