Hepatitis B is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

5-Minute Clinical Consult Explore these free sample topics:

5-Minute Clinical Consult

-- The first section of this topic is shown below --



Systemic viral infection associated with acute and chronic liver disease and hepatocellular carcinoma (HCC)


  • Predominant age: can infect patients of all ages
  • Predominant sex: fulminant hepatitis B virus (HBV): male > female (2:1)
  • In the United States, estimated 38,000 new infections in 2009, 70% due to IV drug use
  • African Americans have the highest rate of acute HBV infection in the United States.
  • Overall rate of new infections is down 82% since 1991 (due to national immunization strategy).
  • U.S. vaccine coverage for the birth dose of HBV increased from 68.6% in 2011 to 71.6% in 2012.

  • In the United States, 800,000 to 1.4 million people have chronic HBV.
  • Asia and the Pacific Islands have the largest populations at risk for HBV.
  • Chronic HBV worldwide: 350 to 400 million persons
    • 1 million deaths annually
      • Second most important carcinogen (behind tobacco)
      • Of chronic carriers with active disease, 25% die due to complications of cirrhosis or HCC.
      • Of chronic carriers, 75% are Asian.

Etiology and Pathophysiology

HBV is a DNA virus of the Hepadnaviridae family. Highly infectious via blood and secretions for at least a week outside the body.

Family history of HBV and/or HCC

Risk Factors

  • Screen the following high-risk groups for HBV with HBsAg/sAb. Vaccinate if seronegative (1)[A]:
    • Persons born in endemic areas (45% of world)
    • Hemodialysis patients
    • IV drug users (IVDUs), past or present
    • Men who have sex with men (MSM)
    • HIV- and HCV-positive patients
    • Household members of HBsAg carriers
    • Sexual contacts of HBsAg carriers
    • Inmates of correctional facilities
    • Patients with chronically elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT)
  • Additional risk factors:
    • Needle stick/occupational exposure
    • Recipients of blood/products; transplanted organ recipients
    • Intranasal drug users
    • Body piercing/tattoos
    • Survivors of sexual assault
Pediatric Considerations
  • Shorter acute course; fewer complications
  • 90% of vertical/perinatal infections become chronic.
Pregnancy Considerations
  • Screen all prenatal patients for HBsAg (1)[A].
  • Consider treating patients with high viral load at 28 weeks with oral nucleos(t)ide medicines beginning at 32 weeks to reduce perinatal transmission (2)[C].
  • Infants born to HBV-infected mothers require HB immune globulin (HBIg) (0.5 mL) and HBV vaccine within 12 hours of birth.
  • Breastfeeding is safe if HBIg and HBV vaccine are administered and the areolar complex is without fissures or open sores. Oral nucleos(t)ide medications are not recommended during lactation.
  • HIV coinfection significantly increases risk of vertical transmission.
  • Continue medications if pregnancy occurs while on an oral antiviral therapy to prevent acute flare.

MarkerAcute InfectionChronic InfectionInactive CarrierResolved InfectionSusceptible to InfectionVaccinated
HBV DNAPresentPresentLow–negative
ALTMarked elevationNormal to mildly elevatedNormalNormalNormalNormal

General Prevention

Most effective: HBV vaccination series (three doses)

  • Vaccinate
    • All infants at birth and during well-child care visits
    • All at-risk patients (see “Risk Factors”)
    • Health care and public safety workers
    • Sexual contacts of HBsAg carriers
    • Household contacts of HBsAg carriers
  • Proper hygiene/sanitation by health care workers, IVDU, and tattoo/piercing artists
    • Barrier precautions, needle disposal, sterilize equipment, cover open cuts
  • Do not share personal items exposed to blood (e.g., nail clipper, razor, toothbrush).
  • Safe sexual practices (condoms)
  • HBsAg carriers cannot donate blood or tissue.
  • Postexposure (e.g., needle stick): HBIg 0.06 mL/kg in <24 hours in addition to vaccination

Commonly Associated Conditions

HIV coinfection, hepatitis C coinfection

-- To view the remaining sections of this topic, please or purchase a subscription --