Are Hepatitis B And C Preventable
Hepatitis B is a vaccine-preventable disease.
There is a three-shot vaccination series that is very effective in protecting people against the virus if theyre exposed. In the United States, all newborns are vaccinated for hepatitis B and all pregnant women are screened for hepatitis B during pregnancy. This way, mothers infected with hepatitis B can take protective steps to decrease the risk of transmission of the virus to the child.
There is no vaccine for hepatitis C.
How Are Hepatitis B And C Treated
Hepatitis B: Not all patients with chronic hepatitis B infection require treatment. At Yale Medicine, specialists decide on an individual basis whether a patient is an appropriate candidate for treatment. Generally, patients require treatment when their hepatitis B virus level is high, and when laboratory tests demonstrate significant inflammation or injury to the liver.
There are currently seven approved drugs for hepatitis B, two of which are considered to be first-line treatments. These drugs are oral pills taken once daily, and while they’re very effective at suppressing the virus to very low or undetectable levels over the long term, they are not considered curative.
Therefore, the goal of treatment is to control the virus long-term and decrease the risk of hepatitis B related complications such as cirrhosis and liver cancer.
Hepatitis C: For the greater part of the last 20 years, treatment of hepatitis C required the use of a chemotherapy-like injection drug called interferon, which has been associated with serious side effects and a low cure rate. Fortunately, advances in hepatitis C treatments within the last three years now allow for the use of oral medications that are significant improvements in terms of safety and effectiveness.
Hepatitis B During Pregnancy
If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.
The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.
The HBV vaccine is safe to receive while pregnant.
People with a high risk of HBV include:
- the infants of mothers with HBV
- the sexual partners of people with HBV
- people who engage in sexual intercourse without contraception and those who have multiple sexual partners
- men who have sex with men
- people who inject illicit drugs
- those who share a household with a person who has a chronic HBV infection
- healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
- people receiving hemodialysis, which is a type of kidney treatment
- people taking medications that suppress the immune system, such as chemotherapy for cancer
People can prevent HBV infection by:
- wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
- not sharing needles
- following safe sexual practices
- cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water
A vaccine against HBV has been available since 1982.
People who should receive this vaccine include:
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Finding Help For Hepatitis
If youve been diagnosed with viral hepatitis, there are a variety of resources that are available to help you. Lets explore a few of them below:
- Your doctor. Your doctor is a great first point of contact for questions and concerns. They can help you to better understand the type of hepatitis you have, as well as how it will be treated.
- American Liver Foundation . ALF is dedicated to ending liver disease through education, research, and advocacy. Their site has educational material about viral hepatitis, as well as ways to find doctors, support groups, and clinical trials in your area.
- Patient assistance programs. If you have hepatitis C, the cost of antiviral drugs can be high. The good news is that many drug manufacturers have patient assistance programs that can help you pay for these medications.
The chart below is an at-a-glance summary of some of the key differences between hepatitis A, B, and C.
| Hepatitis A |
|---|
How You Can Get Hepatitis B
You can get hepatitis B from:
- injecting drugs using shared needles
- being injured by a used needle
- having a tattoo or piercing with unsterilised equipment
- having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked for hepatitis B.
If you’re pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.
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What Occupations Have Increased Risk Of Hepatitis B
In general, occupational groups with increased risk include:
- Health-care workers repeatedly exposed to blood or blood products or those who are at risk of needlestick injury.
- Pathologists, laboratory personnel, or embalmers.
- Dentists, dental assistants, and dental hygienists.
- Certain staff members of institutions for the developmentally handicapped.
- Staff of institutions where workers may be exposed to aggressive, biting residents.
Travellers to regions with intermediate or high rates of endemic HBV infection may also consider being vaccinated.
What Are The Risk Factors For Hepatitis B And C
Hepatitis B: Although most commonly acquired early in life, adults can also contract it. Hepatitis B is largely transmitted through bodily fluids. It can be passed at birth from a hepatitis B-infected mother or through exposure in early childhood to body fluids, blood or contaminated medical instruments. Hepatitis B can also be transmitted through intranasal and injection drug use as well as infected tools used during tattooing and body piercing.
Hepatitis C: The key risk factors are also intranasal and injection drug use, tattoos and body piercings, high-risk sexual contact, blood transfusions before 1992 and organ transplantation.
Another key risk factor for hepatitis C is being born from 1945 to 1965, during the baby-boom years. Eighty percent of all people who currently have hepatitis C in the United States were born in that timeframe.
