Hepatitis B Virus (HBV)

Characteristics

Morphology Partially double-stranded DNA, 42-47 nm diameter, enveloped, Hepadnaviridae; lipoprotein coat contains the Hepatitis B surface antigen (HBsAg)
Growth Conditions Cell culture (PLC/PRF/5 human hepatoma cell line)

Health Hazards

Host Range Humans are the only known natural host. Some NHP can be experimentally infected.
Modes of Transmission

Sharing needles, syringes, or other drug-injection equipment, sexual contact, mother to baby at birth.

Signs and Symptoms

Two major forms: asymptomatic infection and symptomatic hepatitis. Symptoms of acute infection include fever, fatigue, anorexia, abdominal discomfort, nausea and vomiting, arthralgias, jaundice, graycolored bowel movements.

Case definition includes: acute (mostly asymptomatic, or with mild to severe hepatitis, seroconversion to positive HBsAg), chronic (persistence of HBsAg for more than 6 months, increased risk for developing chronic liver disease), or perinatal (transmission from mother to child).

Most persons with acute disease recover with no lasting liver damage; acute illness is rarely fatal, while 15%–25% of chronically infected persons develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.

Infectious Dose Unknown.
Incubation Period Usually 45-160 days; average 120 days

Medical Precautions/Treatment

Prophylaxis Hepatitis B immunoglobulin (HBIG)
Vaccines The following single-antigen vaccines and combination vaccines are currently licensed and available in the United States: Single-antigen vaccines: Engerix-B® and Recombivax HB®. Combination vaccines: Pediarix®, and Twinrix®
Treatment Supportive treatment is an option for acute HBV infection in patients who spontaneously clear the infection. Antiviral therapy is available for severe acute and chronic infections
Surveillance Serology: HBsAg (person is infectious), HBV surface antibody-anti-HBs- (recovery and immunity from HBV infection, or successful vaccination against HBV). Molecular diagnosis using PCR is also available.
Emory Requirements Report all incidents. OSHA requires that personnel working with human samples or other potentially infectious materials (OPIMs) receive the three doses of HBV vaccine and demonstrate HBV antibody titers.

Laboratory Hazards

Laboratory Acquired Infections (LAIs) HBV infection is one of the most frequently reported laboratory-acquired infections via needle stick or other sharp instrument injury
Sources HBsAg-positive blood and blood products, body fluids, and any unfixed tissue or organ

Supplemental References

Containment

BSL-2 Biosafety level 2 practices and containment for activities utilizing infectious body fluids and tissues.
ABSL-2 Work with non-human primates.

Spill Procedures

Small Notify others working in the lab. Allow aerosols to settle. Don appropriate PPE. Cover area of the spill with paper towels and apply an EPA registered disinfectant, working from the perimeter towards the center. Follow the manufacturer’s label instructions to determine the amount of contact time required before disposal and cleanup of spill materials.
Large

Contact Emory’s Biosafety Officer (404-727-8863),
the EHSO Office (404-727-5922), or
The Spill Response Team (404-727-2888).

Exposure Procedures

Mucous membrane Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposures Wash area with soap and water for 15 minutes.
Reporting Immediately report incident to supervisor, complete an employee incident report in PeopleSoft.
Medical Followup 

7am-4pm (OIM): EUH (404-686-7941) EUHM (404-686-7106) WW (404-728-6431)

After Hours: OIM NP On Call 404-686-5500 PIC# 50464

Needle Stick (OIM): EUH (404-686-8587) EUHM (404-686-2352)

Yerkes: Maureen Thompson Office (404-727-8012) Cell (404-275-0963)

Viability

Disinfection 10% fresh sodium hypochlorite (household bleach), 70% ethanol
Inactivation Sensitive to heat; stable at pH 2.4 for up to 6 hours (some infectivity is lost); HBsAg not destroyed by UV of blood products; stable for years at -70° C
Survival Outside Host Survives in dried blood for long periods (weeks), stable on environmental surfaces for a least 7 days at room temperature.

Personal Protective Equipment (PPE)

Minimum PPE Requirements At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with Hepatitis B virus. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions

All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities.

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