Hepatitis B - emergency department revision
Introduction
Hepatitis B virus (HBV) is a blood‑borne, hepatotropic DNA virus causing a spectrum from asymptomatic infection to fulminant hepatitis, chronic liver disease, cirrhosis and hepatocellular carcinoma.
In the ED you must recognise acute presentations, manage blood/sexual exposures with prompt post‑exposure prophylaxis (PEP), perform appropriate testing, arrange follow‑up and trigger public‑health actions (notification, contact immunisation, referral).
Key UK guidance: the Green Book (Hepatitis B, ch.18), GOV.UK/PHE clinical & public‑health guidance, NICE PH43 (testing) and NICE CG165 (chronic HBV).
Virology and natural history (concise)
- HBV is a partially double‑stranded DNA virus.
- Serological markers (HBsAg, anti‑HBc total and IgM, anti‑HBs) define infection stage and immunity.
- Risk of chronic infection depends on age at acquisition: perinatal and early childhood infections have much higher progression to chronicity than infections acquired in adulthood.
- Chronic HBV is defined as persistence of HBsAg for ≥6 months (NICE CG165).
- Chronic infection requires specialist assessment for antiviral therapy and ongoing surveillance.
Clinical presentation
- Asymptomatic seroconversion.
- Prodrome: malaise, anorexia, nausea, myalgia.
- Jaundice, dark urine, pale stools, right upper‑quadrant pain.