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.
Inactivated Vaccines And Toxoids
Immune globulins, including HBIG, are not expected to have a clinically important effect on the immune response to inactivated vaccines or toxoids inactivated vaccines, recombinant vaccines, polysaccharide vaccines, or toxoids may be administered simultaneously with or at any interval before or after HBIG. Neonates born to HBsAg-positive women who receive combined passive immunization with HBIG and active immunization with HepB vaccine at birth can receive other age-appropriate vaccines according to the usually recommend childhood immunization schedule.
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.
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Is Hepatitis B Immune Globulin Safe
Yes. HBIg is prepared from donated human blood that has been tested to ensure its safety. All blood donors are screened for exposure to viruses such as HIV and hepatitis. Each blood donation is also tested for the presence of blood-borne viruses prior to being used to make HBIg. A number of chemical and physical steps are included when preparing HBIg to inactivate and remove viruses and bacteria that can cause disease. The final preparation of HBIg undergoes additional testing to ensure that there are no known infectious viruses present. However, there is an extremely small risk that some blood-borne infections could be passed on through the use of HBIg. Since blood screening and testing began, there have been no reports of blood-borne infections such as HIV, hepatitis B or hepatitis C in people who received HBIg.
Question 1 What Is The Clinical Indication For Hepatitis B Surface Antibody Quantitation
Hepatitis B surface antibody quantitation is used to determine hepatitis B immune status, ie, to determine if the patient has developed immunity against the hepatitis B virus. Such immunity may develop following exposure to the hepatitis B virus or its vaccine.
Patients at higher risk of exposure to the virus include:
- Infants born to infected mothers
- Sex partners of infected persons
- People with more than 1 sex partner in the last 6 months
- People with a history of sexually transmitted infection
- Men who have sex with men
- Injection drug users
- Household contacts of an infected person
- Healthcare and safety workers who have contact with blood and body fluids
- People who have lived or traveled in an area in which hepatitis B is common
- People who live or work in a prison
Testing is not recommended routinely following vaccination. It is advised only for people whose subsequent clinical management depends on knowledge of their immune status. These people include:
- Chronic hemodialysis patients
- Immunocompromised people, including those with HIV infection, hematopoietic stem-cell transplant recipients, and people receiving chemotherapy
- Infants born to women who test positive for the hepatitis B surface antigen
- Sex partners of people who test positive for the hepatitis B surface antigen
- Healthcare and public safety workers who have contact with blood or body fluids
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What Is This Test
This test looks for antibodies called IgM in your blood. The test is used to find out whether you are actively infected with the hepatitis B virus .
HBV has a central core and a surrounding envelope. Your immune system makes IgM antibodies to the core of HBV during the active stage of infection. It can take 60 to 150 days to develop symptoms of hepatitis B after you become infected. Hepatitis B core IgM antibodies begin to appear in your blood several weeks after you are first infected with HBV. People who have had the hepatitis B vaccine will not have the core antibody in their blood.
HBV is one of 5 hepatitis viruses. The others are hepatitis A, C, D, and E. Most hepatitis infections are caused by these 5 viruses. HBV is spread through blood, seminal fluid, and vaginal secretions. The virus causes an infection in the liver. In most cases, this virus clears up on its own within 6 months. But in a small portion of adults and a larger portion of children, the virus does not go away. This is especially true for newborns. This is called having a chronic infection. It may lead to liver cell damage scarring, or cirrhosis or liver cancer.
Taking A Hepatitis B Test
Testing for hepatitis B is performed on a sample of blood. A doctor, nurse, or other health care provider can obtain a blood sample using a small needle to draw blood from a vein.
At-home hepatitis B testing requires that users carefully follow instructions provided in the test kit to collect a small sample of blood, package the sample, and mail it to a lab for testing.
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Postexposure Prophylaxis Of Hepatitis B Virus Infection
HBV postexposure prophylaxis in certain individuals exposed to HBV or HBsAg-positive materials .
Depending on exposure circumstances, PEP regimen may include combined passive immunization with HBIG and active immunization with HepB vaccine to provide both short- and long-term protection.
Multiple-dose regimen of HBIG alone is about 75% effective in preventing HBV infection following percutaneous exposure. However, since health-care personnel and others at risk of HBV exposure are candidates for preexposure vaccination with HepB vaccine and since combined passive and active immunization is more effective than HBIG alone following perinatal HBV exposure, combined active and passive immunization is preferred when PEP is indicated following an exposure to HBsAg-positive material.
HBIG is most effective when administered as soon as possible after exposure and may be ineffective if administered > 7 days after a percutaneous exposure or > 14 days after a sexual exposure.
HBIG not indicated for treatment of acute or chronic HBV infection.
PEP may be indicated in susceptible, unvaccinated health-care personnel following occupational exposure to blood and other body fluids that might contain HBV. If an occupational exposure to HBV occurs, review vaccination status and vaccine-response status of exposed individual and HBsAg status of source.
PEP not necessary in individuals previously infected with HBV such individuals are immune to reinfection.
