How Is Hepatitis B Virus Transmitted

What Should You Do If You Think You Have Hep B

If you think you might be at risk for hep B, there are many ways we can help you. We can offer you support, answer questions and help you find health services near you:

• Get a hep B test: Take a look at our NSW Services Directory to find a hep B testing doctor near you.
• Speak to someone:
• call 1800 803 990 to speak confidentially with one of our Hepatitis Infoline workers
• use our online Live Chat, available on every page of our website.

Epidemiology: Incidence And Prevalence

Incidence: worldwide view and HIV/HBV coinfection

More than one third of the worlds population are estimated to be infected with HBV. About 5% of the worlds population are chronic carriers of HBV, and HBV infection causes more than one million deaths every year . The HBsAg carrier rate varies from 0.1% to 20% of different populations worldwide. In low-risk regions, the highest incidence of infection is seen in teenagers and young adults.

Based on the data from Western cohorts, HIV/HBV coinfection has a profound impact on almost every aspect of the natural history of HBV infection . The consequences include higher rates of chronicity after acute HBV infection, higher levels of HBV replication and rates of reactivation, less spontaneous clearance, higher rates of occult HBV infection , more rapid progression to cirrhosis and HCC, higher rates of liver-related mortality, and decreased treatment response compared with individuals without HIV coinfection . Recent longitudinal cohort studies have found that coinfection with HBV also can lead to increased rates of progression to acquired immune deficiency syndrome -related outcomes and all-cause mortality . An estimated 5% to 15% of the 34 million HIV-infected individuals worldwide are coinfected with HBV, as a chronic infection . The burden of coinfection is greatest in Southeast Asia and sub-Saharan Africa .

Prevalence: international statistics

HBV serotypes and genotypes

How To Prevent Hepatitis B

Hepatitis B is a liver infection caused by a virus . It can be serious and theres no cure, but the good news is its easy to prevent. You can protect yourself by getting the hepatitis B vaccine and having safer sex. If you have oral, anal, and vaginal sex, use condoms and dental dams to help stop the spread of hepatitis B and other STDs.

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Is There A Cure For Chronic Hepatitis B

Currently, there is no complete cure for hepatitis B. But when managed properly, those living with the virus can expect to live a normal life. Maintaining a healthy diet and avoiding alcoholic beverages and tobacco products are crucial components in managing the disease.

You should also visit a doctor familiar with hepatitis B at least annuallythough twice a year might be best to monitor your liver through blood tests and medical imaging. As with most diseases, detecting it early leads to a better outcome. If youre exposed to the virus, you should get an antibody injection within 12 hours of exposure.

Impact Of Hepatitis B Vaccination

The major objective of hepatitis B immunization is prevention of chronic infection, which prevents sequelae such as cirrhosis and hepatocellular carcinoma. Because HBV-related cirrhosis and hepatocellular carcinoma usually occur in adults who were infected with HBV as children, decades must pass before the most significant benefits of HBV vaccination are realized. This lengthy interval creates a challenge in monitoring the impact of hepatitis B immunization programs. In the short term, demonstration of a reduction in the HBV-related disease burden relies on indirect measures such as surveillance for acute hepatitis B, which represents a small but consistent proportion of new infections, and serial cross-sectional seroprevalence studies in populations targeted for vaccination. In the long term, declines in incidence rates and mortality from HBV-related hepatocellular carcinoma can be detected in countries with well-established cancer surveillance systems and registries.

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The Types Of Viral Hepatitis

There are five main types of viral hepatitis known as hepatitis A , hepatitis B , hepatitis C , hepatitis D , and hepatitis E . That said, there have been cases of acute hepatitis that could not be attributed to one of these five types of hepatitis viruses, alcohol, drugs, or autoimmune disease, which lead researchers to try to find another cause.

Though the etiology of these viruses have not yet been fully established, researchers have identified three other types of viral hepatitis , which they have named hepatitis F , hepatitis G , and transfusions transmitted virus . As relatively new diseases and viral discoveries, information about them and how they work is relatively scarce. We do know, however, that cases of TTV have only been associated with hepatitis in people who have had a blood transfusion.

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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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.

Natural History And Clinical Manifestations Of Hbv Infection

HBV infection may result in subclinical or asymptomatic infection, acute self-limited hepatitis, or fulminant hepatitis requiring liver transplantation. Persons infected with HBV may also develop chronic HBV infection, which can lead to cirrhosis or hepatocellular carcinoma. The likelihood that newly infected persons will develop chronic HBV infection is dependent on their age at the time of infection . More than 90 percent of infected infants, 2550 percent of children infected between 1 and 5 years of age, and 610 percent of acutely infected older children and adults develop chronic infection . Immunosuppressed persons are also at higher risk of developing chronic infection .

TABLE 1.

Because of the inverse association between age and risk of chronic infection, persons infected as children assume a disproportionately large burden of morbidity and mortality attributable to HBV. Up to 25 percent of infants and older children who acquire HBV eventually develop HBV-related hepatocellular carcinoma or cirrhosis. Adults who have had chronic HBV infection since childhood develop primary hepatocellular carcinoma at a rate of 5 percent per decade, which is 100300 times the rate among uninfected persons .

