Current RMA Instruments
| Reasonable Hypothesis SOP | 13 of 2017 |
| Balance of Probabilities SOP | 14 of 2017 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 070.2, 070.3
- ICD-10-AM Codes: B16, B18.0, B18.1
Brief description
Hepatitis B is a viral infection of the liver. Since 1992 all Australian Defence Force personnel are screened on enlistment for Hepatitis B virus (HBV) infection and vaccinated if not already immune. The SOP covers only symptomatic acute infection, and chronic (symptomatic or asymptomatic) infection of at least six months duration. The SOP does not cover people with acute Hepatitis B who have a subclinical infection and who do not go on to develop chronic infection. The SOP does cover people with chronic but inactive infection ("carriers").
Confirming the diagnosis
Diagnosis is usually based on laboratory testing for serology or nucleic acid markers. Newer methods such as polymerase chain reaction testing for nucleic acid markers are becoming more widely available. Diagnosis of acute HBV infection requires a clinical illness consistent with acute infection, in conjuction with positive laboratory testing. Positive serology for acute infection comprises:
- HBsAg positive
- Anti-HBc positive
- IgM anti-HBc positive
- Anti- HBs negative
Diagnosis of chronic infection requires confirmation by repeated laboratory testing over a minimum six month period. Positive serology for chronic infection comprises:
- HBsAg positive
- Anti-HBc positive
- IgM anti-HBc negative
- Anti- HBs negative
Additional diagnoses covered by SOP
- Hepatitis B "carrier state"
Conditions that may be covered by SOP
- Serum hepatitis – (an out-dated term) serology required to confirm
Conditions not covered by SOP
- Hepatitis A*
- Hepatitis C*
- Hepatitis D*
- Hepatitis E*
* Another SOP applies
Clinical onset
For acute symptomatic HBV infection, clinical onset will be when the symptoms of the clinical illness, subsequently confirmed to be acute HBV infection, first manifest. For chronic HBV infection (in the absence of acute clinical infection) clinical onset will be when infection with HBV was first diagnosed by laboratory testing.
Clinical worsening
Worsening of HBV infection will mainly be a consderation in cases of chronic infection and is most likely to be evidenced by reactivation of previously inactive disease. Appropriate therapy for HBV infection depends on the individual circumstances and disease manifestations. Anti-viral therapy can be effective in controlling the disease and reducing adverse outcomes.