Causes Of Hepatitis B
Hepatitis B is spread through contact with blood that contains the hepatitis B virus. If infected blood or body fluids enter another persons bloodstream, that person may become infected.
The time from exposure to the hepatitis B virus to the appearance of the illness is 45 to 180 days.
Risky activities that can cause infection include:
- Sharing unsterile or unclean equipment for injecting drugs.
- Piercing the skin with equipment that is not properly cleaned, disinfected and sterilised.
- Sharing razor blades or toothbrushes.
- Coming into contact with infected blood through open cuts or the mucous membranes of another person.
- Having unprotected sex , especially if there is blood present.
Mothers who have hepatitis B can pass the virus to their babies or children at the time of birth or after birth. If the newborn baby is quickly immunised with 2 vaccines, they can be protected from getting hepatitis B.
All blood and blood products produced for medical purposes in Australia are carefully screened for hepatitis B and other blood-borne viruses. The risk of getting infected with hepatitis B from a blood transfusion is extremely low .
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.
Chronic Hepatitis B Complications
Chronic hepatitis B can lead to
- cirrhosis, a condition in which scar tissue replaces healthy liver tissue and prevents your liver from working normally. Scar tissue also partly blocks the flow of blood through the liver. As cirrhosis gets worse, the liver begins to fail.
- liver failure, in which your liver is badly damaged and stops working. Liver failure is also called end-stage liver disease. People with liver failure may require a liver transplant.
- liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.
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Who Are Hepatitis B Carriers
Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.
Hbv Treatment And Monitoring
Response to treatment: HBV viral load levels generally decline more slowly after treatment initiation than HIV viral load levels. Anti-HBV treatment responses are defined as follows :
- Primary nonresponse: HBV DNA < 1 log10 decline at 12 weeks
- Complete virologic response: Undetectable HBV DNA by polymerase chain reaction assay at 24 to 48 weeks
- Partial virologic response: 1 log10 decline but still detectable HBV DNA at 24 weeks
- Maintained virologic response: A response that continues while on therapy
- Sustained virologic response: A virologic response that is still present 6 months after cessation of therapy
Renal toxicity: Renal toxicity with increased creatinine or renal tubular dysfunction has been associated with tenofovir use, and the association is stronger with TDF than TAF . This renal toxicity may be reversible with dose adjustments of TDF or switching to TAF. Clinicians should evaluate electrolytes, serum creatinine levels, and urinalysis every 6 months .
Cirrhosis: Patients with HIV/HBV coinfection and cirrhosis should be referred to a gastroenterologist or hepatologist to assess and manage complications of portal hypertension such as gastroesophageal varices and ascites. Patients with HIV/HBV coinfection and cirrhosis should undergo esophagogastroduodenoscopy at the time of chronic HBV diagnosis and every 1 to 2 years thereafter .
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Prevent Infection After Contact With The Virus
If you think you have been in contact with the hepatitis B virus, see your doctor right away. Doctors typically recommend a dose of the hepatitis B vaccine to prevent infection. In some cases, doctors may also recommend a medicine called hepatitis B immune globulin to help prevent infection. You must get the vaccine dose and, if needed, HBIG shortly after coming into contact with the virus, preferably within 24 hours.
Genetics Of Infection With Hepatitis B
Several genes, many having to do with the host immune response, have been implicated in the susceptibility to chronic hepatitis B infection. The TNFSF9 gene encodes the CD137L protein, and its expression was found to be significantly higher in patients with chronic hepatitis B infection than in healthy controls. Its expression was also found to be higher in patients who had chronic hepatitis B with cirrhosis, in contrast to those without cirrhosis.
Research done in West Africa, where 90% of the population is infected with hepatitis B, shows that certain human leukocyte antigen class II haplotypes influence the likelihood of chronic infection. For reasons that are not completely clear, persons in the study who were heterozygous for the HLA-DRA and HLA-DQA1 genes were found to be less likely to develop a chronic infection.
Several additional genes are associated with susceptibility to hepatitis B infection. The IFNGR1 gene is located at 6q23.3 and encodes the interferon gamma receptor 1, which has an important role in cell-to-cell communications and can be activated in response to infection, but it is not specific to hepatitis B. Patients with significant dysfunction in this gene have a particular immune deficiency that leaves them extremely susceptible to mycobacterial infections.
Variations in vaccine response
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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.
Diagnosis Of Hepatitis B
Blood tests are available to determine if you are or have been infected with hepatitis B. It may take 6 months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this 6-month period, until you know whether you are infected or not, take action to prevent potential infection of other people.
