Hepatitis

PhysiologyRocks

Hello! I was wondering could anyone clarify this for me: If a doctor or medical student has been vaccinated against hep b but does not develop full immunity and somehow contracts the virus, can they ever work with patients again?

Also, does anyone ever actually clear hepatitis from their blood. I have received conflicting opinions from different sources and am quite confounded!

Any information much appreciated.

DrIndy

I'm not completely sure what you are asking - but will try my best.

There are 3 main types of Hepatitis (but many other minor types) causes by viruses - Hepatitis A, Hepatitis B, Hepatitis C. They are caused by different viruses so being immune to one does not mean you are immune to the other kinds.

Hepatitis B is caused by a Hepadnavirus which is very stable in the environment and very infectious.

There are 3 antigens - surface, core and "e" antigen (the e antigen indicates high activity and infectivity)

The vaccination response is either immediately effective causing a lifetime high level of HepB antibody titres or it may require further boosters to achieve this. In a small minority of people - the vaccine is never effective. Due to the high infectivity, it is recommended all health care workers are immune to this to prevent infection and patient spread.

In children, they are less likely to develop full response to a primary infection and clear the virus, but when adults are infected - they are more likely to develop immunity to primary infection - but the "e" antigen makes you highly infectious with chronic hepatitis B.

There are treatment options available for Hepatitis B including lamivudine which can cause conversion to full immunity.

Regulations regarding chronic active hepatitis versus "e" antigen positivity to the best of my knowledge depend on the area you work in and the exposure to patients (do you do invasive procedures?) This is best discussed with a GP or with an occupational health doctor.

Tree

/me is a partial/non responder to the hep B vaccine.

The irish hospitals expect a response >100 units per ml, afair. If you fail to reach this you'll be given a booster or a full course on a different brand of vaccine. (I ended up w/ seven jabs in all)

The new zealand hospitals require it to be >10, so in my case, with a final response that was lower than 100 but higher than ten, it was deemed sufficiently vaccinated. not sure what happens w/ ppl under this level.

PhysiologyRocks

Thanks for the replies.

I am still a student and therefore see as opposed to perform invasive procedures! But I hope to someday. Following the course of vaccinations, we are awaiting information regarding our responses.

The doctor who gave us the injections said that most people who contract the virus do not become chronic carriers.

However, another doctor told our class that if we were ever to contract hep b, we would be removed from situations that involve patient contact.

Finally, another told me that nobody ever clears it, hence my confusion.

DrIndy

Very few people clear it if they have Hepatitis C which is a different virus entirely and only shares the fact that it affects the liver - this may be the mixup.

PhysiologyRocks

Yes, that would make sense.

I know they're not the same virus. They definitely said b, but it was mentioned in passing and could have been a slip of the tongue. The other lecturer may have meant that patient contact is just not allowed while the infection is active.

It's good to know and it certainly clarifies things!

Oh, is it true that hep c is much less easy to catch? My books imply it, but don't state it, and I'm receiving yet more conflicting information!

Thanks again.

tallaght01

Hep C is less contagious by and large.

Do most of you get a 5 year hep B booster, btw?

PhysiologyRocks

Not sure about the policy. I plan to, anyway! Thank you.

sillymoo

I got my Hep B in 2004 and have not been offered a booster. I had to have my serumIg measured in 2006 and it was grand. Is it normal to get a booster? I thought it was a bit like the tetunus shot, once every 10 years if needed.

tallaght01

Some people argue for a 5 year booster. They say you may as well have the vaccine rather than having the blood taken.

BUt the evidence I'm aware of is that that primary course confers very goof protection for many many years.

I was just wondering what people do? Also, what do people think about titres and their relationship to your ability to actually protect against this illness?

DrIndy

I was vaccinated in 1999 - still immune with a titre off the scale still (needed to recheck before getting a visa for oz).

Some people fail primary vaccination and need a booster course to get the titre up high enough - they may benefit from a booster - anyone know the regimen?

Tree

afaik there are two main vaccines licensed in ireland.
The regimen for each is shot on day one, booster after one month, and a booster after three or six months, i cant quite remember. i know there are shorter regimens possible too, eg day one, week two and a month.

My memory of my shots is a bit hazy, all of four/five years ago. i was put on the normal full lenght lot w/ the rest of my class, then given an accelerated series on year 2, and a booster on year three when i encountered occ health at the hospital i was assigned to. my titre hasnt been checked since shortly after the final booster when it was about eighty (afair) At least one of my shots was with a different vaccine to the rest.

PhysiologyRocks

If a doctor or student were to catch Hep C and clear it (to the extent that it was undetectable in the blood, not certain about the specifics) would he/she be allowed to work with patients/perform invasive procedures?

I'm pretty sure the person couldn't donate organs, but that's hardly the same thing as practicing medicine, is it?

Just curious, really. Can't find any info on the topic.