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HEPATITIS B

 

Causative organism Hepatitis B virus
Incubation period 45-180 days (mean 60 days)
How far to trace back

Note: The majority of people with hepatitis B have chronic infection and were infected at birth. Contact tracing needs to be conducted differently than for an acute infection.

6 months prior to onset of acute symptoms. If unknown according to risk history. May include extended family members if vertical transmission to child during pregnancy is likely.

Recent diagnosed chronic hepatitis B infection (6 months and possibly parents/siblings).

Usual testing method Serology for hepatitis B (HBsAg – Hepatitis B surface antigen, anti-HBs – Hepatitis B surface antibody, anti-HBc – Hepatitis B core antibody). Positive HBsAg indicates current infection.
Common symptoms

Jaundice, malaise, abdominal pain, dark urine

Clay coloured stool

Likelihood of transmission per act of condomless intercourse Unknown
Likelihood of long-term sexual partner being infected >20%
Protective effect of condoms High
Transmission by oral sex Low
Duration of potential infectivity

In acute hepatitis B infection, two weeks before onset of symptoms and until the patient becomes surface antigen negative.

More than 95% of adults who are immune-competent, infected with hepatitis B will spontaneously clear the virus.

The majority of those who acquire the infection at birth or as a child will have lifelong chronic hepatitis B infection (where the individual has not been previously tested and has a reactive HBsAg 6 months after the baseline test)

Important sequelae Severe, acute hepatitis, chronic liver disease, cirrhosis and liver cancer, vertical transmission to child during or after pregnancy
Direct benefit of detection and treatment of contacts

Post-exposure prophylaxis for non-immune people exposed to a source that is positive for hepatitis B surface antigen (see below)

Detection and management of hepatitis B infection

Usual management of contacts

Counselling and testing

Post-exposure prophylaxis consists of Hepatitis B Immunoglobulin  (HBIG) and vaccination. These need to be provided as soon as possible after exposure. See Australian Immunisation Handbook for details of dosing.

Contact tracing priority

People known to be immune to HBV will need no further testing.

High for sexual contacts, needle-sharing contacts, a newborn child of an infected birth parent

Medium priority for parents and siblings of an adult with chronic hepatitis B infection, close contacts if any risk exposures

Notification

Acute viral hepatitis B is notifiable by doctors in all Australian states and territories, and New Zealand

Hepatitis B surface antigen-positive results must be notified by laboratories in NSW

Note: Hepatitis D virus (delta agent) is a deficient virus that is entirely dependent on concurrent hepatitis B infection. Measures to control hepatitis B should control HDV.

References:

National HBV Testing Police - Conveying Test Results 

Hepatitis Australia - Clinical Guidelines

 

Page last updated April 2021

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