38 Questions
Which virus is single-stranded RNA?
Hepatitis A Virus (HAV)
How is Hepatitis A Virus (HAV) primarily transmitted?
Fecal-oral route
What is the incubation period for Hepatitis A Virus (HAV)?
28 days
Who is more likely to develop symptoms of Hepatitis A Virus (HAV)?
Persons over 40 years of age
Which group of individuals is considered at risk for acquiring HAV infection?
Persons with chronic liver disease
Which type of liver disease can cause chronic HAV infection?
Hepatitis B virus infection
According to the CDC, which of the following infections can affect the likelihood of symptoms from HAV infection?
HIV infection
Which of the following statements about HAV infection is true?
It is vaccine preventable
What is the mechanism of transmission for Hepatitis A Virus (HAV)?
Excreted in bile and shed in stool, transmitted via the fecal-oral route
What are the recommendations for preventing Hepatitis A Virus (HAV) infection according to the Advisory Committee on Immunization Practices, 2020?
Routine vaccination for specific populations
What is the estimated global population with chronic HBV infection according to the WHO in 2015?
257 million people
What percentage of the US population was estimated to have chronic HBV infection in 2019?
0.3-0.7%
Which serologic marker indicates active HBV infection?
Hepatitis B surface antigen (HBsAg)
What is a common symptom of HBV infection?
Jaundice
Who should be vaccinated to prevent HBV transmission?
Infants, children, household contacts, sexual partners, and healthcare workers
How long does HBV vaccination protection last?
30 years
When is post-vaccination serologic testing recommended?
For certain populations such as healthcare workers at risk for exposure
What is the leading cause of hepatocellular carcinoma?
Hepatitis B (HBV) infection
What can untreated chronic HBV infection lead to in up to 40% of patients?
Cirrhosis
What are some common HBV infection symptoms?
Fever, fatigue, jaundice, dark urine, clay-colored stool, and elevated liver enzymes only
Which of the following individuals is NOT recommended for Hepatitis A vaccination according to the ACIP recommendations?
A 30-year-old individual with chronic liver disease
What is the recommended pre-exposure prophylaxis (PrEP) for individuals planning international travel to endemic areas for Hepatitis A Virus (HAV)?
Hep A vaccine for healthy individuals
What is the recommended post-exposure prophylaxis (PEP) for individuals based on provider risk assessment and age?
IG dose based on provider risk assessment and age
Which category of individuals is NOT mentioned as being at increased risk for HAV infection or severe disease from HAV infection in the US?
Pregnant women at risk for HAV infection
What should be considered when administering live vaccines and immune globulin (IG) for Hepatitis A vaccination?
Vaccine series should be completed using vaccines from different manufacturers
What is the most common mode of transmission for HAV?
Contaminated food or water
Which of the following vaccines is given in a 3-dose series for protection against both Hepatitis A and Hepatitis B?
Twinrix™ (GlaxoSmithKline)
What is the recommended dose for individuals with incomplete vaccinations?
Heplisav-B® x 2 doses 1 month apart
What is the decision to treat chronic HBV based on according to the 2018 AASLD Guidance?
Cirrhosis status and HBeAg levels
What are the goals of chronic HBV therapy?
Achievement of virologic suppression and prevention of clinical complications
Which treatment option is preferred for chronic HBV therapy according to AASLD?
Entecavir (Baraclude™)
Which oral antiviral agent for HBV requires adjustment for hepatic dysfunction?
Entecavir (Baraclude™)
Which interferon-based regimen is preferred for HBV therapy?
Peginterferon alfa-2a
What is the most appropriate treatment option for a 45-year-old Asian female with compensated cirrhosis and normal CrCl?
0.5mg of Entecavir daily on an empty stomach
Which treatment option is not recommended for individuals with decompensated liver disease?
Lamivudine (Epivir™)
Which factor does not influence the decision to treat for chronic HBV according to the 2018 AASLD Guidance?
