Presentasi Vaksin Hep B Utk Ko-Ass

8/9/2019 Presentasi Vaksin Hep B Utk Ko-Ass

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HEPATITIS BVACCINATION

dr. Putri Nugraheni


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Epidemiology

An estimated 3! million persons "orld"ide are#hroni#ally in$e#ted "ith HBV.

In the %nited States& there are an estimated '.(million hepatitis B #arriers& de)ned as personspositi*e $or hepatitis B sur$a#e antigen +HBsAg,$or more than - months.

Carriers o$ HBV are at in#reased ris o$de*eloping #irrhosis& hepati# de#ompensation&and hepato#ellular #ar#inoma +HCC,.


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A/out Hepatitis B

HBV is a 0(1nm 2NA *irus #lassi)ed in theHepadna*iridae $amily. The li*er is the primarysite o$ HBV repli#ation. A$ter a sus#epti/le personis eposed& the *irus enters the li*er *ia the

/loodstream HBV in$e#tion #an produ#e either asymptomati# or

symptomati# in$e#tion. The a*erage in#u/ationperiod is 4! days +range5 -!6'! days, $rom

eposure to onset o$ 7aundi#e and -! days +range50!64! days, $rom eposure to onset o$ a/normalserum alanine aminotrans$erase +A8T, le*els


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9hen present& #lini#al symptoms andsigns #an in#lude anoreia& malaise&nausea& *omiting& a/dominal pain& and

7aundi#e. Etrahepati# mani$estations o$disease +e.g.& sin rashes& arthralgias&and arthritis, also #an o##ur


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Transmission

HBV is transmitted /y perinatal& per#utaneous&and seual eposure& as "ell as /y #loseperson1to1person #onta#t presuma/ly /y open#uts and sores& espe#ially among #hildren inhyperendemi# areas.

The ris o$ de*eloping #hroni# HBV in$e#tiona$ter a#ute eposure ranges $rom 4!: in

ne"/orns o$ HBeAg1positi*e mothers to (:to 3!: in in$ants and #hildren under and toless than : in adults.


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Table 2. Groups at High Risk for HBV Infection Who ShouldBe Screened 5

Indi*iduals /orn in areas o$ high; or intermediate pre*alen#erates< $orHBV in#luding immigrants and adopted #hildren=>

?Asia5 All #ountries

?A$ri#a5 All #ountries

?South Pa#i)# Islands5 All #ountries

?@iddle East +e#ept Cyprus and Israel,

?European @editerranean5 @alta and Spain

?The Ar#ti# +indigenous populations o$ Alasa& Canada& andreenland,

?South Ameri#a5 E#uador& uyana& Suriname& Veneuela& andAmaon regions o$ Boli*ia& Brail& Colom/ia& and Peru

?Eastern Europe5 All #ountries e#ept Hungary

?Cari//ean5 Antigua and Bar/uda& 2omini#a& ranada& Haiti&amai#a& St. Ditts and Ne*is& St. 8u#ia& and Turs and Cai#os.


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Other groups re#ommended $or s#reening

?Born persons not *a##inated as in$ants "hose parents "ere/orn in regions "ith high HBV endemi#ity +:,

?Household and seual #onta#ts o$ HBsAg1positi*e persons>

?Persons "ho ha*e e*er in7e#ted drugs>?Persons "ith multiple seual partners or history o$ seually

transmitted disease>

?@en "ho ha*e se "ith men>

?Inmates o$ #orre#tional $a#ilities>

?Indi*iduals "ith #hroni#ally ele*ated A8T or AST>

?Indi*iduals in$e#ted "ith HCV or HIV>

?Patients undergoing renal dialysis>

?All pregnant "omen

?Persons needing immunosuppressi*e therapy


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Pre*ention

Hepatitis B *a##ination is the most eFe#ti*emeasure to pre*ent hepatitis B *irus +HBV,in$e#tion and its #onseGuen#es& in#luding #irrhosis

o$ the li*er& li*er #an#er& li*er $ailure& and death.

In adults& ongoing HBV transmission o##ursprimarily among un*a##inated persons "ith

/eha*ioral riss $or HBV transmission +e.g.&heteroseuals "ith multiple se partners& in7e#tion1

drug users I2%s& and men "ho ha*e se "ithmen @S@, and among household #onta#ts andse partners o$ persons "ith #hroni# HBV in$e#tion.


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Be$ore hepatitis B *a##ination "as "idelyimplemented& HBV in$e#tion "as re#ognied asa #ommon o##upational haard among persons"ho "ere eposed to /lood "hile #aring.

Sin#e then& routine hepatitis B *a##ination o$health1#are "orers and use o$ standardpre#autions to pre*ent eposure to /lood1/orne pathogens ha*e made HBV in$e#tion a

rare e*ent in these populations. Sin#e the mid1'44!s& the in#iden#e o$ HBV

in$e#tion among health1#are "orers has /eenlo"er than that among the general population.


