B GONE HEP B
HOW PRIMARY CARE CAN MAKE A DIFFERENCE
When I was training to be a doctor over 40 years ago, Hepatitis B was called the ‘Australia antigen’. During my early career, it was regarded as a ‘rare’ illness that either was thought to remain dormant in those who were ‘healthy carriers’ or caused cirrhosis or liver cancer without us being able to do anything about it. It became a disease the medical profession either feared or ignored.
Much has changed in the last 40 years. The prevalence of Hepatitis B in Australia has risen with an increase in the number of migrants from high prevalence countries. We also now have an effective vaccine and are aiming for universal coverage of children. We understand the epidemiology more and no longer think of people as being ‘healthy carriers’. We monitor those with chronic Hepatitis B life-long and we have safe treatments that dramatically decrease the risk of cirrhosis and liver cancer. And most of this is done by GPs. We are the ones who need to be aware of those in our practice who may be at risk of Hepatitis B and know how to screen them appropriately, who needs to be vaccinated, how to monitor people with active Hepatitis B, and when and how to refer them to specialists for treatment.
No longer should we be ignoring or fearing Hepatitis B. The interpretation of Hepatitis B blood results may seem complex, and treatment options may appear confusing but there are good resources to help simplify them and guide us as to what to do. In order to fully protect our patients and our community we need to be sure we know where to find the right resources.
How you can make a difference in Primary Care:
> Promote and provide universal hepatitis B vaccination in children
> Opportunistically test people who are at risk for hepatitis B
> Monitor those with hepatitis B and manage or refer appropriately
> Identify, test and vaccinate those who may be susceptible to infection, including family members, household contacts and sexual contacts of people with hepatitis B
My list of favourite hepatitis B web resources for GPs
HepBHelp is an independent website which aims to assist GPs in the further investigation and management of patients diagnosed with chronic hepatitis B.
J Maclachaln & B Cowie "Chronic hepatitis B: What's new?" Australian Family Physician 2013; 42 (7):448-451
This article discusses some of the key clinical questions that arise in the management of HBV, with a focus on actions that can reduce the impact of chronic hepatitis B on individuals and the community, and the recent developments that will have a substantial impact on the management of HBV in Australian general practice.
Hepatitis B and Primary Care Providers - The role of primary care providers in hepatitis B diagnosis and management, ASHM
Hepatitis SA provides information, education and support services to South Australians affected by hepatitis B and hepatitis C. This includes people with hepatitis B or C, their family and friends, and professionals who support them.
For fast phone help - you can also contact Hepatitis SA on ph 1800 437 222
Here is the quick reference guide I find handy to the hepatitis B virus, vaccines, transmission, prevention and disease course.
SA Health viral hepatitis nurses
A team of Viral Hepatitis Support Nurses in SA provide advice to GPs on the management of patients with viral hepatitis, including assistance with referral to specialists. Patients may also speak to the nurses directly. Support is also available for people in country areas. Scroll down the page to view the video which explains the role of the viral hepatitis nurse.
ASHM GP management plan
No list would be complete without this tool. Download link below.
SHINE SA video - Managing chronic Hepatitis B - Advice for GPs