C and D usually occur as a result of parenteral contact with infected body fluids.
Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact. Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
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We covered Hepatitis A in a previous article in these series of Hepatitis. In this article will cover B symptoms, who is at risk, and treatment.
Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) which affects the liver. It can cause both acute and chronic infections. Many people have no symptoms during the initial infection. Some develop a rapid onset of sickness with vomiting, yellow skin, feeling tired, dark urine and abdominal pain. Often these symptoms last a few weeks and rarely does the initial infection result in death. It may take 30 to 180 days for symptoms to begin. In those who get infected around the time of birth 90% develop chronic hepatitis B while less than 10% of those infected after the age of five do. Most of those with chronic disease have no symptoms; however,cirrhosis and liver cancer may eventually develop. These complications results in the death of 15 to 25% of those with chronic disease.
The virus is transmitted by exposure to infectious blood or body fluids. Infection around the time of birth or from contact with other people’s blood during childhood is the most frequent method by which hepatitis B is acquired in areas where the disease is common. In areas where the disease is rare, intravenous drug use and sexual intercourse are the most frequent routes of infection. Other risk factors include working in healthcare, blood transfusions, dialysis, living with an infected person, travel in countries where the infection rate is high, and living in an institution. Tattooing and acupuncture led to a significant number of cases in the 1980s; however, this has become less common with improved sterility. The hepatitis B viruses cannot be spread by holding hands, sharing eating utensils, kissing, hugging, coughing, sneezing, or breastfeeding. The infection can be diagnosed 30 to 60 days after exposure. Diagnosis is typically by testing the blood for parts of the virus and for antibodies against the virus. It is one of five known hepatitis viruses: A, B, C, D, and E.
The infection has been preventable by vaccination since 1982. Vaccination is recommended by the World Health Organization in the first day of life if possible. Two or three more doses are required at a later time for full effect. This vaccine works about 95% of the time. About 180 countries gave the vaccine as part of national programs as of 2006. It is also recommended that all blood be tested for hepatitis B before transfusion and condomsbe used to prevent infection. During an initial infection, care is based on the symptoms that a person has. In those who develop chronic disease antiviral medication such as tenofovir or interferon maybe useful, however these drugs are expensive. Liver transplantation is sometimes used for cirrhosis.
About a third of the world population has been infected at one point in their lives, including 240 million to 350 million who have chronic infections. Over 750,000 people die of hepatitis B each year. About 300,000 of these are due to liver cancer. The disease is now only common in East Asia and sub-Saharan Africa where between 5 and 10% of adults have chronic disease. Rates in Europe and North America are less than 1%. It was originally known as serum hepatitis. Research is looking to create foods that contain HBV vaccine. The disease may affect other great apes as well.
How common is chronic Hepatitis B outside the United States?
Globally, chronic Hepatitis B affects approximately 240 million people and contributes to an estimated 786,000 deaths worldwide each year.
How likely is it that acute Hepatitis B will become chronic?
The likelihood depends upon the age at which someone becomes infected. The younger a person is when infected with Hepatitis B virus, the greater his or her chance of developing chronic Hepatitis B. Approximately 90% of infected infants will develop chronic infection. The risk goes down as a child gets older. Approximately 25%–50% of children infected between the ages of 1 and 5 years will develop chronic hepatitis. The risk drops to 6%–10% when a person is infected over 5 years of age. Worldwide, most people with chronic Hepatitis B were infected at birth or during early childhood.
How is Hepatitis B spread?
Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:
- Birth (spread from an infected mother to her baby during birth)
- Sex with an infected partner
- Sharing needles, syringes, or other drug-injection equipment
- Sharing items such as razors or toothbrushes with an infected person
- Direct contact with the blood or open sores of an infected person
- Exposure to blood from needlesticks or other sharp instruments
Can a person spread Hepatitis B and not know it?
Yes. Many people with chronic Hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves.
Can Hepatitis B be spread through sex?
Yes. Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50–100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.
Can Hepatitis B be spread through food?
Unlike Hepatitis A, it is not spread routinely through food or water. However, there have been instances in which Hepatitis B has been spread to babies when they have received food pre-chewed by an infected person.
What are ways Hepatitis B is not spread?
Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.
Who is at risk for Hepatitis B?
