How Hbv Is Spread
It is possible for the hepatitis B virus to be spread through the bodily fluids of an infected person, which is to say that the virus can be transmitted through the blood, sweat, tears, saliva, semen, vaginal secretions, menstrual blood, and breast milk of an infected person. That said, having hepatitis B does not necessarily mean that you are infectious only some people with HBV are actually contagious.
Opportunities for exposure can include sharing a syringe or getting tattoos or body piercings with infected tools. But it also means that it is possible to be exposed during childbirth as well as sexual contact and intercourse. In fact, nearly two-thirds of acute cases of hepatitis B in the United States are caused by sexual exposure.
Though HBV can be spread through blood, there is generally very little risk of contracting the virus through blood transfusions as most countries began screening for it by 1975.
Causes And Risk Factors Of Hepatitis D
The primary route of transmission for hepatitis D is contact with infected blood or other bodily fluids. This can happen through sharing needles or drug materials with an infected person or having unprotected sex with an infected person.
Although it is rare, hepatitis D can be passed from mother to child during birth.
People cant get hepatitis D through everyday close contact that doesnt involve blood or bodily fluids.
Treatment And Medication Options For Hepatitis D
Medications are not effective against acute hepatitis D, but fortunately, the acute infection tends to subside on its own.
As for chronic hepatitis D, appropriate treatment depends on the phase of the disease and how severe the infection is.
If a persons liver is severely damaged, a liver transplant may become necessary.
While treatment options for hepatitis D are limited, new medications are being studied.
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How Is Hepatitis D Transmitted
Hepatitis D is not an easily transmitted virus like the common cold or flu. In fact, a person can only get the hepatitis D virus if they already have another form of viral hepatitis known as hepatitis B.
People can get hepatitis B and D at the same time , or they can get hepatitis D separately after first getting hepatitis B .
Hepatitis D can be transmitted in two main ways:
- Exposure through skin puncture: Hepatitis D can be transmitted through activities in which the skin is broken or punctured. This includes exposure to the infection through a syringe, tattooing needle, razor, or body piercing tool.
- Contact with infected blood or bodily fluids: The virus can be contracted through contact with blood, semen, or vaginal secretions. For example, exposure can happen during sexual intercourse, contact with blood or an open sore, and childbirth.
Even though the virus can be present in saliva, hepatitis D is not believed to be transmitted through activities like coughing, sneezing, hugging, handholding, kissing, eating contaminated food, or sharing utensils.
Sexual Transmission And Hepatitis B
Hepatitis B can be transmitted through sexual activity. Unvaccinated adults who have multiple sex partners, along with sex partners of people with chronic hepatitis B infection, are at increased risk for transmission. Injection-drug use and sexual contact are other common modes of hepatitis B transmission in the United States.
Among adults seeking treatment in STD clinics, as many as 10%40% have evidence of past or current hepatitis B virus infection. Many of these infections could have been prevented through universal vaccination during delivery of STD prevention or treatment services. Offering vaccination to all adults as part of routine prevention services in STD treatment facilities has been demonstrated to increase vaccination coverage among adults at risk for hepatitis B infection, as the behavioral risk factors for STDs and hepatitis B are similar.
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Black Americans And Hepatitis B
Centers for Disease Control and Prevention statistics show that Black and white Americans had the same rate of acute hepatitis B infection in 2018.
CDC statistics also show that Black adults had a lower rate of chronic hepatitis B infection than white adults between 2013 and 2016, a much higher hepatitis Brelated death rate in 2016, and a lower HBV vaccination rate in 2015.
The percentage of Black adolescents ages 13 to 17 who had ever received three or more doses of the hepatitis B vaccination was the same as the percentage of white adolescents in 2016.
And the percentage of Black and white children ages 19 to 35 months who had received three doses of hepatitis B vaccine in 2016 was the same.
Data collected in 2009 and 2010 from the Racial and Ethnic Approaches to Community Health across the United States suggests that there are disparities in care when it comes to hepatitis B screening, referral to care, and the initiation of antiviral therapy.
Prevention Of Hepatitis D
Avoiding high-risk behavior helps prevent people from getting hepatitis B and thus from getting hepatitis D.
There is no vaccine for hepatitis D. But if people do not already have hepatitis B, they can be vaccinated with the hepatitis B vaccine Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications . Generally, hepatitis B is more serious than hepatitis A and… read more , which can prevent hepatitis D as well as hepatitis B.
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Symptoms Of Hepatitis D
Coinfection with hepatitis D usually makes the hepatitis B infection more severe.
