Army Action Plan: Standard Operating Procedures for Hepatitus B Management

HIPATITTS B MANAGEMENT.
SOP: 03S Peen e14
Dm= HOSPITAL SOP NO: .0 GUANTANAMO BAY, CUBA
TRW HEPATITIS B MANAGEMENT
Page 1 04 Effective Date: 11 Mar 03 SCOPE: Delwin Haspital
L ENCL:
(1) Hepatitis B Evaluation and Treatment Data Sheet
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(2.1 (*oak Hepatitis B, AASLD Practice Chddelines AniminuipcioolgarblicIFh20-RizesliVodcimc SOP&ISOP Enclosures eeledliacirgalEarlallicassif •
11. BACKGROUND:
Hepatitis B is endemic to certain areas of the world including the Middle Ent All
detainees are screened for 'ecologic evidence of hepatitis B for both the identification of
this disease in this population and for the Faroe Health Protection of the Joint Task Force
personnel in close contact with the detainee population so the appropriate preventive
prawns are taken after expostne. to a hepatitis positive detainee. All detainees
.poiltiVefotHbiAil they. represent ongoing nave *eat* which may bebieh • •
contagious and may lead to progressive liver damage to include cirrhosis, liver failure
and the development of hepatocellular cancer.
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III.POLICY:
Each detainee found to be libsAg (hepatitis &surface antigen) positive will be offered
Rather evaluation at the medical clinic. Each detainee will be given the appropriate
information regarding hepatitis B to make a decision regarding acceptingldeclkting the
evaluation and possible treatment of hisiber hepatitis.
Both the evaluation and treatment
will be completely voluntary. The information collected on the evaluation is found on the enclosed data fem. The policy thus stated in this SOP has beaicoordinsted through consultation with the Gastroenterology Division, Naval Medical Center San Diego.
IV.PROCEDURES:
o The following sections deal with the description, definitions, and elaboration of
the Hepatitis B Evaluation and Treatment Data Sheet. Screening for hepatitis B occurs upon arrival of the detainee at Naval Base Guantanamo Bay. NBGTMO.

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HEPATTrig B MANAGBIWif
BOr: 038 Page2 of 4
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a Those found to be nimbi= forifepatitia B surface antigen represents a possible
case of active hepatida B.
. .
a The detainee with lair, hepatitis is infectious to.oliseteletabiee andiTP
personae! via contact with thb tiebdrieesigtiod.

feces, Ind MOW= are nal moony Fonhakell.unless these Oared* coati! . blood.
o laftanation•reprding the hepatitis B status of each deign= is usefid such that if a blood exposure dale occur, the booth* B status of thelietibee.ntay be assessed md apteropriste preventive therapy (vaccination anifor•inmimogiobulia)
can be offered in a timely mama.
a Hepatitis B inked= may molt In resolution of the.infection by the *nuns gYsleig* mi0..144 id Pends100/ 119***Olidds. idsd td.ProemOsivedyiftniction. Therefore, each with a poditive turiAg will be °fitted
lather evaltisket of this meefroal .edirdidoet. • '2 . The apcenpriate warlt-up will be initiated among those detainees Who desire . evaluation of their hepatitis!' including serologic. for hepatitis A, B, C as shown on the data collection thew. Each detainee Will abo be asked about potential symptoms related to hepatitis B•wbd undergo a physical =ambition. Liver function tests, PT/PTT/INR, mil hepatitis B DNA viral load will also be obtained.
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a A liver biopsy will be offered to those with elevated liver function tests and a high viral load (100,000 copies/ml). if the detainee refines this procedure, therapywill std be offered in approixisie ann.
f. ."
a Beed

ed on the results of the aforementioned tests, each case will be discussed with a board-catified infectious diseases and/or pstroecterologist in regards the
initiation of therapy.
o If the detainee meets indications for treatment, the patient will be offered either treatment with adefovir if that is no evidence for renal dysfunction (Cra 60 and Crt1.0) or lainuvidine. If the patient has or develops rend insufficiency, the patient will be offered therapy with lamuvidine. Therapy for hepatitis B will be administered for a minimal of one-year if the patient complies and desires
therapy.
a The patient will be closely monitored for potential side effects of the therapy at
routine clinic visits.
a Since the standard of care for the evaluation and therapy of hepatitis B is
evolving. the diagnostic testing and drugs may change over time. Detainees
should continue to obtain the standard-of-care of hepatitis B management.

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HEPAirnS•iiMA14.14nitiENT
SOP: S311
• Pap 3 at4 a D refitsingthetapy will be Wad with TOUlingmedical clinic visits
biludingfiver &fiction test approxistuitely every 6 months or as clinically bilkake4
a Al p" with active begaitis B, wilt also be offered Vaccination against . heriOia A sibitit Eta 2-cbse vaccine given it baseline and again in 6-12 months.

a Deis/eat with evideuisi of chronic ktive hepatitiswill be offered screening for hepatoma with in alpla-tbtoprotein (AFP) and/or rigid upper quadrant ultrasound
every 6-12 months.
REPATIliS B hiANAGRIfigia
0311
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STANDARD. OPERATING PROCEDURES Dilation Hospisai . thiiininarno Sty. Oidn
REVIEWED AND APPROVED By: .
OM= In Charge Date
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Senior Enlisted Advisor Date .
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ENTIRE SOP SUPERSEDED BY:
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Title:
SOP NO: , Date:
091-i :15