Lesson_Hepatitis_B_Infection_in_the_Dental_Practice.pdf

Hepatitis Infection in the Dental Practice Infection Control in Dentistry Dr. Wilfredo De Ocampo Jr 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis Infection 9/21/2022 • One of the diseases on high alert to health care professionals, not only in dentistry • Past decades of management and pr...

Hepatitis Infection in the Dental Practice Infection Control in Dentistry Dr. Wilfredo De Ocampo Jr 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis Infection 9/21/2022 • One of the diseases on high alert to health care professionals, not only in dentistry • Past decades of management and precautions have evolved • In some countries, only theoretical concentration in undergraduate education Dr. Wilfredo De Ocampo Jr, DMD Dental Practice in the old days 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis keypoints 9/21/2022 • Liver disease • Inflammation • Causative agent: virus, other microbes, chemicals, medications Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis B Virus • Worldwide cause of acute and chronic hepatitis, cirrhosis, and primary hepatocellular carcinoma • frequently acquired perinatally in the high prevalence regions, from infected mother to offspring • 90% of the carriers live in less developed countries 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis B 9/21/2022 • Major worldwide cause of the ff: • Acute and chronic hepatitis • Cirrhosis • Primary hepatocellular carcinoma Dr. Wilfredo De Ocampo Jr, DMD Hepatitis B is spread when blood, semen, or other body fluid infected with the hepatitis B virus enters the body of a person who is not infected. People can become infected through: Birth (if a pregnant person has hepatitis B, their baby can become infected) Sharing items such as razors or toothbrushes with an infected person Contact with the blood or open sores of an infected person Sex with an infected partner Sharing needles, syringes, or other drug-injection equipment Exposure to blood from needlesticks or other sharp instruments Most people who are vaccinated with hepatitis B vaccine are immune for life. 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD HBV Carrier State and Dentistry • some dentists have transmitted HBV infection to their patients • Most often these cases were investigated by the CDC on finding clusters of HBV infections and determining a common factor of dental care by a single dentist within the previous 2 to 6 months before illness 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD HBV Carrier State and Dentistry • 46-year-old male dentist from Pennsylvania who had no history of hepatitis or any disease with comparable symptoms but transmitted the same subtype of hepatitis that he was found to have to 55 of his patients • He rarely wore gloves while performing dental procedures before the incident occurred • He did wear gloves during the subsequent investigation and only two additional cases of hepatitis developed in more than 4,300 patients seen. 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD HBV Carrier State and Dentistry • Barrier techniques have been shown time and again to be effective in preventing HBV transmission. • In 1984, 26 cases of HBV infection were reported in a dentist’s practice in Indiana, the dentist had positive results for HBsAg with the same subgroup antigen as the infected patients but had no known history of HBV infection. Fulminant hepatitis developed in two patients, resulting in death. The dentist died of HBV infection sequelae in December 1988 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD HBV Carrier State and Dentistry • No documented cases of HBV transmission to dental patients were found from 1987– 2001 • In the May 1, 2007, issue of the Journal of Infectious Diseases quickly returned hepatitis B to the forefront of dental attention and concern: the CDC was able to document that a rare case of patient-topatient transmission of HBV had occurred in an oral surgery practice in late 2001 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD HBV Carrier State and Dentistry • No documented cases of HBV transmission to dental patients were found from 1987– 2001 • In the May 1, 2007, issue of the Journal of Infectious Diseases quickly returned hepatitis B to the forefront of dental attention and concern: the CDC was able to document that a rare case of patient-topatient transmission of HBV had occurred in an oral surgery practice in late 2001 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD PREVENTION OF TRANSMISSION VIA IMMUNOPROPHYLAXIS • Active and Passive Immunity • Hepatitis B Vaccines • Plasma-Derived Vaccine • Recombinant DNA Vaccines • Antibody Persistence and Booster Dose 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Passive and Active Immunity • Passive immunity occurs by transferring preformed antibodies from an actively immunized host to a person in need of immunity; protection provided is transitory, onset is immediate, and examples are injection of immune serum globulin (ISG) or HBIG • Active immunity develops from stimulation of one’s own immune response. Protection is provided only after a latent period, but benefits for the immunized person can be well worth it, as long-term immunity can develop and be maintained 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Passive and Active Immunity • ISG primarily provides protection against HAV infection and is relatively inexpensive • Passive immunoprophylaxis via HBIG provides protection against HBV infection for approximately 2 months and is expensive • Active preincident immunity is preferable • Active immunity can be conferred through host recovery from acute infection or subclinical disease or through hepatitis B vaccination 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Hepatitis B Vaccines Plasma-Derived Vaccine Recombinant DNA Vaccines Hepatitis B vaccine is usually given as 2, 3, or 4 shots Infants should get their first dose of hepatitis B vaccine at birth and will usually complete the series at 6–18 months of age Children and adolescents younger than 19 years of age who have not yet gotten the vaccine should be vaccinated. Adults who were not vaccinated previously and want to be protected against hepatitis B can also get the vaccine. 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Pretesting • The issue of whether to pretest a person for anti-HBs immunity has been discussed at length since introduction of the vaccines • Pretesting can be cost-effective in large groups where the proportion expected to be antibody positive is substantial because those who are already anti-HBs positive are immune to HBV infection and therefore do not need the vaccine • Studies to date have shown that only 6.7% of vaccine recipients in dentistry were already immune • Unfortunately, there can be a significant number of false-positive reports for anti-HBs, particularly in a pretesting situation 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Post-testing • Serologic testing within 6 months of completing the primary series will differentiate people who respond to vaccine from those who fail to respond • Results of testing performed more than 6 months after completion of the primary series are more difficult to interpret • Post-testing should be scheduled soon after the last inoculation, preferably within 1–2 months 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Post-testing • A vaccine recipient who has negative results for anti-HBs several years after vaccination can be a primary non-responder who remains susceptible to HBV or a vaccine responder whose antibody levels have decreased below detectability yet he or she is still protected against clinical disease • Should one not have responded, a second course of three additional doses of vaccine usually is prescribed by physicians. These extra doses will cause seroconversion in approximately 50% to 70% of the “first series” non-responders 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Antibody Persistence and Booster Dose • Ongoing studies have shown that immunological memory in persons who have responded to vaccination with greater than 10 U/mL of anti-HBs lasts for at least 23 years, and probably much longer • According to the CDC, it is not necessary to be tested routinely for anti-HBs each year after vaccination • Antibody response to properly administered vaccine is excellent for adults and children with a normal immune status and protection lasts as mentioned above because of the anamnestic response 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Setia, et al.: Hepatitis B and C infection in dentistry and its 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD management 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Summary • • • • Several hepatitis viruses present a serious threat to members of the dental team. HBV and HDV infection represent the most life-threatening of these diseases HBV and HDV has vaccines for our protection No vaccine for HCV yet 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD https://quizizz.com/join?gc= 34935363 Game Code: 3493 5363 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD Small Group Discussion (30mins) 1. Based on the hierarchy of controls, please make a set of protocols to mitigate Hepatitis transmission in the dental clinic 2. Using epidemiologic information, explain why hepatitis B virus is the bloodborne pathogen target for standard precautions. 3. You receive a copy of a patient’s hepatitis B serological profile. It reads: HBsAg negative, anti-HBc positive, and anti-HBs positive. What is your opinion about the patient’s possible history of hepatitis and immunity? 9/21/2022 Dr. Wilfredo De Ocampo Jr, DMD