Although anyone can get Hepatitis B, some people are at greater risk, such as those who:
- Have sex with an infected person
- Have multiple sex partners
- Have a sexually transmitted disease
- Are men who have sexual contact with other men
- Inject drugs or share needles, syringes, or other drug equipment
- Live with a person who has chronic Hepatitis B
- Are infants born to infected mothers
- Are exposed to blood on the job
- Are hemodialysis patients
- Travel to countries with moderate to high rates of Hepatitis B
High endemicity areas include south-east Asia and the Pacific Basin (excluding Japan, Australia, and New Zealand), sub-Saharan Africa, the Amazon Basin, parts of the Middle East, the central Asian Republics, and some countries in eastern Europe. In these areas, about 70 to 90% of the population becomes HBV-infected before the age of 40, and 8 to 20% of people are HBV carriers.15
In countries such as China, Senegal, and Thailand, infection rates are very high in infants, and continue through early childhood. At that stage the prevalence of HBsAgin serum may exceed 25%. In Panama, New Guinea, Solomon Islands, Greenland, and in populations such as Alaskan Indians, infection rates in infants are relatively low and increase rapidly during early childhood.15
Low endemicity areas include North America, Western and Northern Europe, Australia, and parts of South America. The carrier rate here is less than 2%, and less than 20% of the population is infected with HBV.15, 23
The rest of the world falls into the intermediate.
If I think I have been exposed to the Hepatitis B virus, what should I do?
If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.
If I had Hepatitis B in the past, can I get it again?
No, once you recover from Hepatitis B, you develop antibodies that protect you from the virus for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it. However, some people, especially those infected during early childhood, remain infected for life because they never clear the virus from their bodies.
Does acute Hepatitis B cause symptoms?
Sometimes. Although a majority of adults develop symptoms from acute Hepatitis B virus infection, many young children do not. Adults and children over the age of 5 years are more likely to have symptoms. Seventy percent of adults will develop symptoms from the infection.
What are the symptoms of acute Hepatitis B?
Symptoms of acute Hepatitis B, if they appear, can include:
- Loss of appetite
- Abdominal pain
- Dark urine
- Clay-colored bowel movements
- Joint pain
- Jaundice (yellow color in the skin or the eyes)
How soon after exposure to Hepatitis B will symptoms appear?
On average, symptoms appear 90 days (or 3 months) after exposure, but they can appear any time between 6 weeks and 6 months after exposure.
How long do acute Hepatitis B symptoms last?
Symptoms usually last a few weeks, but some people can be ill for as long as 6 months.
Can a person spread Hepatitis B without having symptoms?
Yes. Many people with Hepatitis B have no symptoms, but these people can still spread the virus.
What are the symptoms of chronic Hepatitis B?
Some people have ongoing symptoms similar to acute Hepatitis B, but most individuals with chronic Hepatitis B remain symptom free for as long as 20 or 30 years. About 15%–25% of people with chronic Hepatitis B develop serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.
How will I know if I have Hepatitis B?
Talk to your health professional. Since many people with Hepatitis B do not have symptoms, doctors diagnose the disease by one or more blood tests. These tests look for the presence of antibodies or antigens and can help determine whether you:
- have acute or chronic infection
- have recovered from infection
- are immune to Hepatitis B
- could benefit from vaccination
How serious is chronic Hepatitis B?
Chronic Hepatitis B is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. Approximately 2,000–4,000 people die every year from Hepatitis B-related liver disease.
What are antigens and antibodies?
An antigen is a substance on the surface of a virus that causes a person’s immune system to recognize and respond to it. When the body is exposed to an antigen, the body views it as foreign material and takes steps to neutralize the antigen by producing antibodies. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it.
What are the common blood tests available to diagnose Hepatitis B?
There are many different blood tests available to diagnose Hepatitis B. They can be ordered as an individual test or as a series of tests. Ask your health professional to explain what he or she hopes to learn from the tests and when you will get the results. Below are some of the common tests and their meanings. But remember: only your doctor can interpret your individual test results.
How is acute Hepatitis B treated?
There is no medication available to treat acute Hepatitis B. During this short-term infection, doctors usually recommend rest, adequate nutrition, and fluids, although some people may need to be hospitalized.
How is chronic Hepatitis B treated?
It depends. People with chronic Hepatitis B virus infection should seek the care or consultation of a doctor with experience treating Hepatitis B. This can include some internists or family medicine practitioners, as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists (liver specialists). People with chronic Hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment. Several medications have been approved for Hepatitis B treatment, and new drugs are in development. However, not every person with chronic Hepatitis B needs to be on medication, and the drugs may cause side effects in some patients.
What can people with chronic Hepatitis B do to take care of their liver?
People with chronic Hepatitis B should be monitored regularly by a doctor experienced in caring for people with Hepatitis B. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver.
Prevention / Vaccination
Can Hepatitis B be prevented?
Yes. The best way to prevent Hepatitis B is by getting the Hepatitis B vaccine. The Hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period.
What is the Hepatitis B vaccine series?
The Hepatitis B vaccine series is a sequence of shots that stimulate a person’s natural immune system to protect against HBV. After the vaccine is given, the body makes antibodies that protect a person against the virus. An antibody is a substance found in the blood that is produced in response to a virus invading the body. These antibodies are then stored in the body and will fight off the infection if a person is exposed to the Hepatitis B virus in the future.
Who should get vaccinated against Hepatitis B?