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2uring (!!! 1 (!!0& sel$1reportedhepatitis B *a##ination #o*erage amongadults at ris $or HBV in$e#tion in#reased

$rom 3!: to 0:This in#rease in *a##ination #o*erage

liely #ontri/uted to the 3: de#line in

a#ute hepatitis B in#iden#e that o##urredduring this period +$rom 3.J to (.0 per'!!&!!! population,.


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HBI and #on#urrent hepatitis B *a##ine ha*e/een sho"n to /e 4: e$)#a#ious in thepre*ention o$ perinatal transmission o$ HBV& thee$)#a#y is lo"er $or maternal #arriers "ith *ery

high serum HBV 2NA le*els +K log'! I%Lm8,. Transmission o$ HBV $rom in$e#ted health #are

"orers to patients has also /een sho"n to o##urin rare instan#es.

Mollo"1up testing is re#ommended $or those "horemain at ris o$ in$e#tion su#h as health #are"orers& in$ants o$ HBsAg1positi*e mothers andseual partners o$ persons "ith #hroni# HBV

in$e#tion.


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e#ommendation

A #omprehensi*e strategy to eliminate HBVtransmission5

', uni*ersal *a##ination o$ in$ants /eginning at /irth

(, pre*ention o$ perinatal HBV in$e#tion through routine

s#reening o$ all pregnant "omen $or hepatitis Bsur$a#e antigen +HBsAg, and posteposureimmunoprophylais o$ in$ants /orn to HBsAg1positi*e"omen or to "omen "ith unno"n HBsAg status

3, *a##ination o$ all #hildren and adoles#ents "ho "erenot *a##inated pre*iously

0, *a##ination o$ pre*iously un*a##inated adults at ris$or HBV in$e#tion


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In settings in "hi#h a high proportion o$adults ha*e riss $or HBV in$e#tion +e.g.&seually transmitted diseaseLhuman

immunode)#ien#y *irus testing andtreatment $a#ilities& drug1a/use treatmentand pre*ention settings& health1#are settingstargeting ser*i#es to I2%s& health1#aresettings targeting ser*i#es to @S@& and#orre#tional $a#ilities,& ACIP re#ommendsuni*ersal hepatitis B *a##ination $or allun*a##inated adults.


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e#ommendations $or Counseling and Pre*ention o$Transmission o$ Hepatitis B $rom Indi*iduals "ith Chroni#HBV In$e#tion5

Carriers should /e #ounseled regarding pre*ention o$

transmission o$ HBV +Ta/le 3,. +III, Seual and household #onta#ts o$ #arriers "ho are negati*e

$or HBV seromarers should re#ei*e hepatitis B *a##ination.+III,

Ne"/orns o$ HBV1in$e#ted mothers should re#ei*e HBI and

hepatitis B *a##ine at deli*ery and #omplete there#ommended *a##ination series. +I,

Persons "ho remain at ris $or HBV in$e#tion su#h as in$antso$ HBsAg1positi*e mothers& health #are "orers& dialysispatients& and seual partners o$ #arriers should /e tested

$or response to *a##ination. +III,


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Va##ination

Hepatitis B *a##ine is a*aila/le as a single1antigen $ormulation and also in )ed#om/ination "ith other *a##ines.

HBsAg is the antigen used $or hepatitis B*a##ination.

K3 intramus#ular doses o$ hepatitis B *a##ine

!& '& and - months

prote#ti*e anti/ody response in approimately3!:6: o$ healthy adults aged 0! yearsa$ter the )rst dose& J: a$ter the se#ond dose&and K4!: a$ter the third dose


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Post*a##ination

Post*a##ination testing is re#ommended$or #ertain health1#are and pu/li# sa$ety"orers #hroni# hemodialysis patients&

HIV1in$e#ted persons& and otherimmuno#ompromised persons and seor needle1sharing partners o$ HBsAg1positi*e persons


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re*a##ination o##urs in persons "ho ha*emeasura/le /ut lo" +'! mI%Lm8, le*els o$anti/ody a$ter the initial series.

A$ter primary immuniation "ith hepatitis B*a##ine& anti1HBs le*els de#line rapidly "ithinthe )rst year and more slo"ly in the net '!1' years.

E*en "hen anti1HBs #on#entrations de#line to'! mI%Lm8& nearly all *a##inated personsremain prote#ted against HBV in$e#tion.


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Con#lusion

Hepatitis B is a highly in$e#titiousdisease "hi#h #an #ause end1stage#ompli#ations

Transmission route in#ludes #onta#t "ith#uts& sores& and /lood

Health #are pro*ider is at all times at ris

o$ getting hepatitis B in$e#tionTransmission #an /e pre*ented /y

*a##ination

All health #are pro*iders arere#ommended to ha*e routine s#reening


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e$eren#es

8o ASM& @#@ahon B. AAS82 Pra#ti#euidelines& Chroni# Hepatitis B %pdate.(!!4.

Alter @& et al. A Comprehensi*eImmuniation Strategy to Eliminate

Transmission o$ Hepatitis B VirusIn$e#tion in the %nited States. (!!-.


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THAND QO%

Presentasi Vaksin Hep B Utk Ko-Ass

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