Q&A: Concerning Hepatitis B Prevention

There are more than two billion individuals with serologic evidence of hepatitis B virus (HBV) infection worldwide. Of these, 292 million are chronic carriers, and approximately 686,000 hepatitis B-related deaths occur annually. Despite advances in antiviral therapy, only a minority of patients with chronic hepatitis B will have a sustained response. Thus, primary prevention by vaccination to increase herd immunity remains the main focus in controlling HBV infection.

This article is for Medical Students & Professionals

This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Hepatitis B article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Vaccination for HBV prevention
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Vaccination for HBV prevention

Hepatitis B virus (HBV) infection can potentially be eradicated through global vaccination. Globally, vaccine coverage for infants based upon completion of the third dose of vaccine (HepB3) has increased from 3 percent in 1992 to 84 percent in 2015. However, even in countries that actively advocate universal vaccination, coverage is less than 100 percent. As an example, the vaccine coverage in Taiwan for birth cohorts from 1984 to 2010 was 88.8 to 96.9 percent.

MCQ: clinical scenario

You are asked to ensure that all your hemodialysis staff have appropriate prophylaxis against hepatitis B. One of the workers is not immunised.

Which agent would offer most appropriate prophylaxis?

a) recombinant hepatitis B vaccine
b) hepatitis B e antigen
c) Hepatitis B surface antigen
d) hepatitis C vaccine
e) hepatitis B immune globulin (HBIG)

MCQ: answer

The correct answer is A

MCQ: explanation

Active immunization has become possible with the advent of hepatitis B vaccine. The original vaccine was prepared from the plasma of hepatitis B carriers. Although this vaccine underwent multistep inactivation that destroyed the infectivity of all known viruses (including HIV), concerns over the origin of the vaccine from high-risk persons limited its acceptance. In 1987, a recombinant vaccine became available, derived from recombinant yeast into which the gene for surface antigen had been inserted. Such vaccines have replaced plasma-derived vaccines.

Reference(s)
1). UpToDate: Hepatitis B virus immunization in adults. Available online: https://www.uptodate.com/contents/hepatitis-b-virus-immunization-in-adults