• Detection of anti-HDV with HBsAg indicates infection
• In acute infection, HBsAg with IgM anti-HBc + anti-HDV
• In chronic infection, negative IgM anti-HBc + anti-HDV

Liver Biopsy

• Usually not performed

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Best Therapy

Supportive

• Reduce physical activity
• Patients should eat whatever they can
• No evidence that low-fat diet is beneficial
• Abstain from alcohol

Encephalopathic Patients

• Evaluate for liver transplantation
• Treat bacterial infections with appropriate antibiotics
• Administer clotting factors for bleeding
• Administer lactulose (30 ml p.o., q. 4 hr) if patient obtunded with high serum ammonia level

Prevention

Immunization

Administration Schedules and Dosing of Hepatitis A Vaccine

• Children (2–18 yr)
  • 0, 6–12 mo
    • Havrix, 720 ELU/0.5 ml
    • VAQTA, 25 U/0.5 ml
  • Residents of AK, AZ, CA, ID, NV, NM, OK, OR, SD, UT, WA, and high-risk areas of AR, CO, MO, MT, TX, WY
  • Provisional ACIP recommendation is for vaccination of all children at 12-23 mo
  • Contraindicated in those with previous allergic reaction to HAV vaccine
• Adults (>18 yr)
  • 0, 6–12 mo;
    • Havrix, 1,440 ELU/1.0 ml
    • VAQTA, 50 U/1.0 ml
  • Travelers
  • Those with chronic liver disease, hemophilia or other clotting factor disorders
  • Other high-risk persons
  • Contraindicated in pregnancy

Administration Schedules and Dosing of Hepatitis B Vaccine

• Infants of HBsAg-negative mother
• 0–2, 1–4, 6–12 mo
  • Engerix-B, 10 µg/0.5 ml
  • Recombivax HB, 2.5 µg/0.5 ml
• Infants of HBsAg-positive mother
• Birth (within 12 hr with hepatitis B immune globulin and HBV vaccine), 1–2, 6 mo
• Engerix-B, 10 µg/0.5 ml
• Recombivax HB, 5.0 µg/0.5 ml

Catch-up Schedule of Hepatitis B Vaccine for Patients Who Start Late or Who Are > 1 Month Behind (no need to restart series regardless of time elapsed between doses)

• Children and adolescents (4 mo–19 yr):
  • 0, at least 4 wk, at least 8 wk (16 wk after first dose)
    • Engerix-B, 10 µg/0.5 ml
    • Recombivax HB, 5.0 µg/0.5 ml
• Alternative series for adolescents (11–15 yr)
  • 0, 4–6 mo
    • Recombivax HB, 10 µg/0.5 ml only
• Adults (≥ 20 yr)
  • 0, 1–2 mo, 4–6 mo
    • Engerix-B, 20 µg/0.5 ml
    • Recombivax HB, 10 µg/0.5 ml
• Immunocompromised adults
  • 0, 1 mo, 6 mo
    • Engerix-B, 40 µg/0.5 ml
    • Recombivax HB, 40 µg/0.5 ml