Hepatitis B
Diagnosis and management

Active infection is indicated by the presence of hepatitis B surface antigen (HBsAg) in serum.

Acute hepatitis B is diagnosed in patients who are positive for HBsAg and have evidence of disturbed liver function, symptoms and a risk history suggesting recent infection. Repeatedly positive HBsAg over a 6 month period, in the absence of acute symptoms or risk history to suggest recent infection, indicates a chronic carrier state.

A person who has positive hepatitis B surface antibody (HBsAb) and negative HBsAg is immune and should not be further tested for hepatitis B.  Positive HBsAb with negative core antibody (HBcAb) is usually indicative of vaccination.

Individuals with active disease, ie HBsAg positive and abnormal liver function tests should be referred to an appropriate specialist.

Non-immune sexual and household contacts of hepatitis B infection are candidates for hepatitis B vaccination.

The STD clinic offers vaccination to

• Non-immune regular sex partners of patients who have positive HBsAg or Hepatitis B DNA

• Sex  workers

• Men who have sex with men (past or current)

• Injecting drug users (past or current)

• Indigenous Australians 

• Persons from high prevalence countries

• Non-immune regular sex partners of the above groups 

• Hepatitis C positive people

Vaccination doses are given at 0, 1 and 6 months. This regimen indicates the minimum time between vaccination doses. There is no need to recommence vaccination if there is a delay between doses.  Evidence of seroconversion is not sought. Booster doses are not recommended.

The following points should be discussed:

• The nature of the infection

• Methods of transmission and preventive measures required (taking into account the infective and immune status of the individuals involved)

• The need to vaccinate sexual and household contacts

• To minimise alcohol intake

• Need to vaccinate against Hepatitis A if indicated

• Provide literature on hepatitis B infection 

• Hepatitis B infection is a notifiable disease.

A person with positive HBsAg should be retested in 6 months.  A positive test on follow-up indicates a chronic carrier state. If the patient has abnormal liver function tests, refer to an appropriate specialist.

Notification

Hepatitis B is a notifiable infection in South Australia.