Although the reasons that baby boomers are more likely to have hepatitis C than others arent entirely understood, its believed that most were infected in the 1970s and 1980s, when rates of hepatitis C were at their peak.
The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend that all U.S. adults born from 1945 to 1965 undergo a one-time screening test for hepatitis C. Connecticut is one of several states that has written this recommendation into law. In Connecticut ,the law requires that primary care clinicians screen all adults born within those years.
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How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- Perinatally: Pregnant people can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
- Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who have HIV.
Treatments For Hepatitis B
Hepatitis B usually clears up on its own without treatment. You may be offered medicine to help with the symptoms, such as painkillers or medicines to stop you feeling sick.
Your GP will refer you to see a liver specialist who will check how well your liver is working.
If hepatitis B lasts for over 6 months it is called long-term hepatitis B.
It is usually treated with antivirals and medicine to help relieve symptoms such as itchiness, pain, and sickness. You will also need to see a liver specialist for regular check-ups.
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Treatment For Suspected Exposure
Anyone who has had potential exposure to HBV can undergo a postexposure prophylaxis protocol.
This consists of HBV vaccination and hepatitis B immunoglobin . Healthcare workers give the prophylaxis after the exposure and before an acute infection develops.
This protocol will not cure an infection that has already developed. However, it decreases the rate of acute infection.
Chronic Hepatitis B And C
Most people with hepatitis B clear the virus from their bodies as they get better. But some dont clear the virus these people have chronic hepatitis B. Some people with chronic hepatitis B stay well for a long time and then get very sick many years later. People with chronic hepatitis B can spread the virus to others even if they do not look or feel sick.
Many people with chronic hepatitis C have no symptoms and dont know they have the disease. However, because the virus is in their bodies, they can spread it to other people. Chronic hepatitis C is a long term illness that can lead to serious liver problems, including scarring of the liver or liver cancer.
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How Is Hepatitis B Spread
- Having unprotected sex.
- Sharing or using dirty needles for drug use, tattoos or piercing.
- Sharing everyday items that may contain body fluids, including razors, toothbrushes, jewelry for piercings and nail clippers.
- Being treated medically by someone who does not use sterile instruments.
- Being bitten by someone with the infection.
- Being born to a pregnant woman with the infection.
Hepatitis B is not spread by:
- Kissing on the cheek or lips.
- Coughing or sneezing.
- Hugging, shaking hands or holding hands.
- Eating food that someone with the infection has prepared.
Antiviral Therapy And Prevention Of Hcv
However, given the adverse effects, it remains uncertain whether patients with decompensated cirrhosis could tolerate HCV eradication treatment and therefore should be treated to prevent progression of decompensation. The AASLD recommends those patients to be referred for consideration of liver transplantation. Eradication of HCV before liver transplantation could reduce post-transplant recurrence of HCV, especially in patients infected with HCV genotypes other than genotype 1. Thus, treatment should be reserved for those patients awaiting liver transplantation. It is recommended that patients with decompensated cirrhosis initiate treatment at a low dose of IFN-based therapy. However, the treatment should be administered with caution since it is still unclear whether the novel agents will be effective in those most difficult-to-treat patients. In addition, use of hematological growth factors can improve the life quality of treated patients and manage treatment-induced cytopenias .
Flowchart of therapy choice for patients with chronic hepatitis C virus infection. HCC: Hepatocellular carcinoma IFN: Interferon NR: No response SVR: Sustained virological response.
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What Is The Treatment For Hepatitis B
Prevention is recommended by receiving a vaccine for HBV.
Receiving an injection of the hepatitis B immune globulin within 12 hours of coming in contact with the virus may help prevent the development of the disease.
At present, there is no specific treatment for patients with acute hepatitis B. Acute infection is usually short and will often resolve on its own. Your health care provider may recommend rest, and adequate nutrition and fluids to help your body fight the infection. Hospitalization may be required for patients who suffer from severe vomiting and who are unable to maintain adequate nutritional levels. It may also be required to prevent the development of complications.
While chronic infection cannot be cured, there are two standard treatments in Canada that may control the virus and prevent further damage to the liver.
- Antiviral medications can fight the virus and slow damage to the liver.
- Interferon which may be given for short periods and if effective, results in suppression of the virus.
