Sunday, January 29, 2023

Low Immunity To Hepatitis B

Is Hepatitis B Contagious

Low Prevalence of Hepatitis B Vaccination Among People Receiving HIV Care

Hepatitis B is highly contagious. Its transmitted through contact with blood and certain other bodily fluids. Although the virus can be found in saliva, its not transmitted through sharing utensils or kissing. Its also not transmitted through sneezing, coughing, or breastfeeding.

Symptoms of hepatitis B may not appear for 3 months after exposure. Symptoms can last for several weeks.

But even without symptoms, you can still transmit the infection to others. The virus can live outside the body and remains infectious for at least

Hepatitis B is a highly contagious condition. Its associated with many serious complications, some of which can be life threatening.

But there are many treatment options available and multiple ways you can prevent infection, including getting vaccinated.

If you suspect you may have been exposed to hepatitis B, its important to talk with a doctor to prevent infection and determine the best course of treatment for you.

What Do Hepatitis B Test Results Mean

Hepatitis B test results help determine if HBV infection is negative or positive, and if positive, whether the infection is acute or chronic, or if recovery is complete. A combination of results are considered to identify and classify HBV infection status.

The following are some interpretations of hepatitis B test results:

Table: Hepatitis B test results and interpretations

Test

What Do The Results Mean

A hepatitis B blood panel consists of three tests that can be done with just one blood sample:

  • Hepatitis B surface antigen . A positive test indicates that youre infected with hepatitis B and that you can spread it to other people. Further tests are needed to see if you have an acute or chronic infection.
  • Hepatitis B core antibody . A positive result can indicate a past or current hepatitis B infection, but doesnt mean youre immune. A positive result needs to be interpreted by a doctor by examining the results of the other two tests.
  • Hepatitis B surface antibody . A positive test indicates that youre protected from hepatitis B either through previous infection or vaccination .

The combination of these tests can indicate your hepatitis B status and whether you need to be vaccinated. Your test will give a negative or positive result for each category depending on whether your results are above or below the cutoff value.

Most peoples test results fall into the following categories. But its possible to have a result that doesnt fall into one of these groups. If youre reading your results yourself, be careful not to confuse HBsAb with HBcAb.

HBsAG

is associated with hepatitis B immunity after vaccination. But research has found that anti-HBs decline over time.

A found that more than 95 percent of people had anti-HBs levels greater than 10IU/L two years after vaccination. But this rate decreased to 70 percent after eight years.

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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:

What Are The Symptoms Of Hepatitis B

New insight in the pathobiology of hepatitis B virus infection

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:

  • Dark-colored urine, light-colored stools

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:

  • Star-shaped vein pattern developing on the swollen belly
  • 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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How You Catch It

Hepatitis B can be spread through contact with blood and/or other body fluids of an infected person via broken skin, open cuts or wounds, sexual contact, sharing drug needles, blood transfusion, and passed from infected mother to baby. Newborn babies of infected mothers can be infected via the birth canal.

People at high-risk of contracting hepatitis B include:

  • Non-immune children exposed to infected children , sharing blood in the playground
  • Injecting drug users
  • Men who have sex with men
  • Household contacts of infected persons
  • Healthcare and public safety workers who have exposure to blood in the workplace
  • People aged 25 years or over who are of MÄori, Pacific Island or Asian ethnicity, and those born in Asia or the Pacific Islands are at higher risk of not being immune or of being exposed.

How Much Does A Hepatitis B Titer Test Cost

The cost of a hepatitis B test varies based on where you get the test. Prices range from roughly $24 to $110.

Your insurance may cover some or all of the cost. Under the Affordable Care Act, all new health plans must cover preventative services including hepatitis B vaccination and testing without a deductible or copay.

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What Do I Do If Im A Hepatitis B Vaccine Non

Approximately 5-10% of people do not develop protective antibodies following the completion of the hepatitis B vaccine series. This is confirmed with a blood test called an anti-HBs titer test which is given 4 weeks following the completion of the series. If the test shows the titer is less then 10 mIU/mL the general recommendation is to complete the series again using a different brand of vaccine . A person is considered to be a non-responder if they have completed 2 full vaccination series without producing adequate protective antibodies.

Another vaccine option is the new two-dose hepatitis B vaccine, HEPLISAV-BTM. The new vaccine is expected to increase immunization rates for adults in the United States and is administered over a one-month period. The vaccine provides greater seroprotection, which can mean a greater antibody response especially in adults who may be older, obese or live with type 2 diabetes making it an effective vaccine option.

