Hepatitis B: Vaccine Preventable Diseases Surveillance Standards

Hepatitis B virus (HBV) is transmitted by exposure of  mucosal membranes or non-intact skin to infected blood  or other body fluids. Transmission can occur perinatally  from mother to child and from person to person. The  incubation period for acute hepatitis B is 75 days on  average, but may vary from about 30 to 180 days. Most  new infections are asymptomatic. Acute hepatitis B  occurs in approximately 1% of perinatal infections, 10%  of early childhood infections and 30% of infections among persons ≥ 5 years of age. Children are frequently  asymptomatic when they become infected with HBV,  making surveillance challenging in this population. 

Acute liver failure develops rarely in infants and children but occurs in 0.5%–1.0% of adult cases, with a casefatality rate of 20%–33%. Chronic hepatitis B occurs in > 80% of perinatal infections, but in < 5% of those infected as healthy adults. Chronic hepatitis B infection has a spectrum of clinical severity, from asymptomatic to liver cirrhosis and hepatocellular carcinoma. Hepatitis B vaccine is recommended for children as a three- or four-dose regimen, including a birth dose to protect against perinatal transmission (1). The introduction of hepatitis B vaccines in the 1980s has resulted in dramatic decrease in chronic hepatitis B prevalence worldwide among children.