Antiviral Therapy And Prevention Of Hbv
Moreover, chronic infection with HBV genotype C is more likely to cause liver cirrhosis than genotype B. Chronic infection with genotype C is related to HBV-associated HCC, especially in cirrhotic patients aged > 50 years, whereas HBV B2 infection is related to high prevalence of HCC in non-cirrhotic young patients and HCC recurrence after resection. In addition, precore or core promoter HBV variants that occur in most patients can prevent or decrease the production of HBeAg. Different HBV subgenotypes have distinct patterns of mutations. We and others have found that serum HBV load and viral mutations in the enhancer II/basal core promoter regions and in the precore/core gene , as well as in the preS region are significantly associated with the occurrence of HCC. Reduction of CD8+ T cell epitopes in HBV to evade immune clearance is one of the most common ways of these mutations. It remains to be evaluated if the HCC-associated HBV mutants are still sensitive to the antiviral treatment.
Flowchart of therapy choice for patients with chronic hepatitis B virus infection. ALT: Alanine aminotransferase HBeAg: Hepatitis B e antigen HCC: Hepatocellular carcinoma HBV: Hepatitis B virus IFN: Interferon NAs: Nucleoside analogues ULN: Upper limit of normal.
IFN
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What Are The Risk Factors
Some people are at an increased risk for contracting HAV, including:
- people traveling to areas of the world where hepatitis A is common
- men who have sex with men
- people who use injectable or noninjectable drugs
- caregivers for those who have hepatitis A
- people who are experiencing homelessness
- people living with a child whos been adopted from an area where hepatitis A is common
What Are The Risk Factors For Getting Hepatitis B
Due to the way that hepatitis B spreads, people most at risk for getting infected include:
- Children whose mothers have been infected with hepatitis B.
- Children who have been adopted from countries with high rates of hepatitis B infection.
- People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
- People who live with or work in an institutional setting, such as prisons or group homes.
- Healthcare providers and first responders.
- People who share needles or syringes.
- People who live in close quarters with a person with chronic hepatitis B infection.
- People who are on dialysis.
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American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
The AASLD does not recommend antiviral therapy in individuals with all of the following, regardless of HBeAg status or age :
- No clinical evidence of cirrhosis
- Persistently normal ALT levels
- Low levels of HBV DNA replication . ]
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
Adults with HBeAg-negative immune-active chronic HBV infection
Children with chronic hepatitis B infection
Individuals with HBV and HCV coinfection
Individuals with HBV and HIV coinfection
Treatment Options For Hepatitis B
People living with chronic hepatitis B infection should expect to live a long and healthy life. There are decisions people can make to protect their livers such as seeing a liver specialist or health care provider regularly, avoiding alcohol and tobacco, and eating healthy foods. There are also approved drugs for both adults and children that control the hepatitis B virus, which helps reduce the risk of developing more serious liver disease, but there is still no complete cure.
Current treatments for hepatitis B fall into two general categories:
- Immune modulator Drugs These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. They are given as a shot over 6 months to 1 year.
- Antiviral Drugs These are drugs that stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. These are taken as a pill once a day for at least 1 year and usually longer.
It is important to know that not everyone with chronic hepatitis B infection needs to be treated. This can be difficult to accept when first diagnosed because taking a drug to get rid of the virus seems like the first step to getting better. Current treatments, however, are generally found to be most effective in those who show signs of active liver disease .
Hepatitis B Drug Watch
Visit the HBF Drug Watch for a complete list of the approved treatments for hepatitis B and promising new drugs in development.
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Treatment For Chronic Hbv Infection
For chronic HBV infection, antiviral medications are available.
This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.
A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.
People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver
Is There A Cure
Though there is no vaccine for Hepatitis C, treatments can reduce the viral load to undetectable levels which is considered cured or in remission.
The virus is considered cured when it is not detected in your blood 12 weeks after treatment is completed. This is otherwise known as a sustained virologic response .
Hepatitis C is one of the most serious hepatitis viruses. However, with newer treatments developed over the past few years, the virus is much more manageable than it was in the past.
Current antiviral drugs that help cure hepatitis C may also help prevent the health complications of chronic liver disease.
The reports less than half of people who contract the hepatitis C virus may clear it from their bodies without treatment. For this group of people, the virus will be a short-term acute condition that goes away without treatment.
But for most people, acute hepatitis C will likely develop into a chronic condition that requires treatment.
Since the virus often doesnt produce symptoms until after more significant liver damage occurs, its important to get tested for hepatitis C if you think you might have been exposed.
approved the antiviral drug Mavyret for an 8-week treatment period for people with all genotypes of hepatitis C.
This treatment is now being used for many people instead of the 12-week treatment that was previously required.
Noninvasive ways to test for liver damage caused by hepatitis C are also now available to aid in diagnosis.
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