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Hepatitis B Envelope Antigen And Antibody
- Hepatitis B e Ag and Ab by EIA
- Lab Code
- Hepatitis B Envelope Antigen and Antibody
- Description
-
The Qualitative detection of Hepatitis B virus e antigen and Hepatitis B virus e antibody in human sera by the FDA approved LIASON® IgG Assay.
The presence of HBeAg in serum is associated with presence of Dane particles and Hepatitis B virus DNA polymerase enzyme. These markers suggest active HBV replication. Hepatitis B Surface antigen positive and HBeAg positive persons are much more likely to transmit infections to others. The development of anti-HBe during acute Hepatitis B infection is a marker of resolution of illness.
- Synonyms
Is Hepatitis B Contagious
Hepatitis B is highly contagious. It spreads through contact with infected blood and certain other bodily fluids. Although the virus can be found in saliva, its not spread through sharing utensils or kissing. It also doesnt spread through sneezing, coughing, or breastfeeding. Symptoms of hepatitis B may not appear for 3 months after exposure and can last for 212 weeks. However, you are still contagious, even
To screen for hepatitis B, your doctor will perform a series of blood tests.
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Symptoms Of Hepatitis B
Some people who are infected with the hepatitis B virus have mild, flu-like symptoms and some do not become sick at all. Children who are infected are less likely to have an illness or get sick after getting hepatitis B than adults.
In more severe cases, hepatitis B can cause:
- Loss of appetite.
- Pain in the joints.
- Jaundice .
Normally, these health problems disappear in a few weeks, but even when the person feels much better, they may still be infectious.
Most adults who become infected with the hepatitis B virus recover completely and do not become infected again. A few people become very ill in the time just after infection and need to go to hospital some may even die.
Hbeag Tests During Pregnancy
Pregnant people are screened for a different antigen, called the hepatitis B surface antigen . It also shows an active infection with hepatitis B.
If the HBsAG test is positive, the HBeAg test may be done along with other tests. These tests may include the HBV DNA concentration test and the alanine aminotransferase test. The ALT focuses on a specific enzyme to assess for liver function.
If the HBeAg test is positive, the Centers for Disease Control and Prevention recommends that the person be referred to a specialist immediately for care during the rest of their pregnancy.
Whether or not the HBeAg is positive and the virus active, the newborn will need to be treated with both passive and active immunization to keep them from becoming infected.
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Module 1 Who Should Be Tested For Hbv
In low-risk populations, routine screening for chronic infection or immunity is not recommended. Testing to determine immune status and/or to detect chronic infection is indicated for those at risk of exposure susceptible people should be immunized.
Clinicians should maintain a high index of suspicion for HBV as infection is frequently asymptomatic 30% of infections have no identified risk factors.Endnote 6
The decision to screen and the selection of tests should be based on a thorough review of the following:
- Self-reported HBV immunization history and/or documentation
- Results of previous testing
- Presence of risk factors for HBV infection
Barriers To Eliminating Hbv
Persistence of cccDNA and its ability to selfreplenish and the lack of direct effects of current therapies on cccDNA account for the difficulty in eliminating cccDNA. There are additional barriers to eliminating HBV. HBV DNA can be integrated into the host genome. Although integrated HBV DNA is often rearranged and/or partially deleted and there is no evidence that it supports the full cycle of HBV replication, recent studies suggest that integrated HBV DNA can be sufficiently intact to support translation of viral proteins, e.g., HBsAg.5 Elimination of integrated HBV DNA will likely require the removal of hepatocytes that harbor these DNA. Control of infections generally requires elimination of the infectious organisms coupled with activation of specific immune responses. Whereas patients who recover from acute HBV infection display rigorous immune responses to multiple HBV epitopes, patients with chronic HBV infection manifest weak immune responses to very few HBV epitopes.6
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Liver Grafts From Hepatitis B Surface Antigen
Correspondence to: Pietro Andreone, MD, Professor of Internal Medicine, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Via Massarenti, 9, 40138 Bologna, Italy.
