Cross Infection in Dental Clinic Hepatitis B Virus

HBV

Sara AlGahtani,BDS Oral Microbiology Demonstrator

Introduction

HEPATITIS

Structure

HBeAg

Epidemiology

Prevalence of HBV in Saudi Arabia is as high as 8% .

G.Gasim ,2013

There is higher prevalence of HBV infection in Asia and Africa (8-15%) than America and Western Europe (<2%).

K.Oakes ,2014

Epidemiology

Viral hepatitis is 2nd common viral infection in KSA. Prevalence according to El-beltagy,2008 is as follows :

Abdo et al , 2012

Central South west East North west

1.5% 5.4% 6.7% 3%

Transmission

HBV may be transmitted via Blood or Body fluids

Risk of contracting HBV

People at High Risk of Infection

HBV Survival

Pathogenesis and Clinical Feastures

High titers of HBV reaching 108 -1011 virions /ml

Fever, Malaise, Nausea,Vomiting ,Dark Urine, Pale fatty stool, Jaundice

States of the Disease

Laboratory Diagnosis

Biochemistry: Bilirubin Hepatic enzymes : GPT , Alkaline Phosphatase

Serology (Hepatitis Markers): HBsAg – Acute or Chronic(Carrier) Infection Anti-HBsAg – Immunity due to Vaccine or Previous Exposure HBeAg – High Infectivity Anti-HBeAg – Low Infectivity and Recovery Anti-HBcAg – Acute(Recent) or Chronic, Previous Exposure

Laboratory Diagnosis

With Recovery

Laboratory Diagnosis

Chronic

State

Precautions And Prevention

Careful history

Blood Tests

PPE

Vaccination

HBV Inactivation

Autoclaving for 15 min. at 1210C

Dry Heat for 1 hour at 1500C

Aqueous Formaldehyde for 12 hours at 16%

Sodium Hypochlorite for 30 min. at 1%

Immunization And Vaccination

Passive Immunization: 1-Immune Serum globulin ISG 2-Hepatitis B Immune Globulin HBIG Needle Injury or Infants in 3rd trimester

Active Immunization (Vaccine): 1-Plasma-derived Vaccine 2-Recombinant DNA Vaccine

Treatment And Dental Management

Medical Management: Acute Vs. Chronic

Dental Management: Active Hepatitis

History of HepatitisHepatitis CarrierSigns and Symptoms of HepatitisInfected Dentist

Practice

Management Status Anti-HBcAg HBeAg Anti-HBsAg HBsAg

Acute Infection

Active Hepatitis– Highly Infectious+ + +

+ +

++

+

_

_ _

_ _

_ _ _

Resolved Infection

History of Hepatitis-Immune

Chronic Infection

Carrier of Hepatitis-Infectious

Vaccinated Immune

References

Little, Dental Management of the Medically Compromised Patient,7th edition Essential Microbiology for Dentistry 3RD EDITIONHepatitis B: prevalence and Pathophysiology ,Kathyrn Oakes,Nursing Times 12.02.14 / Vol 110 No 7 / www.nursingtimes.net Hepatitis B virus in the Arab world: Where do we stand?,Gasim Gasim, Arab Journal of Gastroenterology 14 (2013) 35–43Epidemiology of Viral Hepatitis in Saudi Arabia:Are We Off the Hook?, Abdo et al , The Saudi Journal ofGastroenterology, 349 Volume 18, Number 6, Dhul Hijjah 1433H November 2012Several Resources of Figures.