Hepatitis B

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Hepatitis B is a virus that causes inflammation of the liver. Chronic (long-lasting) hepatitis B can cause liver cell damage, which can lead to cirrhosis (scarring of the liver) and cancer. It is estimated that 5,000 people die each year in the United States due to the complications of cirrhosis and liver cancer as a result of hepatitis B virus (HBV).

According to Centers for Disease Control and Prevention (CDC), it is estimated that between 800,000 and 1.4 million people in the United States have chronic hepatitis B. There were an estimated 38,000 new HBV infections in the United States in 2009.


How is it transmitted?

HBV is transmitted through direct contact with blood, semen, or vaginal secretions.

  • Hepatitis B can be transmitted through unprotected vaginal, anal, or oral sex. In adolescents and adults, this is the most common mode of transmission.
  • Hepatitis B can also be transmitted by injecting drug users who share needles or other injecting equipment contaminated with HBV-infected blood.
  • Although tattoo, body piercing, and acupuncture needles may transmit hepatitis B, these exposures account for only a small proportion of reported cases in the United States.
  • Mothers who have hepatitis B can pass it on to their babies during birth.

Rarely, transmission may occur in the following ways:

  • Saliva can be a means of transmission through bites. However, transmission has not been documented to occur as a result of other types of exposure to saliva, including kissing.
  • The risk of transmission from blood transfusion is currently low in the U.S. since blood banks screen all donated blood.

HBV is found in transmittable levels in body fluids including semen, vaginal secretions, saliva, and blood. HBV has also been found in low concentrations in other body fluids, though these fluids have NOT been associated with transmission: tears; urine; feces; breast milk; cerebrospinal fluid. Hepatitis B is not spread through food or water or by casual contact.


What are the symptoms?

Many adults have few or no symptoms. Symptoms may mimic the flu and can include:

  • Loss of appetite
  • Malaise (feeling of ill-health)
  • Fatigue (feeling tired all the time)
  • Nausea and vomiting
  • Abdominal pain
  • Dark urine
  • Jaundice (yellowing of the skin and eyes)
  • Rash or arthritis may occur prior to the onset of other symptoms (during the prodromal or early acute stage).

A few patients (1%) have a more severe course of illness and may experience sudden and severe liver failure within a short period of time after infection. These people may suddenly collapse with fatigue, have jaundice, and develop swelling in their abdomen. This can be fatal if not treated immediately.


How is hepatitis B diagnosed?

Your health care provider can confirm hepatitis B by using a special blood test to detect HBV particles or antibodies in the blood. Blood tests can determine whether a person has acute or chronic hepatitis.

HBV is not usually included in routine blood tests, so patients may have to request the test from their healthcare provider. There are three standard blood tests for HBV:

  • HBsAg (looks for hepatitis B surface antigens): This test detects the presence and levels of virus in the blood. When this test is positive or reactive, it means that the person is infected with HBV at the present time and can pass the virus to others.
  • Anti-HBs (looks for antibody to the hepatitis B surface antigen): If this test is positive or reactive, it means that the person is immune, either as a result of having had the disease previously or from receiving the hepatitis B vaccine. This person cannot pass the virus to others.
  • Anti-HBc (antibody to hepatitis B core antigen): This is usually present in chronic carriers, who can pass the virus to others. However, if it is present with a positive anti-HBs test, then it is associated with recovery from a previous infection, and this person is not a carrier.

In many settings, a healthcare provider will run all 3 of the above tests and interpret the results based on the outcome of all 3.HBV usually takes between 3 weeks to 2 months to show up in the blood. It may take up to two months after infection for a hepatitis B test to be accurate.

If chronic hepatitis B is suspected, other tests may be ordered. These tests can help to decide treatment options and may include:

  • Ultrasound, which tests for signs of liver damage and cancer
  • Liver biopsy, to detect signs of liver damage and cancer
  • Liver function tests, which tests to see if enzymes are higher than normal levels, which indicates damage to liver cells.
  • E-antigen test, which detects e-antigen, a viral protein that is put out by HBV-infected cells. This test is often used to monitor the effectiveness of some HBV therapies.

After receiving the hepatitis B vaccine, the following people may benefit from antibody confirmatory testing in order to be sure the vaccine is working:

  • A person whose sex partner has chronic hepatitis B.
  • A person whose immune system is compromised (for instance, if someone living with AIDS).
  • A person whose job exposes him or her to human blood.
  • A child who is born to an HBV-positive mother.

The test should be performed within 2 months after completion of the series or it may not give accurate results.

Babies born to infected mothers should get two anti-HBs tests at aged 9 to 15 months to be certain that they are making antibodies, a sign that the vaccine has worked well. (Babies of hepatitis B-infected mothers are not tested at birth but are automatically given the HBIG and the first shot of the hepatitis B vaccine series.)


How is hepatitis B treated?

 

Treatment considerations for HBV vary depending on whether the infection is acute or chronic. Always consult your healthcare provider for specific recommendations and treatment options.

