What Causes Hepatitis B
Hepatitis B is caused by the hepatitis B virus. It can happen through exposure to infected blood and other bodily fluids in the following situations:
- sharing needles and other injecting drug equipment
- sharing razors, toothbrushes or nail clippers
- sexual contact
- tattooing with unsterilised needles and equipment
- close family contact with someone who has hepatitis B
- being born to a mother with hepatitis B
- accidental exposure such as a needle stick injury or being splashed with infected blood or body fluid
- blood transfusion this is now very rare as blood in Australia is screened for hepatitis B
You cannot catch hepatitis B through being coughed or sneezed on by infected people or by consuming contaminated food and drink. You cannot catch the virus from saliva, breast milk or tears.
What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
Genotype And Prediction Of Treatment Success
Genotypes A and B may be associated with a better response to interferon therapy, although the clinical trials that showed this association were not designed to look at the effect of genotype and may be confounded by ethnicity . The success of NUC therapy does not appear to be associated with genotype .
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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.
Phase : Immune Tolerant Phase
The immune tolerant phase is typically the first phase of infection and is characterized by host immune tolerance despite active HBV replication. The lack of host immune response means that liver histology and alanine aminotransferase levels are usually normal. Active HBV replication releases HBV DNA, HBeAg and HBsAg, which are detectable in the serum . The immune response is limited to anti-HBc antibody production , but this does not act to neutralize infection.
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How Is Hepatitis B Spread
You can become infected with hepatitis B through exposure to blood, semen and other bodily fluids of an infected person. You can get the infection by:
- 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.
Hepatitis B And Liver Cancer
Having hepatitis B increases the risk of liver cancer. Liver cancer may develop from long-term inflammation and damage caused by a chronic HBV infection. When your liver remains in a long-term state of inflammation, cirrhosis may develop.
As scar tissue takes over the liver, the DNA in healthy cells can also change, allowing malignant tumors to develop.
While liver cancer itself has been declining in the United States, it is still a deadly cancer. According to the CDC , about 25,000 new cases of liver cancer are diagnosed in men each year, and 11,000 new cases in women. Of these, an estimated 19,000 men and 9,000 women die from the disease.
Liver cancer alone has a 10% to 14% 5-year survival rate, reports the Hepatitis B Foundation. Early detection and treatment can significantly boost this rate to 60% to 70%.
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Complications Of Hepatitis B
A small proportion of people who become infected with the hepatitis B virus develop a long-term hepatitis B infection. They may have the virus in their bloodstream for most of their life without realising they are infected.
People with chronic hepatitis B infection may not notice any health problems until they develop liver problems such as liver disease or liver cancer later in life. Treatment for hepatitis B is essential because it is not possible to be a healthy carrier of the hepatitis B virus. Chronic hepatitis B infection occurs more commonly in some communities, including:
- Aboriginal and Torres Strait Islander communities.
- In people from parts of the world where hepatitis B is more common, such as:
- North-East Asia
- Sub-Saharan Africa.
Natural History Of Chb Infection
The natural history of CHB can be divided into five phases. Not all patients experience every phase, and the duration of each phase can be highly variable. Reversion or reactivation between different phases can occur seemingly without warning, and therefore, clinical management can be challenging . The five phases are summarized below and in and :
Schematic diagram of phases of chronic HBV infection.
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Prevention Of Hepatitis B Virus Infection
Several strategies have been shown to prevent hepatitis B virus infection . Vaccination is the mainstay of prevention. Specific hepatitis B immunoglobulin and lamivudine are useful in specific settings.
Box 1: Factors influencing outcome of chronic hepatitis B virus infection
Screening of blood and blood products
Using universal precautions in healthcare settings
Avoiding needle sharing among injecting drug users
Promoting safe sex practices
Prevention in special settings:
- Preventing vertical transmission
- Post-exposure prophylaxis
- Preventing transmission in patients with liver transplants
Immunisation For Hepatitis B
Immunisation is the best protection against hepatitis B infection. A course of vaccination is recommended for all babies and people in high-risk groups.
Immunisation can be with a vaccine against hepatitis B alone or with a combination vaccine. To be immunised, contact your doctor or local council.
Protection against hepatitis B is available free of charge under the National Immunisation Program Schedule. In Victoria, immunisation against hepatitis B is free for:
- Babies at birth immunisation against hepatitis B alone as soon as possible after birth.
- Babies at 2, 4 and 6 months combination immunisation in the form of a diphtheria, tetanus, whooping cough, hepatitis B, polio and Haemophilus influenzae type b vaccine .
- Premature babies at 12 months premature babies born under 32 weeks gestation or under 2,000g birth weight receive a single booster dose.
- Children up to and including 9 years of age.
- People aged less than 20 years having a catch-up immunisation.
- Refugees and humanitarian entrants aged 20 years and above.