Telephone: +39-51-2143618 Fax: +39-51-345806
Case Reporting And National Notification
Cases of acute, chronic, and perinatal hepatitis B, and hepatitis B during pregnancy should be reported to HDs as specified by state, territorial, or local regulations. Acute, chronic, and perinatal hepatitis B are nationally notifiable conditions . Hepatitis B cases are identified using an event code corresponding to the hepatitis B condition . Data are sent weekly or more frequently, depending on the infrastructure of the jurisdiction sending the data. Cases might be re-classified or removed as needed after the initial transmission to CDC, as long as the changes occur before surveillance data are finalized each year.
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Hepatitis B Blood Tests
The Hepatitis B Panel of Blood Tests
Only one sample of blood is needed for a hepatitis B blood test, but the Hepatitis B Panel includes three parts. All three test results are needed to fully understand whether a person is infected or not. Below is an explanation of the 3-part Hepatitis B Panel of blood test results.
Key Facts And Figures
- HBV is a vaccine-preventable disease that is highly infectious far more so than either HIV or HCV. It is transmitted through perinatal, percutaneous, or sexual exposure to an infected person’s blood / body fluids household contacts are also at risk of infection.
- Acute and chronic HBV infections are frequently asymptomatic or present with nonspecific symptoms about two-thirds of chronically infected people are unaware of their status, and most will only be detected through proactive screening.
- Of those infected as adults, 5% will become chronically infected in contrast, about 90% of infants infected at birth will develop chronic infection.Endnote 1
- Without intervention, 15%40% of chronically infected people will go on to develop cirrhosis, end-stage liver disease, and/or HCC.
HBV is a notifiable disease in all provinces and territories in Canada. As such, it must be reported to the regional/local Medical Officer of Health.
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Hepatitis B: Diagnosis And Treatment
THAD WILKINS, MD DAVE ZIMMERMAN, MD and ROBERT R. SCHADE, MD, Medical College of Georgia, Augusta, Georgia
Am Fam Physician. 2010 Apr 15 81:965-972.
Patient information: See related handout on hepatitis B.
Globally, an estimated 350 million persons are chronically infected with hepatitis B virus , resulting in 600,000 deaths annually from cirrhosis, liver failure, and hepatocellular carcinoma.1,2 Approximately 88 percent of the world’s population live in regions where the prevalence of chronic HBV infection among adults is more than 2 percent.3 The prevalence of HBV infection in the United States is 0.4 percent, with an estimated 0.8 to 1.4 million persons chronically infected.3,4 With the implementation of vaccination programs in 1991, the incidence of new infections in the United States has declined from 11.5 cases per 100,000 persons in 1985 to 1.6 cases per 100,000 persons in 2006.3,4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
High-risk populations should be screened for HBV infection.
HBV = hepatitis B virus.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
High-risk populations should be screened for HBV infection.
HBV = hepatitis B virus.
World Health Organization Recommendations
The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicates treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis , regardless of their levels of ALT or HBV DNA, or their HBeAg status.
Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis , but who have all of the following features , and regardless of HBeAg status :
- Are older than 30 years
- Have persistently abnormal ALT levels
- Have evidence of high-level HBV replication .
In individuals with HBV/human immunodeficiency virus coinfection, the AASLD recommends initiating ART in all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage.
However, the AASLD does not recommend antiviral therapy, indicating it can be deferred, in individuals with all of the following , regardless of HBeAg status or age :
- No clinical evidence of cirrhosis
- Persistently normal ALT levels
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Where Is Your Patient From
This is a figure of a map of the world within Module 1 that is meant to assist clinicians in determining whether a patient is from a country of low , intermediate , or high prevalence of hepatitis B infection. Clinicians are advised that individuals born in regions with intermediate or high endemicity are at particular risk of having chronic hepatitis B infection and that screening populations at high risk of chronic infection is essential to identify anyone who can benefit from monitoring and treatment.
Reproduced with permission from NEJM 359:14 October 2008Endnote 8
Screening populations at high risk of chronic HBV infection is essential to identify anyone who can benefit from monitoring and treatment.