It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus is recommended before diagnosing a person as a vaccine non-responder.

CDC Recommendations for Hepatitis B Vaccine Non-Responders

Check out our previous post on the topic here.

References:

HEPLISAV-B. Retrieved from:

How You Can Get Hepatitis B

Hepatitis B: CDC Viral Hepatitis Serology Training

You can get hepatitis B from:

  • injecting drugs using shared needles
  • being injured by a used needle
  • having a tattoo or piercing with unsterilised equipment
  • having a blood transfusion in a country that does not check blood for hepatitis B. Blood transfusions in the UK are checked for hepatitis B.

If you’re pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.

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Pregnancy And Hepatitis B

Doctors must closely monitor pregnant people who have HBV.

There is a risk that the virus can pass from parent to child during delivery without the correct treatment. Therefore, all people should receive hepatitis B testing during pregnancy. A person with chronic hepatitis B should talk with a doctor about the risks and benefits of antiviral treatment while pregnant.

According to the Hepatitis B Foundation, if someone has HBV, their newborn must immediately receive the first dose of the hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth. The infant should then receive the second and third doses of the vaccine according to the standard childhood immunization schedule.

Pregnant people unsure of their vaccination status can receive the hepatitis B vaccine during pregnancy and breastfeeding or chestfeeding.

However, there is currently not enough safety information about Heplisav-B and PreHevbrio, so pregnant people

What Is The Difference Between Hepatitis B Surface Antibody And Antigen

An antigen is a substance that induces antibody production. Hepatitis B surface antigen is a protein on the surface of hepatitis B virus.

Hepatitis B surface antibodies are produced by the bodys immune system in response to HBsAg. The presence of adequate hepatitis B surface antibodies in the blood indicates protection against hepatitis B virus infection.

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Comparison Of Responses To A Hepatitis B Vaccine Challenge Dose Among Students With < 10 Iu/liter At The Baseline: Baseline Anti

Of the 153 students who completed the study, 131 had an anti-HBsAg level of < 10 IU/liter at the baseline 73 had a level of 0 IU/liter, and 58 had levels of 1 to 9 IU/liter . Thirty-six of 73 with a level of 0 IU/liter and 48 of 58 with levels of 1 to 9 IU/liter responded to the challenge dose . Relative to those with a baseline anti-HBsAg level of 0 IU/liter, students with levels of 1 to 9 IU/liter were more likely to respond to the challenge dose . The anti-HBsAg GMCs after the challenge dose among students whose baseline anti-HBsAg level was 0 IU/liter versus those with baseline anti-HBsAg levels of 1 to 9 IU/liter were 9.8 IU/liter and 99.8 IU/liter , respectively . Among the 58 students with anti-HBsAg levels at the baseline ranging from 1 to 9 IU/liter, 21 had a level of 3 IU/liter of these 21 students, 20 responded to the challenge dose.

Hiv And Hbv Coinfection

Antiviral Therapy for Chronic Hepatitis B in Pregnancy

About 2% of people with HIV in the United States are coinfected with HBV both infections have similar routes of transmission. People with HIV are at greater risk for complications and death from HBV infection. All people with HIV are recommended to be tested for HBV, and if susceptible, are further recommended to receive the hepatitis B vaccination or, if chronically infected, evaluated for treatment to prevent liver disease and liver cancer. For more information about HIV and HBV coinfection, visit HIV.govâs pages about hepatitis B and HIV coinfection.

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What Is The Normal Range For Hepatitis B Surface Antibody

  • Related Resources – What Is the Normal Range for Hepatitis B Surface Antibody?
  • Hepatitis B surface antibodies are measured in blood samples in milli-International Units/milliliter mIU/mL). The ranges for hepatitis B surface antibodies are:

    • Anti-HBs greater than 10-12 mIU/mL: Protected against hepatitis B virus infection, either from vaccination or successful recovery from a previous HBV infection.
    • Anti-HBs less than 5 mIU/mL: Negative for HBV infection, but susceptible and hence requires vaccination.
    • Anti-HBs from 5-12 mIU/mL: Inconclusive results and the test should be repeated.

    However, there is no standardization of these values so it is advisable to check the manufacturers values it is the reason values are mainly reported as positive or negative.

    Symptoms Of Hepatitis B

    Some people who are infected with the hepatitis B virus have mild, flu-like symptoms and some do not become sick at all. Children who are infected are less likely to have an illness or get sick after getting hepatitis B than adults.

    In more severe cases, hepatitis B can cause:

    • Loss of appetite.
    • Pain in the joints.

