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Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. After a course of acute illness, HBV persists in about 10% of patients who were infected during adulthood. Some carriers are asymptomatic; others may develop chronic liver disease including cirrhosis and hepatocellular carcinoma.
HBV is spread primarily through percutaneous contact with infected blood products (ie, blood transfusion, sharing of needles by drug addicts). The virus is found in virtually every type of human body fluid and also is spread through oral and genital contact.
HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions, but it is not commonly transmitted transplacentally. Infection of the infant can occur if the mother is a chronic hepatitis B surface antigen carrier or has an acute HBV infection at the time of delivery. Transmission is rare if an acute infection occurs in either the first or second trimester of pregnancy.
Determining the level of infectivity of chronic hepatitis B in pregnant women
Hepatitis B surface antigen (HBsAg) is the first serologic marker appearing in the serum 6 to 16 weeks following hepatitis B virus (HBV) infection. A confirmed positive result for HBsAg is indicative of acute or chronic hepatitis B. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6 months indicates development of either a chronic carrier state or chronic liver disease. Hepatitis B surface antibody (anti-HBs) appears with the resolution of HBV infection after the disappearance of HBsAg.
Hepatitis B envelope antigen (HBeAg) appears at approximately the same time as HBsAg and indicates that the virus is replicating and the individual is infectious. Appearance of hepatitis Be antibody (anti-HBe) after the disappearance of HBsAg and HBeAg usually indicates recovery and loss of infectivity.
Positive hepatitis B surface antigen (HBsAg) test results should be reported by the patient care provider to the State Department of Heath as required by law in some states.
Individuals, especially neonates and children, who recently received hepatitis B vaccination may have transient-positive HBsAg test results because of the large dose of HBsAg used in the vaccine relative to the individual's body mass.
Not useful for diagnosis of hepatitis B during the "window period" of acute hepatitis B virus (HBV) infection (ie, after disappearance of hepatitis B surface antigen [HBsAg] and prior to appearance of hepatitis B surface antibody [anti-HBs]). Testing for acute HBV infection should also include anti-hepatitis B core IgM.
Assay performance characteristics have not been established for the following specimen characteristics:
-Grossly icteric (total bilirubin level of >20 mg/dL)
-Grossly lipemic (triolein level of >3,000 mg/dL)
-Grossly hemolyzed (hemoglobin level of >61 mg/dL)
-Contain particulate matter
See Viral Hepatitis Serologic Profiles in Special Instructions.
Vranckx R, Alisjahbana A, Meheus A: Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates. J Viral Hepat 1999;6:135-139