Coinfection with hepatitis B and D can lead to fulminant hepatitis Symptoms . Fulminant hepatitis can progress very quickly. Toxic substances normally removed by the liver build up in the blood and reach the brain, causing hepatic encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach… read more . People may lapse into a coma within days to weeks. Fulminant hepatitis may be fatal, especially in adults.
What Are The Complications Of Chronic Hepatitis D
Chronic hepatitis D may lead to cirrhosis, liver failure, and liver cancer. People who have chronic hepatitis B and D are more likely to develop these complications than people who have chronic hepatitis B alone.20 Early diagnosis and treatment of chronic hepatitis B and D can lower your chances of developing serious health problems.
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How Is Hepatitis D Diagnosed
Doctors may suspect a person has hepatitis D when the symptoms of acute hepatitis B are unusually severe, chronic hepatitis B gets worse much faster than usual, or when chronic hepatitis B suddenly gets much worse, which would indicate a superinfection.
If hepatitis D is suspected, the doctor will take a medical history to understand factors that may have led to the infection. A physical exam will look for signs of liver damage, which could include jaundice, swelling in the feet or ankles, and swelling or tenderness in the abdomen.
If its suspected that a person may have hepatitis D, a blood test that confirms the presence of the antibodies that are produced in response to the infection is required to confirm the diagnosis.
There may be additional tests to determine if there is liver damage as a result of hepatitis B and hepatitis D. The tests can include the following:
- An elastography, a special ultrasound that can measure the stiffness of the liver
- A liver biopsy, in which a long needle is used to take a small piece of tissue that will be examined under a microscope to look for signs of disease or damage
- A blood test to measure liver enzyme levels, elevated levels of which often indicate inflammation or damage to the liver cells
Sexual Transmission And Hepatitis A
Transmission of hepatitis A virus can occur from any sexual activity with an infected person and is not limited to fecal-oral contact. People who are sexually active are considered at risk for hepatitis A if they are MSM, live with or are having sex with an infected person, or inject drugs. Vaccination is the most effective means of preventing hepatitis A transmission among people at risk for infection. CDC has published recommendations for prevention of hepatitis A that identify all groups recommended for vaccination, including hepatitis A vaccination for MSM.
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Public Health Significance And Occurrence Of Hepatitis D
Hepatitis D occurs worldwide. It is most prevalent in countries and communities that have a high risk of hepatitis B, including Africa, South America, Romania and parts of Russia among haemophiliacs, people who inject drugs and others who come in frequent contact with blood in institutions for the developmentally disabled and, to a lesser extent, among men who have sex with men.
Outbreaks have been reported in tropical South America , in the Central African Republic, and among people who inject drugs in the United States.
In recent years, as the prevalence of chronic hepatitis B surface antigen carriers has decreased, there has been a decline in both acute and chronic HDV in the Mediterranean area and in many other parts of the world. Better sanitation and social standards may have also contributed to the decline.
New areas of high HDV prevalence continue to appear and include Albania, areas of China, northern India and Japan .
Despite high rates of hepatitis B in Asian countries, the incidence of hepatitis D is lower. Hepatitis D is uncommon in Australia. An average of 13 cases has been reported per year in Victoria since 2010.
Why Getting Tested Is Important
A blood test is one of the only ways to confirm a diagnosis of hepatitis C. Additionally, hepatitis C often has no visible symptoms for many years.
Because of this, its important to be tested if you believe youve been exposed to the virus. Getting a timely diagnosis can help ensure you receive treatment before permanent liver damage occurs.
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Who Is At Risk
Chronic HBV carriers are at risk for infection with HDV.
People who are not immune to HBV are at risk of infection with HBV which puts them at risk of HDV infection.
High prevalence in persons who inject drugs suggest that injecting drug use is an important risk factor for HDV co-infection.
High-risk sexual activity is also an increased risk for HDV infection.
Migration from high HDV prevalence countries to lower prevalence areas might have an effect on the epidemiology of the host country.
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.
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Hispanic Americans And Hepatitis B
Adult Hispanic Americans have a low rate of chronic hepatitis B infection, according to CDC statistics, and they die from hepatitis Brelated causes at the same rate as adult white Americans. Among adults ages 19 to 49, vaccination coverage was lower for Hispanic than for white Americans in 2015, but among Hispanic and white adolescents ages 1317 years and children age 19 to 35 months, it was the same in 2016.
Signs And Symptoms Of Hepatitis D
Symptoms are similar to those of hepatitis B and may include:
- abdominal pain
- yellow skin and eyes
- dark urine and pale faeces
- muscle and joint pain
Image Courtesy Public Health Image Library , Department of Health and Human Services, Centers for Disease Control and Prevention CDC,Dr. Thomas F. Sellers / Emory University
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Prognosis Of Hepatitis D
Your health outlook depends on whether you were coinfected or superinfected with hepatitis D the prognosis is better for people who were coinfected.
