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.
Who Is More Likely To Get Hepatitis B
People are more likely to get hepatitis B if they are born to a mother who has hepatitis B . Hepatitis B virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they 15):
- were born in a part of the world where 2 percent or more of the population has hepatitis B infection
- were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection
People are also more likely to have hepatitis B if they:
- are infected with HIV, because hepatitis B and HIV spread in similar ways
- have lived with or had sex with someone who has hepatitis B
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have sex with men
- are injection drug users
- work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
- live or work in a care facility for people with developmental disabilities
- have diabetes
- have hepatitis C
- have lived in or travel often to parts of the world where hepatitis B is common External link
- have been on kidney dialysis
- live or work in a prison
- had a blood transfusion or organ transplant before the mid-1980s
In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact 16).
Treatment To Prevent Hepatitis B Infection After Exposure
If you know youve been exposed to the hepatitis B virus and arent sure if youve been vaccinated, call your doctor immediately. An injection of immunoglobulin given within 12 hours of exposure to the virus may help protect you from getting sick with hepatitis B. Because this treatment only provides short-term protection, you also should get the hepatitis B vaccine at the same time, if you never received it.
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What Causes Hepatitis A
Hepatitis A is caused by infection with the hepatitis A virus. You get the virus when you unknowingly eat a small amount of infected feces. This can happen through person-to-person contact, or through eating or drinking contaminated food or water.
A person can have and spread hepatitis A, even if that person does not have any symptoms. You are most likely to get hepatitis A from another person when:
- A person who has the virus does not wash their hands properly after going to the bathroom
- A parent does not wash their hands properly after changing the diaper of an infected child
- A caregiver does not wash their hands properly after cleaning up the stool of an infected person
- A person has sex with a person who has the virus
You can also get infected with hepatitis A by eating contaminated food or drinking contaminated water. Contaminated food and water are more common in developing countries. When traveling in areas where hepatitis A is common, avoid eating raw fruits and vegetables, shellfish, ice, and untreated water.
What Should You Know About Hepatitis B Before You Travel
Hepatitis B is quite common in China and other Asian countries, where as many as 1 in 12 people have the virus, though many dont know it. Before traveling to those places, you should make sure youve been vaccinated against the virus.
In addition to getting the vaccine, you can take these additional precautions to reduce your risk of contracting the virus:
- Refrain from taking illegal drugs.
- Always use latex or polyurethane condoms during sex.
- Make sure new, sterile needles are used during all piercings, tattoos and acupuncture sessions.
- Avoid direct contact with blood and bodily fluids.
- Know the HBV status of all your sexual partners.
- Ask your doctor about possible vaccination before you travel to a place where hepatitis B is common.
A note from Cleveland Clinic
Hepatitis B is a liver disease that can cause serious damage to your health. One reason that is dangerous is that it can easily go undetected for years while damaging your liver. Talk with your healthcare provider about being tested for hepatitis B if you have any reason to believe that you were not vaccinated or if you have engaged in risky behavior. If you do test positive, follow the directions from your healthcare provider so that you can live a longer, healthier and happier life.
Last reviewed by a Cleveland Clinic medical professional on 07/09/2020.
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How Can You Prevent Hepatitis B And Hepatitis C
Hepatitis B: Vaccination is the best way to prevent all of the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. In addition to the 3-dose series of hepatitis B vaccine given over 6 months, as of 2017, there is a 2-dose series given over 1 month.
Hepatitis C: No vaccine exists for HCV and no effective pre- or postexposure prophylaxis is available. The best way to prevent hepatitis C infection is to never inject drugs or to stop injecting drugs by getting into and staying in drug treatment. If you continue injecting drugs, always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment.
Treatment For Chronic Hepatitis B
If blood tests show that you still have hepatitis B after 6 months, your doctor may recommend medication to reduce the risk of complications of hepatitis B and regular tests to assess the health of your liver.
Treatment is usually offered if:
- your immune system is unable to control the hepatitis B by itself
- there’s evidence of ongoing liver damage
Hepatitis B medications can help keep the virus under control and stop it damaging your liver, although they will not necessarily cure the infection and some people need lifelong treatment.
The main medicines for chronic hepatitis B include peginterferon alfa 2-a and antiviral medicines.