Why Do I Need This Test
You may need this test if your healthcare provider suspects you have a liver infection caused by HBV. You may also need this test if you have symptoms of hepatitis B. Symptoms usually start slowly. Many people have no symptoms or only feel like they have a mild case of the flu. You may not have symptoms until the infection is chronic or severe.
The most common symptom is extreme tiredness. Other symptoms may include:
-
Nausea
-
Belly pain
-
Swelling and confusion. This is in extreme cases.
You may also have this test if you have a history that puts you at risk for being in contact with the virus. Risk factors for hepatitis B infection include:
-
Having sex with someone infected with the virus
-
Living in close contact with someone who has the virus
-
Being a man who has sex with men
-
Being a child born to a mother who has the virus
-
Sharing needles for intravenous drug use
-
Working in a healthcare center where you are exposed to blood
-
Getting a blood transfusion or organ transplant. This is less common with active screening.
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How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
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Cases And Clusters Of Potential Public Health Importance
Jurisdictions should review and analyze hepatitis B data regularly to identify cases and clusters of hepatitis B that merit further investigation. When resources are limited, these should be prioritized for investigation based on the degree of public health importance. The following are examples of high priority cases and clusters:
- People of childbearing age who are or have the potential to become pregnant, indicating the potential for perinatal transmission
- Children 24 months of age to detect perinatal transmission
- People in age and demographic groups for whom infection may be acute due to recent transmission, including those
- 70 years of age
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Does Hepatitis B Show Up In Routine Blood Tests
Routine blood tests do not detect hepatitis B virus infection. Hepatitis B tests are specifically done if blood tests show abnormal liver function results, or if a person experiences symptoms or falls into the high-risk category for HBV infection.
A panel of HBV-specific blood tests are required to detect HBV infection.
How Many People Have Hepatitis B
In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2018, 3,322 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 21,600 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.
Globally, HBV is the most common blood-borne infection with an estimated 257 million people infected according to the World Health Organization .
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Module 9 Treatment Of Chronic Hbv And Monitoring Of Patients On Treatment
The goal of treating chronic HBV is to prevent disease progression and induce disease regression to minimize liver damage and its complications .
The current approved treatments for HBV are interferon injections or oral nucleoside/nucleotide analogues . As oral antivirals are excreted by the kidney, dose adjustments are required in renal failure.
Not all patients with chronic HBV infection need to be treated. The decision to treat depends on several factors including age, serial ALT and HBV DNA levels, and severity of liver disease. Co-infection, particularly with HIV and HCV, needs to be considered when deciding on which medications to use.
Treatment should be initiated by a hepatologist or other physician with experience in the management of viral hepatitis.
The duration of therapy depends on the type of treatment. Interferon is used for up to 48 weeks oral antiviral medication is used indefinitely or until the treatment endpoint is achieved . Note: Treatment cannot be stopped in organ transplant recipients or infected individuals who require immunosuppressive therapy for another disorder.
All patients being treated for chronic HBV require laboratory monitoring of HBV DNA levels and liver biochemistry every 3 – 6 months. This is necessary both to assess response to treatment and to permit early detection of resistance to antiviral therapy.
Resolution Time And Clinical Course Of Infection
The majority of immunocompetent adults will recover within 6 months and develop lifelong immunity the remainder will be chronically infected. Immunocompromised adults are at a particular risk of developing chronic infection. The risk of developing chronic infection is also much higher for those who acquired the infection in infancy or before 7 years of age .Endnote 3, Endnote 13, Endnote 14
Acute HBV does not require antiviral treatment. Management should focus on relief of symptoms, monitoring and prevention of hepatic complications, as well as counselling aimed at preventing transmission. Persistence of HBsAg for 6 months indicates chronic infection.
Baseline laboratory testing to assess liver function and screen for other infections:
- Bilirubin , albumin, INR , creatinine
- ALT, AST, ALP
- anti-HBc IgM
- Testing for STIs, including HIV, and for HCV, where appropriate
- Repeat HBsAg at least 6 months after baseline, to confirm / rule out chronic infection. . See Module 6 for additional testing recommendations for those with confirmed chronic HBV
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