The vast majority of coinfected people experience only the acute phase of the disease most of these people will get better over two to three weeks. Liver enzyme levels typically return to normal within four months.
About 10 percent of people infected with hepatitis D develop a chronic liver infection.
Chronic hepatitis D leads to cirrhosis, or scarring of the liver, in about 70 to 80 percent of cases. Once a person has cirrhosis, the disease may remain stable for as long as 10 years, although a high percentage of people with chronic hepatitis D and cirrhosis eventually die of acute liver failure or liver cancer unless they get a liver transplant.
The overall mortality rate of hepatitis D is unclear, with estimates placing it between 2 and 20 percent. As with most forms of hepatitis, prevention is the best strategy.
Identification Of Hepatitis D
Onset of disease is usually abrupt, with signs and symptoms resembling those of HBV infection.
HDV infection may be severe.
HDV infection may occur as an acute co-infection with HBV infection or as a superinfection in people with chronic HBV infection.
Acute HDV co-infection is usually self-limiting, whereas HDV superinfection usually progresses to chronic hepatitis. Fulminant cases occur in superinfections rather than in co-infections.
Children can have a severe clinical course, which usually progresses to severe chronic hepatitis.
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How Hepatitis D Is Spread
Hepatitis D is spread when infectious body fluids come into contact with body tissues beneath the skin or mucous membranes . In Australia most infections are associated with:
- immigration from a country where hepatitis D is relatively common
- sharing injecting equipment
- mother-to-baby transmission of hepatitis D virus at or around the time of birth can occur, although this is uncommon.
How Hcv Is Spread
The hepatitis C virus is transmitted primarily through blood to blood contact, meaning that a person can become infected with the virus should the blood of a person who carries the virus be introduced into another person’s bloodstream.
Therefore, as with hepatitis B, blood transfusions , tattooing and body piercing, occupational exposure, medical procedures, and intravenous drug use can all lead to possible exposure to the virus. Unlike hepatitis B, however, sexual contact and childbirth have both been shown to be an inefficient route of exposure to HCV.
The hepatitis G virus is thought to be transmitted in a similar way to HCV.
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Parenteral Routes: Transmission Of Hepatitis B Hepatitis D And Hepatitis C
Hepatitis B, C, and D viruses are all transmitted by what is known as the parenteral route. Parenteral simply means that these viruses can be introduced by all routes except through the intestinal tract, which leaves the door wide open in terms of possible exposure. Let’s look at the possible transmission routes for each of these types of hepatitis virus more closely.
What Causes Hepatitis D
The hepatitis D virus causes hepatitis D. The hepatitis D virus spreads through contact with an infected persons blood or other body fluids. Contact can occur by
- sharing drug needles or other drug materials with an infected person
- having unprotected sex with an infected person
- getting an accidental stick with a needle that was used on an infected person
The hepatitis D virus rarely spreads from mother to child during birth.
You cant get hepatitis D from
- being coughed on or sneezed on by an infected person
- drinking water or eating food
- 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
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Sexual Transmission And Viral Hepatitis
Certain adults who are sexually active should be vaccinated against hepatitis B.
CDC and the Advisory Committee on Immunization Practices recommend hepatitis B vaccination for
- sexually active people with more than one sex partner during the previous 6 months
- people seeking evaluation or treatment for a sexually transmitted disease
- sex partners of people with hepatitis B and
- men who have sex with men .
Etiologic And Clinical Manifestation
Hepatitis D virus is a small 36 nm single-stranded negative sense RNA virus that requires the presence of hepatitis B virus for its assembly and replication. Co-infection and super-infection represent two types of HDV known infections. During co-infection, the patient acquires HDV and HBV at the same time while super-infection occurs when a patient with chronic HBV infection becomes infected with HDV. Hepatitis D virion is composed of an outer lipoprotein envelope made of the surface antigen of the HBV and an inner ribonucleoprotein structure in which the HDV genome resides. HDV produces one protein with two forms a 27 kDa large-HDAg , and a small-HDAg of 24 kDa . The N-terminals of the two forms are identical they differ by an additional 19 amino acids in the C-terminal of the large HDAg. These two proteins play diverging roles during the course of an infection. HDAg-S is produced in the early stages of an infection and enters the nucleus supporting viral replication. HDAg-L, in contrast, is produced during the later stages of an infection, acts as an inhibitor of viral replication, and is required for the assembly of viral particles. Eight different genotypes of HDV have been identified, each with different geographic distribution and distinct clinical course. Genotype I shows wide geographic distribution including Europe and the United States.
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