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MCQs in Tropical Medicine

Rob Skelly DTM+H FRCP

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Answer 15

Hepatitis B

a. Babies born to hepatitis B e antigen positive (HBeAg+ve) mothers should be given active and passive immunisation at birth.
b. According to current DHSS guidelines, children in the UK. should be vaccinated against hepatitis B by age 16.
c. Co-infection with delta virus may occur in intravenous drug abusers but occurs less commonly with homosexual transmission.
d. Super-infection with delta virus causes a clinical deterioration.
e. Is the major underlying cause of hepatocellular carcinoma.

HBeAg+ve mothers are highly infectious. The chance of the baby acquiring the infection during pregnancy, at birth or whilst breast-feeding is high. Active and passive immunisation appears to reduce the rate of vertical transmission.

Present DHSS guidelines on whom to vaccinate concentrate on high risk groups such as hospital workers, homosexual men and intravenous drug misusers. Some other European countries do vaccinate school-leavers.

Delta virus infection occurs only in the presence of hepatitis B infection. The two viruses may be acquired at the same time, or delta virus infection may follow hepatitis B infection by months or years.

Any sudden deterioration in a previously stable hepatitis B carrier should suggest the possibility of delta virus super-infection. This scenario is especially common in intravenous drug abusers.

On a world-wide scale, Hepatitis B is the major underlying cause of hepatocellular carcinoma. Aflotoxin and Hepatitis C virus have also been implicated but are of lesser importance.

Copyright: Rob Skelly 2006