In Victoria, free hepatitis B vaccine is provided for people who are at increased risk of infection, including:
Immunisation is also recommended, but not necessarily free, for people who are at increased risk of infection, including:
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Causes And Risk Factors Of Hepatitis B
- Through sex with a partner who has the virus
- During birth, when an infected mother passes the virus to her baby
- Through accidental needle stick injuries that occur from an infected person
- Making direct contact with an infected person’s blood or open sores
- Getting a tattoo or piercing from a contaminated needle
Some people are more at risk for infection than others. The CDC recommends hepatitis B testing for:
- People who were born in countries with high rates of hepatitis B
- People who were born in the United States, but weren’t vaccinated as infants, to parents who were from countries with high rates of hepatitis B
- Men who have sex with men
- People who work in a job where they’re exposed to blood
- People who inject drugs
How Is Hepatitis B Treated
There is no specific treatment for acute hepatitis B infection. Treatment aims to maintain good health but not to cure the illness.
Not everyone with chronic hepatitis B needs treatment. In general, people who have chronic hepatitis B but do not have any signs of current liver damage will not need treatment. But it is important to have regular medical checkups to watch for signs of liver damage.
Those who already have liver damage should have close medical supervision and may need antiviral medications, regular monitoring and screening for liver cancer. Antivirals help reduce the risk of developing liver disease in the long term. If you have chronic hepatitis B, you may have to take medicines for the rest of your life.
If you have hepatitis B, you should drink plenty of fluids, eat a healthy balanced diet, get enough rest and avoid alcohol.
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What Should You Know About Pregnancy And Hepatitis B
A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.
You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.
If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.
You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.
Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.
Diagnosis Of Hepatitis B
Blood tests are available to determine if you are or have been infected with hepatitis B. It may take 6 months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this 6-month period, until you know whether you are infected or not, take action to prevent potential infection of other people.
There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so talk to your doctor.
All pregnant women are tested for hepatitis B. If you are found to have chronic hepatitis B, your doctor can help reduce the risk of transferring the infection to your newborn child.
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What Should You Do If Exposed To The Hepatitis B Virus
If you know you were recently exposed to the hepatitis B virus, you may get protection from an injection of hepatitis B immunoglobulin , which is different from hepatitis B vaccine. HBIG is given only when it is suspected or known that someone has been infected with hepatitis B, and it is given within 24 hours after the exposure. HBIG will protect you for 3 to 6 months, but it is strongly recommended that you also begin the hepatitis B vaccination series within 7 days of your exposure.
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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How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
How Many People Have Hepatitis B
In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2019, 3,192 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 20,700 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.
Globally, HBV is the most common blood-borne infection with an estimated 296 million people infected according to the World Health Organization .
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Prevention Of Mother To Child Transmission
PEP, initiated at birth, is recommended for all infants of HBV infected mothers . PEP using a combination of HBIG and an accelerated course of HBV vaccine has been shown to be effective in preventing perinatal HBV transmission in 90% of cases . Many countries, including the USA and the UK, have introduced routine antenatal screening of all pregnant women to identify HBsAg-positive mothers and maximize opportunities to prevent mother to child transmission of HBV infection .
What Are The Complications Of Hepatitis B
The course of hepatitis B infection depends mostly on the age at which a person is infected.
People infected as infants are likely to develop long term infection and can get complications such as scarring of the liver or liver cancer. Infants have a 9 in 10 chance and children have a 3 in 10 chance of developing a chronic, lifelong infection.
People infected as teenagers or adults are likely to become unwell with symptoms , but have a smaller chance of developing a chronic infection. Others develop a silent infection, without any symptoms.
Most people infected as adults clear the virus from the body within 6 months. They develop immunity to future hepatitis B infections and do not develop long-term liver damage.
However, approximately 1 in 20 adults cannot clear the virus and develop chronic hepatitis B. They are at risk of developing complications such as cirrhosis and liver cancer in the longer term.
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Who Should Be Vaccinated For Hepatitis B
All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:
- People who have more than one sexual partner.
- Men who have sex with men.
- Adults with diabetes.
- Sexual partners of infected people and people who share households with infected individuals.
- People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who cant take care of themselves.
Cdc: Less Than A Third Of Hepatitis C Patients Seek Treatment For Curable Virus
AUSTIN A new study published Tuesday in the U.S. Center for Disease Control and Preventions Morbidity and Mortality Weekly Report suggests that less than a third of adults with hepatitis C receive treatment for the curable disease.
Hepatitis C is liver inflammation caused by a viral infection that spreads via blood. Usually, modern sanitation and sterilization practices prevent the spread, but lax procedures allow it to perpetuate. There is no vaccine for hepatitis C, unlike for hepatitis A and B.
According to the CDCs estimates, roughly two million adults in the U.S. have hepatitis C and the virus contributes to 14,000 deaths annually. In Texas, 2019 data shows that only 0.2 people per 100,000 have the virus.
The cure for hepatitis C is 8-12 weeks of taking a pill, and the CDC says that the cure rate is 90%. However, these pills can be expensive, which creates a barrier to patients seeking treatment.
Everyone with hepatitis C should have access to lifesaving treatment, regardless of race, ethnicity, age or insurance status, said CDC Acting Principal Deputy Director Dr. Debra Houry in a press release. We must reduce the barriers and get more people treated for hepatitis C in our country. This is critical to stop preventable deaths and prevent new infections.
Among insured people the rate of seeking treatment is slightly better than the average at 35%, but for those on Medicaid and Medicare the rates are 23% and 28% respectively.
The full study is available here:
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