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Countries With Intermediate Endemicity

In Malaysia, which introduced universal infant vaccination in 1990, HBsAg seroprevalence among schoolchildren decreased from 1.6 percent in 1997 to 0.3 percent in 2003 . Population-based surveillance data in Italy have shown a decline in the incidence of acute hepatitis B from 11 per 100,000 population in 1987 to three per 100,000 population in 2000 . In addition, the overall prevalence of chronic HBV infection decreased from 13.4 percent in 1978 to 3.7 percent in 1997 .

What Are The Symptoms Of Hepatitis B

After the virus enters the body, there is an incubation period lasting 1.5 to 6 months until illness begins. During the acute phase most persons have no symptoms or might experience a mild illness. Symptoms of acute HBV infection, when present, may include:

• Jaundice
• Dark-colored urine, light-colored stools
• Fever

During the chronic phase hepatitis B usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring may include:

• Ascites
• Star-shaped vein pattern developing on the swollen belly
• Jaundice
• Easy bruising and bleeding

Chronic HBV infection can lead to serious liver disease, liver scarring , and hepatocellular cancer.

Because symptoms of hepatitis B are usually absent, persons with risk for HBV infection should be tested. If you think you have hepatitis B, or are at risk for hepatitis B, you should contact your doctor.

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Global Patterns Of Transmission

Geographic distribution of the prevalence of chronic hepatitis B virus infection, 2002. .)

Approximately 60 percent of the world’s population lives in areas where HBV infection is highly endemic, including China , Indonesia , Nigeria , and much of the rest of Asia and Africa . Some notable examples of high pre-vaccine-era burdens of disease include Taiwan, where 1520 percent of the general population had chronic HBV infection and 30 percent of those chronically infected were HBeAg-positive , and the Gambia, where the prevalence of chronic infection among children was 36 percent .

Southern Europe, the Middle East, and South Asia have an intermediate level of HBV endemicity. HBsAg seroprevalence in India is approximately 5 percent, and the major modes of HBV transmission are perinatal, child-related/horizontal, and health-care-related, particularly unsafe injections . In Italy, Russia, and Turkey, the prevalence of chronic HBV infection ranges from 3 percent to 10 percent, and unsafe injections have been implicated as a major route of HBV transmission .

Most of Central and South America is considered a region of low HBV endemicity. However, the western Amazon basin, including Brazil and Peru, is a highly endemic area, with observed HBsAg seroprevalence rates greater than 10 percent .

How Common Is It

In 2006, the Public Health Agency of Canada reported the incidence of HBV as 2.0 cases for every 100,000 or about 650 cases reported annually in Canada. In the year 2013, the incident rate was 0.5 per 100,000 . Incidence of the disease varies from region to region but has been declining due to increasing use of the vaccine and universal immunization programs.

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Important Questions And Needs For Future Research

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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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.

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.

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Good Nutrition And Rest

• All family members should eat a well-balanced diet that includes foods shown in the graphic MyPlate . You can find more information about balanced nutrition on the website ChooseMyPlate.gov .
• All family members should get at least 8 hours of sleep each night.
• Young children who are ill should rest during the day when possible.

When Should I Contact A Health

Any infant, child, or adult that has not been vaccinated against HBV should be vaccinated especially if they have had any close association with HBV-infected individuals.

An individual with chronic hepatitis B infection is advised to

• have follow-up every 6-12 months to maximize their health,
• get vaccinated against hepatitis A, and

Discuss diet, lifestyle changes, and ways to prevent transmission of their disease to others with your health-care professional.

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Transmission Of Hepatitis B

The hepatitis B virus is transmitted through blood and sexual fluids. This can most commonly occur in the following ways:

Direct contact with infected blood

Unprotected sex

Use of illegal or street drugs

Needles and other medical/dental equipments or procedures that are contaminated or not sterile

From an infected woman to her newborn during pregnancy and childbirth

Body piercing, tattooing, acupuncture and even nail salons are other potential routes of infection unless sterile needles and equipment are used. In addition, sharing sharp instruments such as razors, toothbrushes, nail clippers, earrings and body jewelry can be a source of infection.

Hepatitis B is NOT transmitted casually. It cannot be spread through toilet seats, doorknobs, sneezing, coughing, hugging or eating meals with someone who is infected with hepatitis B.

Whats The Prognosis For Hepatitis B

Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:

• Your liver is working normally.
• You have hepatitis B surface antibody.

But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:

• Unprotected sex

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When To Call The Doctor

• The child has not felt hungry or wanted to eat in the past 24 hours.
• Your childs fever is over 100.4 degrees Fahrenheit for more than 2 days.
• Your child has a stomachache.
• Your child vomits more than 2 times in an hour.
• Your child’s skin or the white part of the eyes turns yellow.
• Your child is overly tired for more than 2 days.

Hepatitis B Vaccine Recommendations And Program Implementation

In 1992, the World Health Organization recommended the integration of hepatitis B vaccine into the national immunization programs of all highly endemic countries by 1995 and all other countries by 1997 . As of 2004, more than 150 of 192 World Health Organization member states had adopted universal childhood hepatitis B vaccination policies . Notably absent are several highly endemic countries, most of them located in sub-Saharan Africa, including the populous and rapidly growing nation of Nigeria. Several highly developed countries with low endemicity, including the United Kingdom, Japan, and the Scandinavian countries, do not routinely vaccinate children but have instead created policies targeting immigrant groups from highly endemic parts of the world, adolescents, and adults with risk factors for HBV infection .

Three-dose hepatitis B vaccine coverage among children aged 1935 months, by year of survey, United States, 19922004.

TABLE 2.

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