Treatment, Recovery,and theVaccine

Contents:
1. The Treatment (Click Here)
2. Recovery (Click Here)
3. The Vaccine (Click Here) 

1. The Treatment:

(Please note that much of this section is not easily comprehensible without some degree of biological knowledge.)

• For chronic active hepatitis B, the use of steroids and immunosuppressives has fallen out of favour.
• Lymphoblastoid Alpha-Interferon is the only licensed medication to treat patients with chronic hepatitis B and hepatocellular carcinoma (HCC). (?)
• Lymphoblastoid Alpha-Interferon can prevent the development of HCC in high-risk HBsAg-positive patients, especially those who had developed HCC, cirrhosis and in family members of HCC patients.
• Interferon therapy is able to successfully treat 30% to 40% cases of chronic hepatitis B.
• This drug suppresses viral replication by inhibiting viral protein synthesis and stimulates cell-mediatied response.
• It causes the production of anti viral inhibitory cytokines.
• It also causes the expression of a major histoincompatibility class 1 antigen on the surface of HCC tumours, making them susceptible to natural killer cells, monocytes and cytotoxic cell destruction.
• It also inhibits the activity of tumour cellular protein production by depressing the tumour's 2'-5' oligodenlylic acid synthetase activity.

Side effects of Lymphoblastoid Alpha-Interferon Therapy:

• Fever (80%)
• Chills (50%)
• Headache (50%)
• Myalgia (3%)
• Dizziness (10%)
• Reversible erythema and pruritus (1%)
• Reversible thrombopenia and leucopenia (60%)
• lassitude (70%)

2. Recovery:

• Recovery from an acute attack of hepatitis B would usually confer lifelong immunity to HBV to the patient.
• The recovered patient's blood would have no detectable hepatitis B markers, but there would be the presence of antibodies to hepatitis B markers (e.g. anti-HBs, anti-HBc).
• The total antibody titre of a recovered patient should be measured periodically to ensure that the level of antibodies in the patient is still sufficiently high to confer immunity.
• If the antibody level falls too low, booster injections of the hepatitis B vaccine should be given to the patient.
• The amount and frequency of the vaccine to be administered would depend on the patient's original antibody level.

3. The Vaccine:

• The name of the vaccine used is B-Hepvac MSD.
• HBsAg is non-infectious, and is a major component of the Hepatitis B vaccine.
• The WHO has been actively promoting vaccination programmes.
• The World Health Assembly recommends that the vaccine be given to all new-borns in regions of high and low endemicity before the end of the century.
• WHO and UNICEF have pooled efforts to purchase large bulk supplies of hepatitis B vaccines to supply countries which still cannot hepatitis B immunization for their populations, at a reduced cost.
• Vaccination does not confer full protection, as there is a slight chance that a vaccinated individual will get infected by HBV.
• Only 90% to 95% of vaccinated people are protected.
• The vaccine is generally well tolerated. Very rarely, mild discomfort at the infection site may occur.

Vaccination Categories:
1. Adults and Infants who are not infected (Click Here)
2. Adults who are just infected (Click Here)
3. Infants born by infected or carrier mothers  (Click Here)

For more information on hepatitis B vaccination, and to view a comprehensive table of the various vaccination categories, Click Here!

1. Adults who are not infected:

• 3 subcutaneous injections of B-Hepvac MSD given over a period of six months.
• (I'm not sure of the exact vaccine dosage administered each time.)

2. Adults who are just infected:

• 5 ml of hepatitis B immunoglobulin (HBIG), of a titre of anti-HBv of at least 200 IU/ml to be given at within 24 hours of exposure.
• In those under 40 years of age, this should be followed by B-Hepvac MSD, 10ug stat and at one and six months subsequently.
• For those over 40 years of age 20ug doses may be needed.

3. Infants born by infected or carrier mothers:

• HBIG 0.5ml i.m. at delivery followed by 5ug B-Hepvac MSD in another limb.
• Subsequent doses would be given at one, two, and six months.
• Vaccination is 100% efficacious when the child is HBsAg seronegative at 24 hours.
• However the efficacy falls to 88% when the child is already infected at 24 hours.

References:
C.J.Oon, 1986, Hepatitis B: Clinical features and prospects for elimination
C.J.Oon, 1994, Natural lymphoblastoid alpha-interferon in the prevention of hepatocellular carcinoma in high-risk hepatitis B surface antigen (HBsAg) positive carriers: a 5-year follow-up.
C.J.Oon, 1995, Viral hepatitis from A to F
Hepatitis B virus (HBV) Overview
HepNet: Mechanisms of Anti-Viral Therapy
Public information pamphlet by SmithKline Beecham Pharmaceuticals