To B or not to B: how the hepatitis B surveillance case definition can misdirect public health actions

Authors

  • Anna B Pierce South East Public Health Unit, Monash Health, Clayton, Victoria, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
  • Simon Crouch South East Public Health Unit, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  • Edura Jalil South East Public Health Unit, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  • Adrian Alexander Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
  • Joe Sasadeusz Victorian Infectious Diseases Service at The Royal Melbourne Hospital, Victoria, Australia; Peter Doherty Institute for Infection and Immunity, University of Melbourne and The Royal Melbourne Hospital, Victoria, Australia
  • Victor Au Yeung South East Public Health Unit, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; General Medicine, Monash Health, Clayton, Victoria, Australia
  • Aswan Tai General Medicine, Monash Health, Clayton, Victoria, Australia
  • Rhonda L Stuart Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; South East Public Health Unit, Monash Health, Clayton, Victoria, Australia

DOI:

https://doi.org/10.33321/cdi.2024.48.39

Keywords:

hepatitis B, case definition, surveillance, transmission

Abstract

Surveillance case definitions are utilised to understand the epidemiology of communicable diseases and to inform public health actions. We report a case of hepatitis B infection that meets the case definition for newly acquired infection. However, further investigation revealed that this was most likely past resolved hepatitis B infection with subsequent reactivation secondary to immunosuppression, rather than a newly acquired infection. This case highlights the importance of thorough case and clinician interviews, in combination with detailed assessment of pathology results in collaboration with treating clinicians, to determine the most appropriate public health actions.

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References

Shepard CW, Simard EP, Finelli L, Riore AE, Bell BP. Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev. 2006;28:112–25. doi: https://doi.10.1093/epirev/mxj009.

Communicable Diseases Network Australia (CDNA). Hepatitis B CDNA Guidelines for Public Health Units. Canberra: Australian Government Department of Health and Aged Care; 21 March 2017. [Accessed on 14 September 2023.] Available from: https://www.health.gov.au/sites/default/files/documents/2020/02/hepatitis-b-cdna-national-guidelines-for-public-health-units.pdf.

Krugman S, Overby LR, Mushahwar IK, Ling CM, Frosner GG, Deinhardt F. Viral hepatitis, type B. Studies on natural history and prevention re-examined. N Engl J Med. 1979;300(3):101–6. doi: https://doi.10.1056/NEJM197901183000301.

Ganem D, Prince AM. Hepatitis B virus infection – natural history and clinical consequences. N Engl J Med. 2004;350(11):1118–29. doi: https://doi.org/10.1056/NEJMra031087.

Doyle J, Raggatt M, Slavin M, McLachlan SA, Strasser SI, Sasadeusz JJ et al. Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement. Med J Aust. 2019;210(10):462–8. doi: https://doi.org/10.5694/mja2.50160.

Lan TY, Lin YC, Tseng TC, Yang HC, Kao JH, Cheng CF et al. Risk of hepatitis B virus (HBV) reactivation in HBsAg-negative, anti-HBc-negative patients receiving rituximab for autoimmune diseases in HBV endemic areas. Gut Liver. 2023;17(2):288–98. doi: https://doi.org/10.5009/gnl210551.

United States Food and Drug Administration (FDA). Highlights of prescribing information: rituxan (rituximab). Silver Spring: Federal Government of the United States, FDA; October 2012. [Accessed on 14 September 2023.] Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/103705s5367s5388lbl.pdf.

Gastroenterological Society of Australia (GESA). Australian consensus recommendations for the management of hepatitis B infection. Melbourne: GESA; March 2022. [Accessed on 14 September 2023.] Available from: https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/Hep%20B/HBV%20consensus%20Mar%202022%20Updated.pdf.

Stamouli M, Gizaris V, Totos G, Papaevangelou G. Decline of hepatitis B infection in Greece. Eur J Epidemiol. 1999;15(5):447–9. doi: https://doi.org/10.1023/a:1007539517341.

Alexopoulos CG, Vaslamatzis M, Hatzidimitriou G. Prevalence of hepatitis B virus marker positivity and evolution of hepatitis B virus profile, during chemotherapy, in patients with solid tumours. Br J Cancer. 1999;81(1):69–74. doi: https://doi.org/10.1038/sj.bjc.6690652.

The Kirby Institute, Australian Red Cross Blood Service. Safe blood – a focus on education, epidemiology and testing. Transfusion-transmissible infections in Australia: 2011 Surveillance Report. Sydney: University of New South Wales, The Kirby Institute/Australian Red Cross Blood Service. [Accessed on 14 September 2023.] Available from: https://www.lifeblood.com.au/sites/default/files/resource-library/2021-12/185.-safe_blood_a_focus_on_educationepidemiology_and_testing_8940.pdf.

Lewis JD, Enfield KB, Sifri CD. Hepatitis B in healthcare workers: transmission events and guidance for management. World J Hepatol. 2015;7(3):488–97. doi: https://doi:10.4254/wjh.v7.i3.488.

Communicable Diseases Network Australia (CDNA). CDNA National Guidelines for healthcare workers on managing bloodborne viruses. Canberra: Australian Government Department of Health and Aged Care; October 2019. [Accessed on 14 September 2023.] Available from: https://www.health.gov.au/resources/collections/cdna-national-guidelines-for-healthcare-workers-on-managing-bloodborne-viruses.

Etienne S, Vosbeck J, Bernsmeier C, Osthoff M. Prevention of hepatitis B reactivation in patients receiving immunosuppressive therapy: a case series and appraisal of society guidelines. J Gen Intern Med. 2023;38(2):490–501. doi: https://doi.10.1007/s11606-022-07806-9.

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Published

17/07/24

How to Cite

Pierce, Anna B, Simon Crouch, Edura Jalil, Adrian Alexander, Joe Sasadeusz, Victor Au Yeung, Aswan Tai, and Rhonda L Stuart. 2024. “To B or Not to B: How the Hepatitis B Surveillance Case Definition Can Misdirect Public Health Actions”. Communicable Diseases Intelligence 48 (July). https://doi.org/10.33321/cdi.2024.48.39.

Issue

Vol. 48 (2024)

Section

Case report

Categories

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