I. Disease description.pdf

VPD Surveillance Manual Chapter 4 (v. 1999) 4–1 The clinical manifestations of acute HBV infection are age- dependent. Generally, newborns do not develop any clinical signs or symptoms. Older children and adults are symptomatic in 30%–50% of infections. Chapter 4: Hepatitis B Craig N. Shapiro, MD; Francis J. Mahoney, MD; Annemarie Wasley, ScD; and Eric E. Mast, MD, MPH I. Disease description Acute hepatitis B Hepatitis B is caused by infection with the hepatitis B virus (HBV), a double- stranded DNA virus of the family hepadnaviridae. The liver is the primary site of HBV replication and high concentrations of virus are found in blood. Hepatitis B surface antigen (HBsAg) is found on the surface of the virus, is produced in excess amounts and circulates in the blood as 22 nm spherical and tubular particles. Antibody to HBsAg (anti-HBs) protects against infection. The nucleocapsid contains the hepatitis B core antigen (HBcAg) and antibody to HBcAg is indicative of HBV infection. The presence of a soluble, conformational antigen of HBcAg called hepatitis B e antigen (HBeAg) indicates high concentrations of circulating virus. . Hepatitis B virus is blood-borne and is transmitted by percutaneous and mucosal exposure to infectious body fluids. The incubation period for acute HBV infection is between 45–160 days (average 120 days). Clinical signs and symptoms of acute HBV infection include anorexia, nausea, malaise, vomiting, jaundice, dark urine, clay colored or light stools, and abdominal pain. Occasionally, extrahepatic manifestations occur and include skin rashes, arthralgias, and arthritis. Fulminant hepatitis occurs in about 1%–2% of persons with acute disease, and has a case-fatality ratio of 63%–93%. The clinical manifestations of acute HBV infection are age-dependent. 1 Generally, newborns do not develop any clinical signs or symptoms, and infection produces typical illness in 5%–15% of children 1– 5 years of age. Older children and adults are sym