Transmission

Incubation

Illness

Treatment

There is no specific treatment available for acute hepatitis B. Patients are encouraged to rest, drink plenty of fluids, have a healthy diet and avoid alcohol and certain prescribed drugs.

Patients with chronic hepatitis B can be treated with alpha interferon, or other drugs with antiviral properties such as lamivudine. Treatment should be based on an individual basis, as not all patients are suitable for treatment.

Click here for further information and guidelines on the treatment of hepatitis B and co-infection with HIV from the British HIV Association. 

Click here for further guidelines on the management of hepatitis B from the British Association of Sexual Health and HIV.

Click here for further information on the European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus.

Exclusion

Notification

Complications

Prevention

If the healthcare worker becomes exposed to the hepatitis B virus during an occupational procedure they should follow the exposure guidelines and seek advice immediately. Certain procedures must be carried out straight away in order to maximise their effectiveness. 

The site of injury should be immediately washed and cleaned. The exact method of cleansing depends upon the type of injury and the area of the body involved:

Following exposure to hepatitis B infection, through an occupational incident, then a full risk assessment should be carried out. This includes taking and storing a sample of serum and plasma from the healthcare worker at the time of the incident (or baseline). The potential for transmission should be assessed based on the type of exposure and body material involved. Consent should be sort from the patient involved to test for Hepatitis B. If consent is not obtained then the patient  should be considered as  being infectious.

Click here for full details of the recommended European post-exposure prophylaxis.

Vaccine

An effective vaccine is available to protect against hepatitis B. Hepatitis B is the only sexually transmitted disease that can be prevented by a vaccine. The vaccine produces an immune response within the body giving immunity against the disease. There is also a specific immunoglobulin available which produces a passive response. This gives an immediate but temporary immunity against the virus and can be used in cases where accidental inoculation or contamination has occurred.

The vaccine is given in three doses over a six-month period. In GUM clinics this is given over one month at nought, one and three-week intervals. An accelerated vaccine is available for travellers. In general, the vaccine is very well tolerated and has few side-effects.

All healthcare workers should be vaccinated against hepatitis B, following the standard vaccination schedule. It is recommended that all individuals are vaccinated, or tested for immunity, against hepatitis B before they enter nursing or medical schools, or before they begin employment within the healthcare environment.

Click here for further information on immunisation against hepatitis B.

NHS Quality Improvement Scotland (QIS) was set up as a special health board by the Scottish Parliament in 2003. Its role was to improve the quality of care and treatment delivered by NHS Scotland. As part of its role, NHS QIS investigated the sexual health services within Scotland and recommended how they can best support and improve the services offered around sexual health.

From their investigation, the group came up with five key clinical indicators (KCI) which would be used to monitor the improvement in sexual health care. Hepatitis vaccine uptake of men who have sex with men is one of the KCI set out for 2006.

Click here for more detail on the NHS:QIS Sexual Health Services project preliminary report (June 2006).        

Contraindications

Further information

Click here for further information on hepatitis B and pregnancy.

Click here for further information on hepatitis B in children.

Click here for information on the surveillance of significant occupational exposures to bloodborne viruses in healthcare workers.

The Department of Health has published a toolkit for assessing the range of competencies in skills, knowledge and attitudes required to manage sexually transmitted infections when delivering more specialised sexual health services within primary care. Click here for more information.

Further web links

References

BROOK G (2005) United Kingdom national guideline on the management of viral hepitides A, B and C. Clinical Effectiveness Group [on-line]. London: British Association of Sexual Health and HIV.
Available at: www.bashh.org/guidelines/ [Accessed 14 April 2005].

CHIN J, ed (2000) Control of communicable diseases manual. 17th ed. Washington: American Public Health Association.

DEPARTMENT OF HEALTH (1996) Immunisation against infectious disease (The green book) [on-line]. London: Department of Health.
Available at: www.dh.gov.uk/assetRoot/04/07/30/12/04073012.pdf [Accessed 14 April 2005].

HEALTH PROTECTION AGENCY (2003) Hepatitis B - General information [on-line].
Available at: www.hpa.org.uk/infections/topics_az/hepatitis_b/menu.htm [Accessed 14 April 2005].

NHS DIRECT (2004) Hepatitis [on-line]. NHS Direct online health encyclopaedia.
Available at: www.nhsdirect.nhs.uk/en.asp? [Accessed 14 April 2005].

PURO V, et al (2005). European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill, 10 (10), 260-264. Available at: http://www.eurosurveillance.org/em/v10n10/1010-226.asp [Accessed 5 June 2006].

This content is not intended nor does it replace individual professional advice. Please contact a healthcare professional or seek advice from NHS Direct (0845 46 47) NHS Direct Wales (0845 46 47) or NHS 24 in Scotland (08454 24 24 24).