    Normally, these health problems disappear in a few weeks, but even when the person feels much better, they may still be infectious.

    Most adults who become infected with the hepatitis B virus recover completely and do not become infected again. A few people become very ill in the time just after infection and need to go to hospital some may even die.

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    What Are The Treatments For Hepatitis B

    If you think you may have been exposed to hepatitis B, its important to talk with a healthcare professional as soon as possible.

    A doctor or other healthcare professional may administer the first dose of the hepatitis B vaccine and a shot of hepatitis B immunoglobulin. This is a combination of antibodies that provide short-term protection against the virus.

    Though both can be given up to a week after exposure, theyre most effective at preventing infection if administered within 48 hours.

    If you receive a diagnosis of acute hepatitis B, a doctor may refer you to a specialist. They may advise you to get regular blood tests to ensure you dont develop chronic hepatitis.

    Many people with acute hepatitis B dont experience serious symptoms. But if you do, it can help to:

    • get plenty of rest
    • take over-the-counter pain mediation, like naproxen, when needed

    Other lifestyle changes may also be needed to manage your infection, such as:

    • eating a nutritious, balanced diet
    • avoiding substances that can harm your liver, such as:
    • certain herbal supplements or medications, including acetaminophen

    If blood tests show you still have an active infection after 6 months, your doctor may recommend further treatment, including medications to help control the virus and prevent liver damage.

    Hepatitis B And Pregnancy

    Viral hepatitis (A, B, C, D, E) – causes, symptoms, diagnosis, treatment & pathology

    Hepatitis B can be transmitted from a birthing parent to a newborn infant. This is because the newborn is exposed to blood and bodily fluids during delivery.

    In fact, 90% of mothers with an acute hepatitis B infection and 10% to 20% of mothers with chronic hepatitis B will transmit the virus to their newborn, estimates the American College of Obstetricians and Gynecologists.

    For this reason, birthing parents are routinely screened for hepatitis B during each pregnancy.

    Additionally, the hepatitis B vaccine and hepatitis B immune globulin are both administered to infants with an HBV-positive birthing parent within of birth to prevent infection.

    According to the

    • people with hepatitis C infection
    • men who have sex with men
    • people with multiple sexual partners
    • people who are seeking treatment for a sexually transmitted infections
    • people with current or recent injection drug use
    • family members or sexual partners of those with hepatitis B
    • people with chronic liver disease
    • people traveling to areas with high rates of hepatitis B
    • people on maintenance dialysis
    • people who are incarcerated

    The hepatitis B vaccine is usually administered in three shots, given 1 month and 6 months after the first dose. Another recently approved vaccine is completed in two doses spaced 1 month apart.

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    Whats The Procedure For A Hepatitis B Titer Test

    A hepatitis titer test requires a healthcare professional to draw a small amount of blood for testing.

    No special preparation is needed beforehand. If needles or the sight of blood make you anxious, you may want to arrange a drive ahead of time in case you feel faint.

    Heres what will typically happen during this test:

  • The person administering the test ties a band around your arm to make your veins easier to find.
  • The person sterilizes the injection site and inserts a small needle into your vein. You may feel a sharp pain, but it should quickly pass.
  • After the needle is removed, the test administrator asks you to apply a gentle pressure with a gauze or a cotton ball.
  • A bandage is applied to the area, and youre free to leave.
  • Home tests that require a fingerpick are also available. The results of your tests are generally available within 3 days.

    Whats The Hepatitis B Titer Test Used For

    A hepatitis B titer test measures antibodies in your blood to see if youre immune either due to vaccination or previous infection.

    Hepatitis B is a viral infection that targets your liver. It can be transmitted by coming into contact with the bodily fluids of an infected person. A person with the virus can also infect their child during birth.

    Hepatitis B can develop into a chronic infection. Chronic infection occurs when your body cant fight off the virus within six months. Chronic hepatitis B infections most commonly develop less than six years old, especially in infants.

    Hepatitis B titer tests can be used to evaluate:

    • whether a high-risk person is immune to hepatitis B
    • whether hepatitis B immunoglobulin is needed after a needle prick
    • men who have sex with men
    • people born in countries with a hepatitis B prevalence greater than 2 percent
    • people born in the United States not vaccinated as children and with parents born in regions with more than 8 percent hepatitis B prevalence

    You may need your titer test results as proof of hepatitis B immunity in order to get into healthcare programs at many schools for example, the nursing program at Lone Star College. In the United States, employers are not allowed to withdraw a job offer if they learn you have hepatitis B.

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