Hepatitis B vaccination is recommended for:
- All infants, starting with the first dose of Hepatitis B vaccine at birth
- All children and adolescents younger than 19 years of age who have not been vaccinated
- People whose sex partners have Hepatitis B
- Sexually active persons who are not in a long-term, mutually monogamous relationship.
- Persons seeking evaluation or treatment for a sexually transmitted disease
- Men who have sexual contact with other men
- People who share needles, syringes, or other drug-injection equipment
- People who have close household contact with someone infected with the Hepatitis B virus
- Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
- People with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
- Residents and staff of facilities for developmentally disabled persons
- Travelers to regions with moderate or high rates of Hepatitis B
- People with chronic liver disease
- People with HIV infection
- Anyone who wishes to be protected from Hepatitis B virus infection
When should a person get the Hepatitis B vaccine series?
Children and Adolescents
- All children should get their first dose of Hepatitis B vaccine at birth and complete the vaccine series by 6–18 months of age.
- All children and adolescents younger than 19 years of age who have not yet gotten the vaccine should also be vaccinated. “Catch-up” vaccination is recommended for children and adolescents who were never vaccinated or who did not get the entire vaccine series.
- Any adult who is at risk for Hepatitis B virus infection or who wants to be vaccinated should talk to a health professional about getting the vaccine series.
Is the Hepatitis B vaccine recommended before international travel?
The risk for Hepatitis B virus infection in international travelers is generally low, although people traveling to certain countries are at risk. Travelers to regions with moderate or high rates of Hepatitis B should get the Hepatitis B vaccine.
Is the Hepatitis B vaccine series effective?
Yes, the Hepatitis B vaccine is very effective at preventing Hepatitis B virus infection. After receiving all three doses, Hepatitis B vaccine provides greater than 90% protection to infants, children, and adults immunized before being exposed to the virus.
Is the Hepatitis B vaccine safe?
Yes, the Hepatitis B vaccine is safe. Soreness at the injection site is the most common side effect reported. As with any medicine, there are very small risks that a serious problem could occur after getting the vaccine. However, the potential risks associated with Hepatitis B are much greater than the risks the vaccine poses. Since the vaccine became available in 1982, more than 100 million people have received Hepatitis B vaccine in the United States and no serious side effects have been reported.
Is it harmful to have an extra dose of Hepatitis B vaccine or to repeat the entire Hepatitis B vaccine series?
No, getting extra doses of Hepatitis B vaccine is not harmful.
Is there a vaccine that will protect me from both Hepatitis A and Hepatitis B?
Yes, there is a combination vaccine that protects people from both Hepatitis A and Hepatitis B. The combined Hepatitis A and B vaccine is usually given as three separate doses over a 6-month period.
Do babies need the Hepatitis B vaccine even if a pregnant woman does not have Hepatitis B?
Yes. The Hepatitis B vaccine is recommended for all infants. CDC recommends that the infant get the first shot before leaving the hospital.
Why is the Hepatitis B vaccine recommended for all babies?
Hepatitis B vaccine is recommended for all babies so that they will be protected from a serious but preventable disease. Babies and young children are at much greater risk for developing a chronic infection if infected, but the vaccine can prevent this.
Hepatitis B is one of the world’s most common and serious infectious diseases. It is estimated that more than one third of the world’s population has been infected with the hepatitis B virus. About 5% of the population are chronic carriers of HBV , and nearly 25% of all carriers develop serious liver diseases such as chronic hepatitis,cirrhosis, and primary hepatocellular carcinoma. HBV infection causes more than one million deaths every year.15, 23, 30, 39
Hepatitis B is a vaccine-preventable disease, but although global control of hepatitis B is achievable, it has not been attained yet.5, 36, 37 In fact, a large pool of carriersand the burden of their disease remains, so that efforts must necessarily continue to treat the various stages of disease.
HB vaccine is the first and currently the only vaccine against a major human cancer. Vaccination is the most effective tool in preventing the transmission of HBV and HDV.Vaccines are composed of the surface antigen of HBV (HBsAg), and are produced by two different methods: plasma derived or recombinant DNA. When administered properly, hepatitis B vaccine induces protection in about 95% of recipients.5
A safe and effective vaccine against HBV infection has been available for 20 years. HB vaccine is effective in preventing HBV infections when it is given either before exposure or shortly after exposure, At least 85%-90% of HBV-associated deaths arevaccine-preventable.
Despite the availability of a vaccine, worldwide infection persists.
Systematic hepatitis B vaccination of newborns renders the screening of pregnant women for HBsAg-status before delivery superfluous.23
WHO recommends that hepatitis B vaccine be included in routine immunization services in all countries. The primary objective of hepatitis B immunization is to prevent chronic HBV infections which result in chronic liver disease later in life. By preventing chronic HBV infections, the major reservoir for transmission of new infections is also reduced,