Hepatitis B Immunization And Postimmunizationserology
Michael John, MB, Ch.B., FRCP
Before the introduction of avaccine, hepatitis B virus was a major occupational risk to health care workers.Some of the highest infection rates were found in dentists and surgeons.1Infected health care workers have a 5-10% risk of developing chronic hepatitis B. A numberof clusters of dentist-to-patient HBV transmissions have been reported over the years,although these have decreased since the introduction of universal precautions.2Recent guidelines from Health Canada recommend restriction of practice of health careworkers who test positive for hepatitis B e antigen.3
The development of hepatitis vaccines in the 1980s has substantially decreased dentalworkers risk of acquiring HBV. A recent survey4 of dentists in Canadashowed that more than 90% had completed an immunization series and an additional 3% hadnatural immunity. However, rates of immunization among dental assistants and hygienistswas found to be much lower.
Hepatitis B Vaccines
The vaccine is administered intramuscularly into the deltoid muscle, as glutealinjection may result in decreased response rates. Response to vaccine following a 3-doseseries is typically greater than 95% in young, healthy people, although it decreases withage . Other factors such assmoking, obesity and chronic disease decrease vaccine efficacy and may be used to predictrisk of nonresponse.6 Adverse events are minimal, although mild injection-sitereactions may occur in 20% of recipients.
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Who Should Get The Hepatitis B Vaccine
All newborn babies should get vaccinated. You should also get the shot if you:
- Come in contact with infected blood or body fluids of friends or family members
- Use needles to take recreational drugs
- Have sex with more than one person
- Are a health care worker
- Work in a day-care center, school, or jail
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.
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Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event temporally related to vaccination. An unexpected AEFI is an event that is not listed in available product information but may be due to the immunization, or a change in the frequency of a known AEFI.
Refer to Reporting Adverse Events Following Immunization in Canada and Adverse events following immunization in Part 2 for additional information about AEFI reporting.
What Other Tests Might I Have Along With This Test
Your healthcare provider may order other blood tests to look for HBV. These tests can look for antigens on the surface, envelope, and core of the virus, as well as the antibodies to these antigens. Because the symptoms of all 5 hepatitis infections are much the same, this blood test is often done along with other hepatitis blood tests to tell your provider which type of virus you may have.
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Review Of Current Recommendations
Table highlights the current recommendations for hepatitis A and B vaccinations. The Hepatitis C Task Force recommends both vaccines for newly diagnosed CHC patients without evidence of immunity to hepatitis A and/or B, based on expert opinion . The Advisory Committee on Immunization Practices recommends hepatitis A vaccine for susceptible patients with chronic liver disease but not routinely for CHB or CHC patients without chronic liver disease . The American Association for the Study of Liver Diseases and the European Association for the Study of the Liver both recommend hepatitis A vaccine for all CHC patients with no evidence of preexisting antibody, but the AASLD similarly recommends vaccinating CHB patients with chronic liver disease . AASLD guidelines state that hepatitis B vaccine should be offered to CHC patients. The ACIP recommends hepatitis B vaccination of adults with chronic liver disease in addition to those at risk for infection by sexual exposure or exposure to blood . The Physician Quality Reporting System quality indicator from the Centers for Medicare and Medicaid Services counts all CHC patients with at least 1 hepatitis A vaccine or documented immunity to hepatitis A .
Hepatitis A and B Vaccination Recommendations and Quality Measures for Patients With Chronic Hepatitis B or C
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What Are The Possible Reactions After Hepatitis B Immune Globulin
Common reactions to HBIg may include soreness where the immunization was given. Headache, fever, nausea, sore muscles or joints, diarrhea, or allergic reactions may also occur.
Some immune globulins may be associated with a risk of thrombosis within 24 hours of receiving them, especially when large volumes are given. The risk of thrombosis is increased in those:
- 45 years of age and older
- with a history of thrombosis or
- with risk factors for thrombosis.
For more information on Reye Syndrome, see HealthLinkBC File #84 Reye Syndrome.
It is important to stay in the clinic for 15 minutes after getting any immunization because there is a rare possibility, less than 1 in a million, of a life-threatening allergic reaction called anaphylaxis. This may include hives, difficulty breathing, or swelling of the throat, tongue or lips. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number.
It is important to always report serious or unexpected reactions to your health care provider.
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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.
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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Can I Take The Test At Home
Samples for hepatitis B testing can be collected at home. At-home hepatitis B testing requires a patient to collect a blood sample, typically from a fingerstick using a very small needle provided in the test kit. Once a blood sample is collected, it is prepared according to the instructions contained in the test kit and mailed to a laboratory for testing.
Because there are numerous types of tests for HBV, it is important to look closely at the specific components of any at-home test kit. Many at-home test kits only look for hepatitis B surface antigen .
If I Have Hepatitis B And Feel Healthy Do I Need To Keep Going To My Doctor
Chronic hepatitis B is a silent disease because often no symptoms appear until your liver is severely damaged. Although many people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have an active disease that may lead to cirrhosis, liver failure, and liver cancer.
Because hepatitis B has no symptoms until your liver is badly damaged, a blood test is the only way for your doctor to find out if your hepatitis B is active or inactive, and to offer treatment, if needed. To help your doctor monitor how your disease behaves over time, you will need lifelong repeat blood tests every six to 12 months. Some tests, such as HBV DNA may need to be done more frequently . No treatment is required while the virus is inactive, but you should continue to get regular blood tests from your doctor to monitor your liver disease.
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