Detection Of Antiviral Resistance
National and international surveillance is performed by the CDC to determine effectiveness of the current FDA-approved antiviral flu drugs. Public health officials use this information to make current recommendations about the use of flu antiviral medications. further recommends in-depth epidemiological investigations to control potential transmission of the resistant virus and prevent future progression. As novel treatments and detection techniques to antiviral resistance are enhanced so can the establishment of strategies to combat the inevitable emergence of antiviral resistance.
When To Get Medical Advice
Hepatitis B can be serious, so you should get medical advice if:
- you think you may have been exposed to the hepatitis B virus emergency treatment can help prevent infection if given within a few days of exposure
- you have symptoms associated with hepatitis B
- you’re at a high risk of hepatitis B high-risk groups include people born in a country where the infection is common, babies born to mothers infected with hepatitis B, and people who have ever injected drugs
You can go to your local GP surgery, drug service, genitourinary medicine clinic or sexual health clinic for help and advice.
A blood test can be carried out to check if you have hepatitis B or have had it in the past.
The hepatitis B vaccine may also be recommended to reduce your risk of infection.
How Can I Avoid Getting Hepatitis B
There is a safe and effective vaccine that can protect you from getting hepatitis B. The vaccine is usually given in three doses over a six month period. The vaccine will give you long-lasting protection. A combined vaccine for hepatitis A and hepatitis B is also available.
Other ways to protect yourself or your loved ones include:
- Adopt safe sex practices.
- Avoid sharing personal hygiene items
- If you have been exposed to the hepatitis B virus , an injection of hepatitis B immune globulin may help protect you.
- If you are pregnant, make sure you are screened for hepatitis B. If the test result shows that you have the virus, make sure your baby receives the free hepatitis B vaccine. If you have hepatitis B, breastfeeding is safe if the baby has received both protective antibody called immune globulin, and the first dose of hepatitis B vaccine within the first 12 hours of life. Talk to your doctor about having your newborn immunized .
- If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single-use needles and inks and/or follows proper sterilization procedures.
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Outlook For Hepatitis B
The vast majority of people infected with hepatitis B in adulthood are able to fight off the virus and fully recover within 1 to 3 months.
Most will then be immune to the infection for life.
Babies and children with hepatitis B are more likely to develop a chronic infection.
Chronic hepatitis B affects around:
- 90% of babies with hepatitis B
- 20% of older children with hepatitis B
- 5% of adults with hepatitis B
Although treatment can help, there’s a risk that people with chronic hepatitis B could eventually develop life-threatening problems, such as scarring of the liver or liver cancer.
Page last reviewed: 30 January 2019 Next review due: 30 January 2022
Origin Of Antiviral Resistance
The genetic makeup of viruses is constantly changing, which can cause a virus to become resistant to currently available treatments. Viruses can become resistant through spontaneous or intermittent mechanisms throughout the course of an antiviral treatment. Immunocompromised patients, more often than immunocompetent patients, hospitalized with are at the highest risk of developing oseltamivir resistance during treatment. Subsequent to exposure to someone else with the flu, those who received oseltamivir for “post-exposure prophylaxis” are also at higher risk of resistance.
Multiple strains of one virus can be present in the body at one time, and some of these strains may contain mutations that cause antiviral resistance. This effect, called the , results in immense variation in any given sample of virus, and gives the opportunity for natural selection to favor viral strains with the highest fitness every time the virus is spread to a new host. Also, recombination, the joining of two different viral variants, and , the swapping of viral gene segments among viruses in the same cell, play a role in resistance, especially in influenza.
Antiviral resistance has been reported in antivirals for herpes, HIV, hepatitis B and C, and influenza, but antiviral resistance is a possibility for all viruses. Mechanisms of antiviral resistance vary between virus types.
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Can Hepatitis B Be Prevented
The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.
The disease has also been more widely prevented thanks to:
- Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
- Safer blood injection practices, using clean needles.
- Safe-sex practices.
You can help prevent hepatitis B infections by:
- Practicing safe sex .
- Never sharing personal care items like toothbrushes or razors.
- Getting tattoos or piercings only at shops that employ safe hygiene practices.
- Not sharing needles to use drugs.
- Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.
Prevent Infection After Contact With The Virus
If you think you have been in contact with the hepatitis B virus, see your doctor right away. Doctors typically recommend a dose of the hepatitis B vaccine to prevent infection. In some cases, doctors may also recommend a medicine called hepatitis B immune globulin to help prevent infection. You must get the vaccine dose and, if needed, HBIG shortly after coming into contact with the virus, preferably within 24 hours.
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Hepatitis B And Pregnancy
If youâre pregnant, you might pass the virus to your baby at birth. Itâs less likely to happen during your pregnancy.
If your baby gets the virus and isnât treated, they could have long-term liver problems. All newborns with infected mothers should get hepatitis B immune globulin and the vaccine for hepatitis at birth and during their first year of life.
Reducing The Risk Of Hepatitis B
Simple steps that everyone can take to protect themselves against hepatitis B include:
- Making sure you and your children are immunised this is the best protection.
- Using condoms every time you have anal or vaginal sex with new partners until you both get a check-up .
- Avoiding oral sex if you or your partner have herpes, ulcers or bleeding gums it is unlikely that you will contract hepatitis through oral sex unless blood is present.
- Choosing to have any body piercing or tattooing done by an experienced practitioner who follows good sterilisation and hygiene practices, and who works at premises registered by the local council.