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Virion Structure And Genome
HBV particles, also known as Dane particles , were firstly identified by Dane and colleagues in 1970 . Their shape is spherical, with a diameter of â¼42 nm. They consist of an outer envelope, which is a host-derived lipid bilayer containing three different-sized HBV surface antigens âlarge , middle and small âsurrounding the viral nucleocapsid. The nucleocapsid is icosahedral and comprises the HBV core protein , as well as the viral DNA genome and the viral DNA polymerase . The virus also secretes a wide range of defective particles , including enveloped nucleocapsids that are empty or contain defective immature genomes and subviral lipid particles containing the viral surface antigens. The subviral particles are secreted along with the infectious virions at levels that are thousands of times higher, and they play an important role in suppressing antibody responses to the virus .
Hepatitis B Virus particles. Infectious HBV virion . The lipid envelope, bearing three types of surface proteinsâsmall , middle and large âsurrounds the nucleocapsid, consisting of HBV relaxed circular DNA , the viral DNA polymerase , and the core protein . Non-infectious HBV particles enveloped nucleocapsids containing immature or defective DNA/RNA, subviral particles, and naked nucleocapsids.
Hepatitis B Virus genome. Partially double-stranded, relaxed circular DNA with four overlapping open reading frames .
Hiv And Hepatitis B And Hepatitis C Coinfection
Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.
Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.
Given the risks of hepatitis B or hepatitis C coinfection to the health of people living with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from someone who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.
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Is There A Way To Prevent Hepatitis C
Although currently theres no vaccine to protect people from contracting hepatitis C, there are vaccines for other hepatitis viruses, including hepatitis A and hepatitis B.
If you receive a hepatitis C diagnosis, your healthcare provider may advise you to get vaccinated against hepatitis A and B.
The vaccinations are recommended because these hepatitis viruses can lead to additional health and liver complications, especially in those with preexisting liver disease.
Since you cant prevent hepatitis C through a vaccine, the best prevention is to avoid exposure. Hepatitis C is a bloodborne pathogen, so you can limit your chances of exposure through these healthy lifestyle practices:
- Avoid sharing needles, razor blades, or nail clippers.
- Use proper safety precautions if youll be exposed to bodily fluids, such as when performing first aid.
- Hepatitis C isnt usually transmitted through sexual contact, but its possible. Limit your exposure by practicing sex with a condom or other barrier method. Its also important to openly communicate with sexual partners and to get tested if you suspect youve been exposed to the hepatitis C virus.
Because hepatitis C is transmitted through blood, its possible to contract it through a blood transfusion.
However, since the early 1990s, blood product screening tests have been standard protocol for minimizing the risk of this type of transmission.
Subsequent testing is based on risk. Talk to your doctor about your needs.
Emergency Hepatitis B Treatment
See your GP as soon as possible if you think you may have been exposed to the hepatitis B virus.
To help stop you becoming infected, they can give you:
- a dose of the hepatitis B vaccine you’ll also need 2 further doses over the next few months to give you long-term protection
- hepatitis B immunoglobulin a preparation of antibodies that work against the hepatitis B virus and can offer immediate but short-term protection until the vaccine starts to take effect
These are most effective if given within 48 hours after possible exposure to hepatitis B, but you can still have them up to a week after exposure.
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Who Is At Risk For Hepatitis B Virus Infection
The following populations are at increased risk of becoming infected with hepatitis B virus:
- Infants born to infected mothers
- Sex partners of infected persons
- Sexually active persons who are not in a long-term, mutually monogamous relationship
- Men who have sex with men
- Injection drug users
- Household contacts of persons with chronic hepatitis B virus infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Hemodialysis patients
- Residents and staff of facilities for developmentally disabled persons
- Travelers to countries with intermediate or high prevalence of hepatitis B virus infection
Hepatitis B Vs Hepatitis C
Hepatitis has many different types. HBV and the hepatitis C virus have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
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Low Response Rates And Nonresponders
Low vaccination response rates have been associated with obesity, smoking, immunosuppression, and advanced age. Approximately 25-50% of persons who initially do not have a vaccine response will show a response to 1 additional vaccine dose, and 50-75% of individuals will have a response to a second 3-dose series.
It is recommended that testing for anti-HBs be obtained 4-12 weeks following vaccination. Revaccinate nonresponders, with another series of 3-dose hepatitis B vaccine. Consider delaying revaccination for several months after initiation of antiretroviral therapy in patients with CD4 counts below 200 cells/mm3 or those with symptomatic HIV disease. The delay in these individuals is an attempt to maximize the antibody response to the vaccine.
