全英文乙肝与乙肝病毒课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,“,”,单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,二级,三级,四级,五级,*,*,Epidemic jaundice described by Hippocrates in 5,th,century BC,Jaundice reported among recipients of human serum and yellow fever vaccines in 1930s and 1940s,Australian antigen described in 1965,Serologic tests developed in 1970s,Hepatitis B,Epidemic jaundice described by,Hepatitis B Virus,Hepadnaviridae family(DNA),Numerous antigenic components,Humans are only known host,May retain infectivity for at least 1 month at room temperature,Hepatitis B VirusHepadnavirida,200 million carriers worldwide,Established cause of chronic hepatitis and cirrhosis,Human carcinogen-cause of up to 80%of hepatocellular carcinomas,Hepatitis B Virus Infection,200 million carriers worldwid,HBsAg,HBcAg,HBeAg,Hepatitis B Virus,HBsAgHBcAgHBeAgHepatitis B Vir,Hepatitis B Clinical Features,Incubation period 6 weeks to 6 months(average 120 days),Nonspecific prodrome of fever,malaise,headache,myalgia,Illness not specific for hepatitis B,At least 50%of infections asymptomatic,Hepatitis B Clinical FeaturesI,Fulminant hepatitis,Hospitalization,Cirrhosis,Hepatocellular carcinoma,Death,Hepatitis B Complications,Fulminant hepatitisHepatitis B,Chronic Hepatitis B Virus Infection,Chronic viremia,Responsible for most mortality,Overall risk 10%,Higher risk with early infection,Chronic Hepatitis B Virus Infe,Risk of Chronic HBV Carriage by Age of Infection,Risk of Chronic HBV Carriage b,Hepatitis B Epidemiology,ReservoirHuman.Endemic,TransmissionBloodborne,Subclinical cases,transmit,Communicability1-2 months before,and after onset of,symptoms,Chronic carriers,Hepatitis B EpidemiologyReserv,Hepatitis B Perinatal Transmission*,If mother positive for HBsAg and HBeAg,70%-90%of infants infected,90%of infected infants become chronic carriers,If positive for HBsAg only,20%of infants infected,90%of infected infants become chronic carriers,*in the absence of postexposure prophylaxis,Hepatitis B Perinatal Transmis,High(,8%):45%of global population,lifetime risk of infection 60%,early childhood infections common,Intermediate(2%-7%):43%of global population,lifetime risk of infection 20%-60%,infections occur in all age groups,Low(2%):12%of global population,lifetime risk of infection 8%):45%of global pop,Hepatitis B United States,1978-2000,Hepatitis B vaccine licensed,Decline among,homosexual men,Decline among,IV drug users,Hepatitis B United States,1,Total infections 80,000/yr,Current carriers 1 million,New carriers 5,000,Death,fulminant hepatitis 200,liver cancer 1,500,cirrhosis 4,000,HBV Disease Burden in the United States*,*1999 estimates,Total infections 80,000/,Age of Infection of Acute and Chronic Hepatitis B Virus Infection,Acute infection,Chronic infection,CDC Sentinel Sites.1989 data.,Age of Infection of Acute and,Risk Factors for Hepatitis B,CDC Sentinel Sites.1992-1993 data.,Risk Factors for Hepatitis BCD,Hepatitis B Virus Infection by Duration of High Risk Behavior,0,3,6,9,12,15,Years at Risk,0,20,40,60,80,100,Percent infected,IV drug user,Homosexual men,HCWs,Heterosexual,Hepatitis B Virus Infection by,Strategy to Eliminate Hepatitis B Virus Transmission-United States,Prevent perinatal HBV transmission,Routine vaccination of all infants,Vaccination of children in high-risk groups,Vaccination of adolescents,Vaccination of adults in high-risk groups,Strategy to Eliminate Hepatit,1965Discovery of Australian antigen,1973Successful HBV infection of chimpanzees,1981Licensure of plasma-derived vaccine,1986Licensure of recombinant vaccine,1991Universal infant vaccination,1996Universal adolescent vaccination,Hepatitis B Vaccine,1965Discovery of Australian,Hepatitis B Vaccine,CompositionRecombinant HBsAg,Efficacy95%(Range,80%-100%),Duration ofImmunity15 years,Schedule3 Doses,Booster doses not routinely recommended,Hepatitis B VaccineComposition,Hepatitis B Vaccine Formulations,Recombivax HB(Merck)-5.0 mcg/0.5 ml(pediatric)-10 mcg/1 ml(adult)-40 mcg/1 ml(dialysis),Engerix-B(GSK)-10 mcg/0.5 ml(pediatric)-20 mcg/1 ml(adult),Hepatitis B Vaccine Formulatio,Recommended Dose of Hepatitis B Vaccine,Infants and children,20 years,Recombivax HB,Dose(mcg),0.5 ml(5),0.5 ml(5),1.0 ml(10),Engerix-B,Dose(mcg),0.5 ml(10),0.5 ml(10),1.0 ml(20),Recommended Dose of Hepatitis,Hepatitis B VaccineLong-term Efficacy,Immunologic memory established following vaccination,Exposure to HBV results in anamnestic anti-HBs response,Chronic infection rarely documented among vaccine responders,Hepatitis B VaccineLong-term,Hepatitis B Vaccine,Routine booster doses are,NOT,routinely recommended for any group,Hepatitis B VaccineRoutine boo,Hepatitis B Vaccine Recommendations,Year,1981,1991,1995,Recommendation,Persons at high risk,All infants,Adolescents,Hepatitis B Vaccine Recommenda,Indications for Hepatitis B Vaccine,Infants,Adolescents 11-12 years of age,Selected adults,Indications for Hepatitis B Va,Dose,Primary 1,Primary