There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so talk to your doctor.
All pregnant women are tested for hepatitis B. If you are found to have chronic hepatitis B, your doctor can help reduce the risk of transferring the infection to your newborn child.
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Assessment Before Hbv Treatment
HAV: For information on HAV/HIV coinfection, see the NYSDOH AI guideline Prevention and Management of Hepatitis A Virus Infection in Adults With HIV > Management of HAV/HIV Coinfection.
HCV: HBV/HCV coinfection is associated with higher rates of cirrhosis, increased severity of liver disease, and increased risk of HCC than HBV or HCV monoinfection . This is of particular concern in patients with HIV/HBV coinfection patients with HIV infection have more severe liver disease and higher rates of liver complications than patients without HIV . For information on screening, diagnosis, and treatment of HCV in patients with HIV, see the NYSDOH AI guideline Treatment of Chronic HCV with Direct-Acting Antivirals.
HDV: Formerly known as hepatitis delta virus, HDV is a defective satellite RNA virus that requires active HBV infection to replicate. HIV/HBV/HDV tri-infection is associated with more rapid liver disease progression and higher rates of decompensated cirrhosis, HCC, and mortality than HIV/HBV coinfection . HDV infection is uncommon in the United States it is not a reportable disease, and the prevalence is unknown . The majority of cases occur among people who migrate or travel to the United States from countries with high HDV endemicity .
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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Treatment For Suspected Exposure
Anyone who has had potential exposure to HBV can undergo a postexposure prophylaxis protocol.
This consists of HBV vaccination and hepatitis B immunoglobin . Healthcare workers give the prophylaxis after the exposure and before an acute infection develops.
This protocol will not cure an infection that has already developed. However, it decreases the rate of acute infection.
How Common Is Hepatitis B
The number of people who get this disease is down, the CDC says. Rates have dropped from an average of 200,000 per year in the 1980s to around 20,000 in 2016. People between the ages of 20 and 49 are most likely to get it.
About 90% of infants and 25-50% of children between the ages of 1-5 will become chronically infected. In adults, approximately 95% will recover completely and will not go on to have a chronic infection.
As many as 1.2 million people in the U.S. are carriers of the virus.
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What Is Chronic Hepatitis B
Doctors refer to hepatitis B infections as either acute or chronic:
- An acute HBV infection is a short-term illness that clears within 6 months of when a person is exposed to the virus.
- A person who still has HBV after 6 months is said to have a chronic hepatitis B infection. This is a long-term illness, meaning the virus stays in the body and causes lifelong illness. An estimated 850,000 to more than 2 million people in the U.S. have chronic HBV.
The younger someone is when infected, the greater the chances for chronic hepatitis B.
What If I Am Pregnant
It’s recommended that all pregnant women have a blood test for hepatitis B in early pregnancy.
If you have hepatitis B and are pregnant, treatments can reduce the risk of transmission of hepatitis B to the baby.
If you have hepatitis B, it is important to protect others from infection.
Important ways to prevent the spread of hepatitis B include:
- vaccination of all your close contacts
- practise safe sex until your sexual contacts are fully vaccinated and immune
- do not donate blood, organs or body tissue
- do not allow your blood to contact another person
- inform healthcare workers
- if your work involves potential for your blood or other body fluid to spread to other people, discuss your situation with your doctor
The hepatitis B vaccine is safe and effective in protecting against hepatitis B infection, providing protection in 95 in 100 vaccinated people.
In Australia, hepatitis B vaccination is part of the standard immunisation schedule for all newborn babies and infants. It’s also recommended for adults who are at high risk of exposure, people who are immunosuppressed or have other liver disease. People in these risk groups should be vaccinated against hepatitis B. Talk to your doctor about your level of risk and whether hepatitis B vaccination is recommended for you.
If you werent vaccinated against hepatitis B as a child, or if youre not sure whether you are vaccinated, talk to your doctor about whether you need a catch-up vaccine.
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Hepatitis B And Pregnancy
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.
How Is Hepatitis B Prevented
Testing & Vaccination
- The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
- The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
- The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
- If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
- immune to hepatitis B or
- susceptible to hepatitis B and need vaccination or
- infected with hepatitis B and need further evaluation by a physician
- California law requires testing of all pregnant women for hepatitis B infection
- If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
- Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
- Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune
After Exposure to Hepatitis B
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What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
Is Hepatitis B Contagious
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.
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