乙肝与乙肝病毒课件.ppt
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1、乙肝与乙肝病毒文档乙肝与乙肝病毒文档乙肝与乙肝病毒文档乙肝与乙肝病毒文档Hepatitis B VirusHepadnaviridae family(DNA)Numerous antigenic componentsHumans are only known hostMay retain infectivity for at least 1 month at room temperatureH e p a t i t i s B V i r u s H e p a d n a v i r i d a200 million carriers worldwideEstablished cause
2、of chronic hepatitis and cirrhosisHuman carcinogen-cause of up to 80%of hepatocellular carcinomasHepatitis B Virus Infection 2 0 0 mi l l i o n c a r r i e r s w o r l d w i dHBsAgHBcAgHBeAgHepatitis B VirusH B s A g H B c A g H B e A g H e p a t i t i s B V i rHepatitis B Clinical FeaturesIncubatio
3、n period 6 weeks to 6 months(average 120 days)Nonspecific prodrome of fever,malaise,headache,myalgiaIllness not specific for hepatitis BAt least 50%of infections asymptomaticH e p a t i t i s B C l i n i c a l F e a t u r e s IFulminant hepatitisHospitalizationCirrhosisHepatocellular carcinomaDeathH
4、epatitis B ComplicationsF u l mi n a n t h e p a t i t i s H e p a t i t i s BChronic Hepatitis B Virus InfectionChronic viremiaResponsible for most mortalityOverall risk 10%Higher risk with early infectionC h r o n i c H e p a t i t i s B V i r u s I n f e0102030405060708090100Birth1-6 mo7-12 mo1-4
5、 yrs5+yrsAge of infectionCarrier risk(%)Risk of Chronic HBV Carriage by Age of InfectionR i s k o f C h r o n i c H B V C a r r i a g e bIntegrate into routine adolescent immunization visitTwo 10 mcg doses of Recombivax HB separated by 4-6 months6-18 monthsRoutine vaccination recommended through age
6、 18yearsPain at injection sitePrimary 3Overall risk 10%For infants,at least 6 months of ageStrategy to Eliminate Hepatitis B Virus Transmission-United StatesTwo 10 mcg doses of Recombivax HB separated by 4-6 monthsHeterosexual with multiple partnersHousehold members and sexual partners of HBV carrie
7、rsManagement of Nonresponse to Hepatitis B VaccineCertain health care workersAdult Hepatitis B Vaccine CandidatesHealth care workers who have contact with patients or blood should be tested for antibody after vaccination.May be nonresponder or hyporesponderGlobal Patterns of Chronic HBV InfectionHep
8、atitis B EpidemiologyReservoirHuman.EndemicTransmissionBloodborneSubclinical cases transmit Communicability1-2 months before and after onset of symptomsChronic carriersI n t e g r a t e i n t o r o u t i n e a d o l e s cHepatitis B Perinatal Transmission*If mother positive for HBsAg and HBeAg70%-90
9、%of infants infected90%of infected infants become chronic carriersIf positive for HBsAg only20%of infants infected90%of infected infants become chronic carriers*in the absence of postexposure prophylaxisH e p a t i t i s B P e r i n a t a l T r a n s mi s High(8%):45%of global populationlifetime ris
10、k of infection 60%early childhood infections common Intermediate(2%-7%):43%of global populationlifetime risk of infection 20%-60%infections occur in all age groups Low(2%):12%of global populationlifetime risk of infection 8%):4 5%o f g l o b a l p o p0500010000150002000025000300001978198219861990199
11、41998CasesHepatitis B United States,1978-2000Hepatitis B vaccine licensedDecline amonghomosexual menDecline amongIV drug usersH e p a t i t i s B U n i t e d S t a t e s,1Total infections 80,000/yrCurrent carriers 1 millionNew carriers 5,000Deathfulminant hepatitis 200liver cancer 1,500cirrhosis 4,0
12、00HBV Disease Burden in the United States*1999 estimatesT o t a l i n f e c t i o n s 8 0,0 0 0/4%4%84%8%Age of Infection of Acute and Chronic Hepatitis B Virus Infection12%24%58%6%AdolescentChildrenPerinatalAdultAcute infectionChronic infectionCDC Sentinel Sites.1989 data.A g e o f I n f e c t i o
13、n o f A c u t e a n d Unknown31%Other1%Inj drug use15%Homosexual9%Heterosexual41%Health care worker1%Household contact2%Risk Factors for Hepatitis BCDC Sentinel Sites.1992-1993 data.R i s k F a c t o r s f o r H e p a t i t i s B C DHepatitis B Virus Infection by Duration of High Risk Behavior036912
14、15Years at Risk020406080100Percent infectedIV drug userHomosexual menHCWsHeterosexualH e p a t i t i s B V i r u s I n f e c t i o n b yStrategy to Eliminate Hepatitis B Virus Transmission-United StatesPrevent perinatal HBV transmissionRoutine vaccination of all infantsVaccination of children in hig
15、h-risk groupsVaccination of adolescentsVaccination of adults in high-risk groupsS t r a t e g y t o E l i mi n a t e H e p a t i t1965Discovery of Australian antigen1973Successful HBV infection of chimpanzees1981Licensure of plasma-derived vaccine1986Licensure of recombinant vaccine1991Universal inf
16、ant vaccination1996Universal adolescent vaccinationHepatitis B Vaccine1 9 6 5D i s c o v e r y o f A u s t r a l i a n Hepatitis B VaccineCompositionRecombinant HBsAgEfficacy95%(Range,80%-100%)Duration ofImmunity15 yearsSchedule3 DosesBooster doses not routinely recommended H e p a t i t i s B V a c
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