HBV Jeopardy!

1
Statistics Transmission Prevention Diagnosis Treatment Grab Bag
100 100 100 100 100 100
200 200 200 200 200 200
300 300 300 300 300 300
400 400 400 400 400 400
500 500 500 500 500 500
2
What is one of the top 5 causes of death by
cancer?
Liver cancer
3
How many people worldwide have been infected
with HBV?
Nearly 2 BILLION people
4
How many people are living with chronic HBV
worldwide?
350 400 million people Compare to the 40
million people worldwide that are living with HIV
5
What percentage of Asians in the US have chronic
HBV?
10 of Asian Americans Which is about 0.3 of the
US population
6
How many people worldwide die each year from
HBV-related complications?
600,000
7
True or FalseHepatitis B is hereditary.
Nahttttttttt
8
How is HBV transmitted?List 3 major transmission
methods

1. VERTICAL TRANSMISSION mother to child at birth
2. BLOOD reusing contaminated medical devices,
   sharing IV needles or razors, open wound contact
3. SEX unprotected sex with someone that has HBV

9
True or FalseHBV can be transmitted from person
to person by mosquitoes.
Actually, we duno ? There are no documented cases
of this happening. However, it is known that
different strains of mosquitoes are able to carry
and transmit different viruses.
10
Can a non-symptomatic person with HBV still
transmit it to someone else?
Hell yeah they can. An infected individuals
blood will still have the virus even if no
symptoms are present. Its important to remember
that for the most part, symptoms do not show
until its too late.
11
The patient is pregnant and has chronic HBV. Can
transmission of HBV to the child be prevented by
getting a C-section at birth?
NO. A C-section will NOT prevent vertical
transmission of HBV! Also, a C-section is
unnecessary as long as the child gets the birth
dose of HBIg (HBV immunoglobulin) and finishes
the HBV vaccination series
12
While tabling, someone asks you, I want to
protect myself from both Hepatitis A and B. What
can I do?
You should be vaccinated for Hepatitis A and B
(if surface antigen test is negative). The
Hepatitis A vaccine is a 2-shot series. The
Hepatitis B vaccine is a 3-shot series. There is
also a combination Hepatitis A and B vaccine on
the market called Twinrix the shot schedule for
Twinrix is the same as that for the HBV
vaccine. Then give em a fancy Twinrix pen.
13
Why does the WHO call the HBV vaccine the 1st
anti-cancer vaccine?
HBV causes 80 of all liver cancer preventing
and eliminating HBV infection can essentially
eliminate 80 of all liver cancer.
14
I received my 1st HBV shot a year ago, but never
completed the series. What should I do?
You should complete the 2nd and 3rd shots
asap You do not need to repeat the 1st dose.
The recommended schedule for the HBV vaccine is
only a series of MINIMUM time requirements
between each shot. (1st shot -1 month 2nd shot
5 months 3rd shot) Why? The 3rd does is
essentially like a booster shot after the 1st 2
doses, 80 of people have already developed
immunity to HBV.
15
True or FalseCurrent CDC guidelines recommend
getting your blood tested ten years after being
vaccinated, and then getting a booster shot.
False! The CDC currently has no recommendations
for HBV booster shots
16
Does the HBV vaccine series work for everyone?
NOT 100! Some individuals need to be vaccinated
multiple times for any sort of immunity to
develop. About 5 of people are immunologically
non-responsive to the vaccine. It is recommended
that these individuals avoid high-risk
activities, such as sharing IV needles or
engaging in unprotected sex, etc.
Drunk driving doesnt count as a high-risk
activity in this case, but you should probably
avoid that anyway ?
17
What should I do to find out if I have HBV?
Ask your physician for the hepatitis B surface
antigen (HBsAg) blood test. This is the ONLY
blood test that can positively identify whether
or not youre infected.
18
At a recent physical my doctor said that my liver
function blood tests are normal, and I feel
completely healthy. Does this mean I am
HBV-free? Why or why not?
Not necessarily. The HBsAg test is the only
blood test that can definitively determine
whether or not you are an HBV carrier. Also,
not all HBV carriers show abnormal liver enzyme
levels. In many carriers, these levels stay
normal until they reach the end stages of liver
damage or liver cancer.
19
DailyDouble!
20
Explain these test results 1) HBsAg- /
anti-HBs / HBcAb 2) HBsAg- / anti-HBs / HBcAb-

• The core antibody test (HBcAB) is , indicating
  that immunity was developed during a prior
  infection. The surface antibody test (anti-HBs)
  is also , so the person is protected from
  chronic HBV infection.
• The core antibody test is negative but the
  surface antibody is positive, indicating that
  immunity was developed by getting the HBV
  vaccine.

