Correct Answer: Statement (a) - Hepatitis B Can Be Transmitted Through Contact with Wounds
Statement (a) is correct: Hepatitis B virus can be transmitted through contact with wounds and exudates from dermatologic lesions.
Detailed Analysis of Each Statement
Statement A: HBV Transmission Through Wound Contact - CORRECT
HBV is definitively transmitted through contact with wounds and contaminated surfaces, representing a well-established route of infection. 1
Prolonged, close personal contact with an infected person can transmit HBV via contact with exudates from dermatologic lesions, contact with contaminated surfaces, or sharing personal items like toothbrushes or razors, as occurs in household contact. 1
HBV remains viable and infectious in the environment for at least 7 days and can be present in high concentrations on inanimate objects, even in the absence of visible blood. 1
The highest concentrations of virus are found in blood; however, semen and saliva also have been demonstrated to be infectious. 1
Primary routes of transmission include percutaneous exposure to infectious body fluids and prolonged close personal contact with infected persons. 1
Statement B: HBV and Hepatocellular Carcinoma - INCORRECT
This statement is false. HBV is definitively a major cause of hepatocellular carcinoma worldwide. 1, 2
Current estimates suggest HBV causes approximately 50% of hepatocellular carcinoma globally. 1
HBV infection is associated with the risk of developing HCC with or without underlying liver cirrhosis, due to various direct and indirect mechanisms promoting hepatocarcinogenesis. 2
As much as 40% of men and 15% of women with perinatally acquired HBV infection will die of liver cirrhosis or hepatocellular carcinoma. 3
Chronic HBV infection causes over 800,000 deaths each year, primarily from complications secondary to liver cirrhosis and hepatocellular carcinoma. 1
Statement C: Hepatitis A and Chronic Liver Disease - INCORRECT
This statement is false. HAV infection produces a self-limited disease that does not result in chronic infection or long-term liver disease. 1
HAV is usually acquired by the fecal-oral route and does not result in chronic infection or long-term liver disease. 1
Signs and symptoms usually last less than 2 months, although 10%-15% of symptomatic persons have prolonged or relapsing disease lasting less than 6 months. 1
Peak infectivity occurs during the 2-week period before the onset of jaundice or elevation of liver enzymes. 1
Statement D: Hepatitis E and Contaminated Needles - INCORRECT
This statement is not supported by the evidence provided. The evidence does not describe HEV transmission through contaminated needles as a primary or established route. HEV is typically transmitted through the fecal-oral route, similar to HAV, though this specific comparison is not detailed in the provided evidence.
Statement E: HBV Viral Load Measurement - PARTIALLY CORRECT BUT MISLEADING
This statement is technically related to viral load assessment but is imprecise. HBV viral load is measured by quantifying HBV DNA levels, not by directly measuring the polymerase enzyme itself. 1, 4
Patients with HBeAg typically have high levels of HBV DNA (10^6-10^10 IU/mL), whereas those who are HBeAg-negative and anti-HBe-positive generally have low or only modest HBV DNA levels (0-10^5 IU/mL). 1
HBV DNA quantification is essential for proper classification and cannot be omitted in chronic hepatitis B management. 4
The polymerase protein functions as a reverse transcriptase, RNase H, and DNA polymerase, but viral load is assessed by measuring the DNA product, not the enzyme directly. 1
Clinical Implications
Understanding HBV transmission routes is critical for infection control and prevention strategies:
Healthcare workers and household contacts must recognize that HBV can be transmitted through non-percutaneous routes, including contact with contaminated surfaces and wound exudates. 1
Standard universal infection control precautions are essential, as few cases of healthcare worker-to-patient transmission have been reported since their implementation. 1
Post-exposure prophylaxis with HBIG and vaccine should be administered as soon as possible, preferably within 24 hours after exposure, with maximum effectiveness unlikely to exceed 7 days for percutaneous exposure. 5