Key Information for Clinical Management

Case managers have the opportunity to collaborate with other professionals and learn about an effective first line of defense against morbidity and mortality associated with chronic HBV infection by:

• Immunizing all infants, children and adolescents, as well as adults at risk to acquire HBV, following guidelines from the CDC and American Academy of Pediatrics.
• Screening those at high risk, as per CDC guidelines.
• Performing clinical and laboratory evaluation of patients who have chronic HBV infection to determine current phase of disease (i.e., ALT, HBV-DNA, HBeAg).
• Monitoring patients in the immune tolerant or inactive phases every six to 12 months for disease progression.
• Consulting with a liver specialist or HBV-experienced provider for patients in the immune active phase to determine treatment strategies.
• Checking family history to ensure family members (and close household contacts) are tested and vaccinated if susceptible, and referred to care if found to be infected.

Screening Patients: New Practice Recommendations

Screening appropriate patients is important to manage patients effectively by:

• Screening patients at risk of contracting HBV, especially those from HBV-endemic regions of the world, by testing for hepatitis B surface antigen and antibody (HBsAg and anti-HBs).
• Vaccinating all infants, childre, and adolescents following guidelines of the CDC and American Academy of Pediatrics, as well as at-risk adults whose screening results are negative for both HBsAg and anti-HBs.
• Providing periodic monitoring for patients who are HBsAg-positive. While these patients may appear asymptomatic, they are infected with HBV and require further evaluation.
• Consulting a specialist experienced in treating hepatitis if active liver disease is suspected in patients with chronic HBV infection who present with elevated alanine aminotransferase (ALT) and HBV DNA >2,000 IU/mL.

These new guidelines offer a clear roadmap to positive disease management against HBV in the months and years to come.

Kimberly D. Jungkind, MPH, RN, BSN, CCM, is a board member of the Hepatitis B Foundation (HBF). More information about hepatitis B is available at www.hbf.org. Contact: kjungkind@gmail.com