Hepatitis D virus status
Which anti-viral agent is associated with potential side effects such as flu-like symptoms, depression, and anemia?
Interferon-alpha-2b (Intron A™)
Which oral antiviral agent for HBV should be taken on an empty stomach?
Entecavir (Baraclude™)
Study Notes
- The text discusses recommendations for preventing Hepatitis A Virus (HAV) infection in the United States, as per the Advisory Committee on Immunization Practices (ACIP).
- HAV is most commonly spread through contaminated food or water. Endemic areas include HAV highest endemic areas: Africa, Asia, and Central and South America.
- Persons at increased risk for HAV infection or severe disease from HAV infection in the US include:
- Persons with chronic renal failure undergoing dialysis.
- Solid organ, bone marrow, or stem cell transplant recipients.
- Persons requiring treatment with immunosuppressive drugs/biologics or long-term systemic corticosteroids.
- HAV vaccines available in the US include:
- Hep A inactivated (2 doses): Havrix™ (GlaxoSmithKline) and Vaqta™ (Merck).
- Combined Hep A and Hep B (3 doses): Twinrix™ (GlaxoSmithKline).
- Recommendations for HAV vaccination in the US include:
- Persons at risk for severe disease from HAV infection.
- International travelers.
- Men who have sex with men.
- Persons who use injection or noninjection drugs.
- Persons with occupational risk for exposure.
- Persons who anticipate close personal contact with an international adoptee.
- Persons with chronic liver disease.
- Persons with HIV.
- Pregnant women at risk for HAV infection or severe outcome from HAV infection.
- Any person requesting vaccination.
- Children: all children aged 12-23 months, unvaccinated children and adolescents 2-18 years (catch-up vaccination).
- HAV Pre-exposure Prophylaxis (PrEP) recommendations for international travel:
- Hep A vaccine is recommended for healthy individuals.
- Immune globulin (IG) is recommended for individuals less than 6 months of age and those with chronic liver disease or immunocompromise.
- IG dose recommended depends on duration of travel.
- Live vaccines should be administered at least 2 weeks before or at least 6 months after administration of IG.
- Vaccine series can be completed using vaccines from different manufacturers.
- If hep A vaccine and IG are administered simultaneously, they must be done in different anatomic sites.
- HAV Post-exposure Prophylaxis (PEP) recommendations:
- Hep A vaccine and IG are recommended for individuals based on provider risk assessment and age.
- IG dose recommended for individuals with chronic liver disease or immunocompromise.
- If hep A vaccine and IG are administered simultaneously, they must be done in different anatomic sites.
- Live vaccines should be administered at least 2 weeks before or at least 6 months after administration of IG.
- Vaccine series can be completed using vaccines from different manufacturers.
- Revaccination/booster dosing not recommended.
- Pre and post vaccination serologic testing not recommended for routine vaccination.
- Hepatitis B Virus (HBV) is a partially double stranded DNA virus that is enveloped and transmitted through infected blood and body fluids. It can present as either acute or chronic infection and can persist indefinitely within a hepatocyte serving as a reservoir of viral replication. The risk of developing chronic infection depends on age, with higher risk in younger individuals. HBV is vaccine preventable.
- Concept check #1: A 45-year-old patient presents to your pharmacy asking if he should obtain the hepatitis A vaccine. He has been diagnosed with cirrhosis and has HIV, and he is currently enrolled in a rehabilitation program for use of injection drugs. He is immune to hepatitis B. This patient has several risk factors for HAV infection, including cirrhosis, HIV, and injection drug use. Vaccination is recommended for this patient to prevent HBV infection.
Test your knowledge on the epidemiology of Hepatitis B virus (HBV) infection, including rates of chronic infection, recovery, and related complications such as cirrhosis and hepatocellular carcinoma (HCC). This quiz covers important statistics and information on HBV infection.
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