21
Explain these test resultsHBsAG / anti-HBs
Patient has the antibodies for HBV, but is still
infected. He/She should follow the same
monitoring recommendations for those with chronic
HBV. FYI this is a rare occurrence Dont
forget! This person can still transmit HBV along
to someone else.
22
?
Couldnt think of a question
23
True or FalseEveryone with chronic HBV needs
treatment.
FALSE! Treatment is costly and harsh on the
body. If no symptoms occur, regular monitoring
(ALT, AFP, ultrasound) is the best course.
24
What are your recommendations for monitoring of
people with chronic HBV?
With appropriate monitoring, it is completely
possible to lead a normal and healthy life. There
are a few tests you should do regularly to screen
your liver for early signs of damage or
cancer. Every 6 months - alanine transferase
(ALT) test screens for liver damage. -
alpha-fetoprotein (AFP) test screens for liver
cancer Also, get an ultrasound of the liver once
a year to scan for tumors. The combination of
all 3 of these tests is essential, as either one
by itself is not 100 effective in detecting
liver damage or cancer. We also recommend
getting the hepatitis A vaccine to prevent any
further damage to your liver. Also avoid
drinking alcohol.
25
How many FDA-approved treatments (not vaccines)
for HBV exist today?
There are currently only 5 FDA-approved
medications for HBV. None of these medications
can completely eliminate the virus from your
body, but they can help control the viral load.
There have been no other proven treatments found
to get rid of the virus. 3 Oral Antiviral meds
Adefovir, Entecavir, Lamivudine 2 Infection
meds alpha-Interferon, Pegylated interferon
shots
26
Patient HBsAG / anti-HBs How long should
this patient takethe 3 oral medications?
(Adefovir, Entecavir, Lamivudine)
Long-term / For life
27
I have chronic hepatitis B. I also have
cirrhosis, and my family has a history of liver
cancer. What changes, if any, would you make to
the normal recommendations for monitoring my
disease?
Increase the frequency of AFP screening (for
liver cancer) to once every 3-4 months, and
increase the frequency of ultrasounds to once
every 6 months.
28
What are the differences between Hepatitis A, B,
and C?
Hepatitis A is a food-borne virus, Hepatitis B
and C are blood-borne. The main mode of
transmission for Hepatitis A is food and water,
for Hepatitis B is mother to child, and for
Hepatitis C is blood transfusion. Hepatitis A is
acute infection only Hepatitis B and C are
usually chronic infections. Hepatitis A and B
have vaccines. Hepatitis C does not.
29
Why are HBV rates so much higher in Asians than
in any other ethnic group?
HBV is endemic to Asia in the same way that HIV
is endemic to Africa. Main mode of transmission
for Asians is vertical transmission. Non-Asian
HBV transmission occurs later in life, usually
through IV drug use or unprotected sex. Since
HBV is passed generation to generation in Asians,
education and awareness are especially crucial.
30
DailyDouble!
31
China carries the biggest burden of HBV in the
world. How many people in China are living with
chronic HBV?
130 million people
32
True or FalseA majority of liver cancer is
caused by alcohol abuse.
FALSE! 80 of liver cancer is due to chronic
HBV. and yes this question is too easy for a
400 point question
33
I completed all three shots of my hepatitis B
vaccine series, but I still do not have immunity.
What are some possible reasons for this? What
do you recommend that I do?

• 1. The vaccine was not stored properly (an
  environment that is too hot or cold can render
  the vaccine ineffective)
• 2. The vaccine was administered incorrectly
• You are immunologically nonresponsive to the
  vaccine this is the case in about 5 of all
  people.
• You can try the vaccine series again, perhaps
  using a different brand of vaccine. Get the
  blood test afterwards to confirm whether or not
  the vaccine worked. If the vaccine doesnt work
  after multiple tries, you are likely in the 5 of
  those unresponsive to the vaccine. In this case,
  avoid engaging in high-risk activities like
  sharing needles, having multiple sexual partners,
  etc.

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Final Jeopardy
35
Is it true that the HBV vaccine is equally
effective if administered in the arm or the butt?
Explain.
NOPE The vaccine does not work if injected in
fat, so it must be given in muscular tissue such
as the arm or thigh. It also does not work
subcutaneously.