Tuesday, July 24, 2012

Approach to the management of an incidentally detected HBsAg carrier

I had a mother who was incidentally detected to be Hbsag +ve during pregnancy. She has been asymptomatic even after two kids and apparently suffers from no ill-efefcts, the question waws, how to monitor such a person. Here is what I found ....

  1. No treatment is required
  2. Reassurance should be given to patients
  3. Family members should be screened with HBsAg and anti-HBs; if negative they should be vaccinated and success of vaccination should be tested by anti-HBs assay
  4. Protected intercourse should be practised until partner has developed protective antibodies. Eventual offspring needs active and passive vaccination
  5. Avoid alcohol
  6. Patients should be made aware of possibility of reactivation or superinfection by other viruses and advised to consult their physician if there is jaundice, malaise or increased fatigue
  7. They should regularly be followed up at every 6-12 months' intervals with transaminases, as fluctuations in ALT and HBV DNA levels are common during the course of chronic HBV infection
  8. If person is more than 50 years of age or there is positive family history of HCC, AFP estimation and USG should be performed every 6-12 months.
  9. They should not be denied employment or hospital treatment. Universal precautions should be taken while treating such patients in the hospital
  10. In the case of health care workers, they should be allowed to do routine designated duties and there is no need for changing the duty. They must follow universal precautions.
  11. They should not be allowed to donate blood, organ or semen
  12. Close monitoring is required and prophylactic lamivudine therapy should be given if undergoing chemotherapy or receiving immunosuppressive medications
  13. For pregnant women vaccinate the newborn at birth with acute and passive immunization within 12 hours of birth.

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