- Wearing single-use gloves if you give someone first aid or need to clean up blood or body fluids.
- Never sharing needles and syringes or other equipment , if you inject drugs. Always use sterile needles and syringes. These are available from needle and syringe programs and some pharmacists. Always wash your hands before and after injecting.
If you have hepatitis B:
If you think you have been exposed to hepatitis B, see a doctor immediately. Your doctor can give you treatment in some instances, which greatly reduces the risk of you becoming infected with hepatitis B.
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What Hepatitis B Immunisation Involves
Full protection involves having 3 injections of the hepatitis B vaccine at the recommended intervals.
Babies born to mothers with hepatitis B infection will be given 6 doses of hepatitis B-containing vaccine to ensure long-lasting protection.
If you’re a healthcare worker or you have kidney failure, you’ll have a follow-up appointment to see if you have responded to the vaccine.
If you have been vaccinated by your employer’s occupational health service, you can request a blood test to see if you have responded to the vaccine.
How Are Hepatitis B And Hepatitis C Spread From Person To Person
Like HIV, the hepatitis B and hepatitis C viruses spread:
- From mother to child: Pregnant women 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 are living with HIV.
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What Is Hepatitis B
Hepatitis B is caused by a virus that infects the liver. It is one of the most common vaccine-preventable diseases affecting travellers and can cause either acute or chronic infection.
About 90 to 95 percent of adults with acute hepatitis B infection will clear the virus on their own within six months, and develop lifelong protection against it.
Some people are unable to clear the virus, and develop chronic hepatitis B. Untreated chronic hepatitis B can later develop into serious health problems. Children under four years old are at particular risk of chronic hepatitis B, because only up to 10% will clear the virus.
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
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Symptoms Of Hepatitis B
Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it.
If symptoms do develop, they tend to happen 2 or 3 months after exposure to the hepatitis B virus.
Symptoms of hepatitis B include:
- flu-like symptoms, including tiredness, a fever, and general aches and pains
- loss of appetite
- tummy pain
- yellowing of the skin and eyes
These symptoms will usually pass within 1 to 3 months , although occasionally the infection can last for 6 months or more .
How Do Doctors Treat The Complications Of Hepatitis B
If chronic hepatitis B leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, minor medical procedures, and surgery. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order blood tests and an ultrasound or another type of imaging test to check for liver cancer.
If chronic hepatitis B leads to liver failure or liver cancer, you may need a liver transplant.
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History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
Causes Of Noninfectious Hepatitis
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. Itâs three times more common in women than in men.
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Who Is Most Affected
In the United States, rates of new HBV infections are highest among adults aged 40-49 years, reflecting low hepatitis B vaccination coverage among adults at risk. The most common risk factor among people with new HBV infections is injecting drugs, related to the opioid crisis.
The highest rates of chronic hepatitis B infection in the United States occur among foreign-born individuals, especially people born in Asia, the Pacific Islands, and Africa. Approximately 70% of cases in the United States are among people who were born outside of the United States. CDC developed this map of the geographic distribution of hepatitis B around the world – PDF. Other groups who have higher rates of chronic HBV infection include people who inject drugs and men who have sex with men.
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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Chronic Hepatitis B Complications
Chronic hepatitis B can lead to
- cirrhosis, a condition in which scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.
- liver failure, in which your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. People with liver failure may require a liver transplant.
- liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.
What Causes Hepatitis B
The hepatitis B virus causes hepatitis B. The hepatitis B virus spreads through contact with an infected persons blood, semen, or other body fluids. Contact can occur by
- being born to a mother with hepatitis B
- having unprotected sex with an infected person
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools that were used on an infected person and werent properly sterilized, or cleaned in a way that destroys all viruses and other microbes
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
You cant get hepatitis B from
- being coughed on or sneezed on by an infected person
- drinking unclean water or untreated water that has not been boiled
- eating food that is unclean or has not been properly cooked
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
Mothers who have hepatitis B can safely breastfeed their babies. If a baby receives hepatitis B immune globulin and starts receiving the hepatitis B vaccine to prevent hepatitis B infection shortly after birth, hepatitis B is unlikely to spread from mother to child through breastfeeding.15
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How Is It Transmitted
Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:
- blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
- unprotected sex with an infected person
- sharing needles or equipment for injecting drugs
- unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
- sharing toothbrushes or razors
- childbirth
- household contact between family members
Hepatitis B And Your Liver
The liver is such an important organ that we can survive only one or two days if it completely shuts down – if the liver fails, your body will fail, too. Fortunately, the liver can function even when up to 80% of it is diseased or removed. This is because it has the amazing ability to regenerate – or create – itself from healthy liver cells that still exist.
If your body were an automobile, your liver would be considered the engine. It does hundreds of vital things to make sure everything runs smoothly:
- Stores vitamins, sugar and iron to help give your body energy
- Controls the production and removal of cholesterol
- Clears your blood of waste products, drugs and other poisonous substances
- Makes clotting factors to stop excessive bleeding after cuts or injuries
- Produces immune factors and removes bacteria from the bloodstream to combat infection
- Releases a substance called “bile” to help digest food and absorb important nutrients
The word hepatitis actually means inflammation of the liver. Thus, hepatitis B refers to inflammation of the liver caused by the hepatitis B virus. With early detection and appropriate follow-up medical care, people living with a chronic hepatitis B infection can expect to enjoy a long and healthy life.
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