Do not defer vaccination in pregnant patients or patients who are unlikely to achieve an increased CD4 count. Individuals at increased risk of severe complications due to HBV infection include those unlikely to achieve CD4 counts of 200 cells/mm3 or above after antiretroviral therapy and HIV-infected pregnant women.
A combined hepatitis A virus /HBV vaccine is licensed in many countries and offers the advantage of protection against both of these viruses at the same time. The vaccine seems to be safe, although some questions exist regarding neurologic complications.
Durability And Related Factors After Hbsag Clearance
When patients with HBeAg-positive CHB achieve a satisfactory antiviral treatment endpoint , the clinical recurrence is 2040%, and the virological recurrence can be as high as 8090% after drug withdrawal . Because the safety of drug withdrawal is uncertain, HBsAg clearance is recommended as the ideal treatment endpoint for CHB patients. The accessibility and rate of HBsAg clearance was mentioned above, but the durability of HBsAg clearance after treatment cessation remains controversial.
HBeAg status should also receive attention in the pursuit of HBsAg clearance. The clearance of HBsAg in most patients is based on HBV DNA suppression and HBeAg seroconversion, but a few patients exhibit different HBsAg response patterns, such as HBsAg clearance without HBeAg seroconversion. Only HBsAg clearance based on HBV DNA suppression and HBeAg seroconversion is safe for drug withdrawal .
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How Many New Hepatitis B Virus Infections Occur Annually In The United States
In 2014, a total of 2,953 cases of acute hepatitis B were reported from 48 states to the Centers for Disease Control and Prevention . The overall incidence rate for 2014 was 0.9 cases per 100,000 population. After adjusting for under-ascertainment and under-reporting, an estimated 19,200 acute hepatitis B cases occurred in 2014. In 2017, the annual number of hepatitis B infections rose in some states 32). Experts think the rise was related to increases in injection drug use. Injection drug use increases the risk of hepatitis B infection.
- Around 60,000 new cases of hepatitis B virus infection annually 33)
- 2 million or more people with chronic hepatitis B infection 34)
- Prevalence is higher in black, Hispanic, and Asian populations compared to whites 35)
- Prevalence is lower in people less than 12 years of age born in the U.S.
- Accounts for 5% to 10% of chronic end-stage liver disease and 10% to 15% of cases of hepatocellular cancer
- Causes 5000 deaths annually
High-risk groups for hepatitis B virus infection include intravenous drug users, infants born to infected mothers, males who have sexual intercourse with other males, hemodialysis patients , healthcare workers, household contacts of known patients with chronic hepatitis B virus . A majority of the global hepatitis B virus disease burden is primarily through vertical transmission.
Figure 1. Acute Hepatitis B virus incidence rate
Nucleocapsid Assembly Inhibitors Or Modulators
The HBV core particle is actively involved in the HBV replication cycle. It is required for the transfer of the viral genome to and from the nucleus of the infected hepatocyte, as well as for a successful reverse transcription . Thus, it is a promising target for antiviral drugs . New regulators or inhibitors of nucleocapsid assembly can affect various stages of the HBV replication cycle, including capsid formation, reverse transcription, and pgRNA encapsidation . Based on the three-dimensional structure of capsids when they interact with a ligand, two categories of analogues have been developed .
Both classes of CpAMs inhibit the release of viral particles. Thus, the amount of HBV DNA and RNA leaving the hepatocyte is reduced. They also prevent de novo cccDNA formation due to blocking the formation of functional capsids, and hence viral replication . The structures of the abovementioned compounds are shown in .
Nucleocapsid assembly modulators or inhibitors .
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What Are The Signs & Symptoms Of Hbv Infection
HBV can cause a wide range of symptoms, from a mild illness and general feeling of being unwell to more serious chronic liver disease that can lead to liver cancer. Someone with hepatitis B may have symptoms similar to those caused by other viral infections, like the flu. The person might:
- be extra tired
- feel like throwing up or actually throw up
- not feel like eating
- have a mild fever
HBV also can cause darker than usual pee, jaundice , and belly pain.
People exposed to hepatitis B may start to have symptoms from 1 to 6 months later. Symptoms can last for weeks to months.
In some people, hepatitis B causes few or no symptoms. But even someone who doesn’t have any symptoms can still spread the disease to others.