Acute (newly acquired):

  • No specific treatment is available for acute HBV infection.
  • Most patients with acute viral hepatitis experience a self-limited illness (one that runs a limited course), and go on to recover completely.
  • There is no accepted treatment and no restrictions on diet or activity.
  • In most cases, hospitalization should be avoided, to prevent spread of the virus to other patients. It should, however, be considered for patients who are severely ill.
  • Your healthcare provider can recommend the best options based on your individual needs for care.

Chronic (persistent):

  • Interferon is used to help stop the replication of HBV. It is called an antiviral agent. Interferon has been 40 percent effective in eliminating chronic HBV infection. Persons who became infected during adulthood were most likely to respond to this treatment. Long-term follow up of treated patients suggests that remission of chronic HBV from treatments with interferon is of long duration. Talk to your health care provider about the use of Interferon.
  • Lamivudine (Epivir) is now available to treat chronic HBV. It is the first medication specifically formulated to do so. Talk to your health care provider for more information about lamivudine and to learn if it is right for you.
  • Adefovir dipivoxil (Hepsera™), is the first nucleotide analog approved to treat chronic HBV. Adefovir dipivoxil slows the progression of chronic HBV by interfering with the virus' replication process within the body. Results show that adefovir dipivoxil can significantly reduce liver inflammation and scarring. It has been shown to work in people who have resistance to the drug lamivudine. Consult your health care provider for more information about adefovir dipivoxil and to learn it is right for you.
  • Entecavir (Baraclude™) slows the progression of chronic hepatitis B by interfering with viral reproduction. In clinical studies, patients treated with entecavir showed significant improvement in the liver inflammation caused by HBV and an improvement in the degree of liver fibrosis (scarring). It is important to stay under your doctor’s care while taking entecavir. Baraclude™ was approved by the Food & Drug Administration (FDA) in March 2005. Talk to your doctor to learn more about this treatment.
  • Peginterferon (Pegasys®) is the first and only pegylated interferon approved for the treatment of chronic hepatitis B, including both variations of the virus. Peginterferon has a dual mode of action; it slows replication of the hepatitis B virus and boosts the immune system. Pegasys® was approved by the FDA to treat chronic hepatitis B in May 2005. Talk to your healthare provider to learn more about peginterferon.

What does it mean for my health?

Hepatitis B can cause:
  • Chronic infection
  • Cirrhosis (scarring) of the liver
  • Liver cancer
  • Death

The good news is that hepatitis B is preventable through vaccination. A person can choose to be vaccinated and no longer have to worry about being infected with hepatitis B.


Is there a vaccine to prevent hepatitis B?

Yes! Hepatitis B is preventable through vaccination. Since hepatitis D can only coexist with hepatitis B, getting vaccinated against hepatitis B also protects you against hepatitis D.

  • The HBV vaccine is given in a series of three or four doses.
  • The first and second doses must be given at least one month apart.
  • The first and third doses must be given at least 4 months apart.

The Centers for Disease Control and Prevention (CDC) recommends hepatitis B vaccination for:

  • Sex partners of anyone who has hepatitis B
  • Anyone who is sexually active but not in a long-term, monogamous relationship
  • Those treated for STD/STIs
  • Men who have sex with men

Others recommended for hepatitis B vaccine include:

  • All infants and children under age 19 who have not had the vaccine
  • Injecting drug users who share needles
  • Those living in households with someone who has hepatitis B
  • Anyone whose work places them in contact with blood
  • Those with HIV or chronic liver disease
  • Individuals in correctional facilities
  • Travelers to areas with a high prevalence of hepatitis B

Sexual Prevention

Besides vaccination, there are other ways to protect yourself against sexual transmission of hepatitis B:

  • Abstinence and mutual monogamy between two uninfected partners also offer a high level of protection.
  • Latex condoms offer effective prevention during vaginal and anal sex by reducing contact with infected bodily fluids (semen, vaginal secretions and blood).
  • A non-lubricated latex condom can be used for mouth-to-penis contact. Household plastic wrap, dams or a latex condom cut lengthwise and opened flat can reduce the risk of transmission during mouth-to-vulva or oral-anal contact.

Non-Sexual Prevention

Other ways to prevent hepatitis B:

  • Avoid contact with infected blood or other body fluids directly or on objects such as needles, razors, toothbrushes, etc.
  • Clean surfaces contaminated with blood or other body fluids with a solution of 1 part household bleach and 10 parts water.
  • Cover cuts, sores, and rashes with bandages.

Talking to a partner

If you have an acute or chronic hepatitis B infection, you should discuss it with your partner so that he or she can learn how to protect themselves from becoming infected with HBV.


More information:

Centers for Disease Control (CDC):
Viral Hepatitis Division and National Immunziation Program
Hepatitis Foundation International
American Liver Foundation
Immunization Action Coalition (IAC)
Parents of Kids with Infectious Diseases (PKID)

Hepatitis and Men

Men who have sex with men (MSM), compared the population as a whole, are at increased risk of getting hepatitis A and B. However, there are safe and effective vaccines available for both hepatitis A and B. Learn more about hepatitis risks and prevention, take a risk assessment and take a quiz to check your knowledge at ASHA's hepatitis website for men.