What Causes Hepatitis B
- being born to a mother with hepatitis B
- having unprotected sex with an infected person
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools that were used on an infected person and werent properly sterilized, or cleaned in a way that destroys all viruses and other microbes
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
You cant get hepatitis B from
- being coughed on or sneezed on by an infected person
- drinking unclean water or untreated water that has not been boiled
- eating food that is unclean or has not been properly cooked
- 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
Mothers who have hepatitis B can safely breastfeed their babies. If a baby receives hepatitis B immune globulin and starts receiving the hepatitis B vaccine to prevent hepatitis B infection shortly after birth, hepatitis B is unlikely to spread from mother to child through breastfeeding.15
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Hepatitis B Causes And Risk Factors
Itâs caused by the hepatitis B virus, and it can spread from person to person in certain ways. You can spread the hepatitis B virus even if you donât feel sick.
The most common ways to get hepatitis B include:
- Sex. You can get it if you have unprotected sex with someone who has it and your partnerâs blood, saliva, , or vaginal secretions enter your body.
- Sharing needles. The virus spreads easily via needles and syringes contaminated with infected blood.
- Accidental needle sticks.Health care workers and anyone else who comes in contact with human blood can get it this way.
- Mother to child.Pregnant women with hepatitis B can pass it to their babies during childbirth. But thereâs a vaccine to prevent newborns from becoming infected.
What Are The Complications Of Hepatitis B
The course of hepatitis B infection depends mostly on the age at which a person is infected.
People infected as infants are likely to develop long term infection and can get complications such as scarring of the liver or liver cancer. Infants have a 9 in 10 chance and children have a 3 in 10 chance of developing a chronic, lifelong infection.
People infected as teenagers or adults are likely to become unwell with symptoms , but have a smaller chance of developing a chronic infection. Others develop a silent infection, without any symptoms.
Most people infected as adults clear the virus from the body within 6 months. They develop immunity to future hepatitis B infections and do not develop long-term liver damage.
However, approximately 1 in 20 adults cannot clear the virus and develop chronic hepatitis B. They are at risk of developing complications such as cirrhosis and liver cancer in the longer term.
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Acute Hepatitis B Infection
An acute hepatitis B infection may last up to six months and infected persons are able to pass the virus to others during this time. A simple blood test can let a person know if the hepatitis B virus is in their blood or if they have successfully gotten rid of the virus. The doctor should periodically test your blood over the six-month period to monitor the health of your liver and check progress towards recovery. In a person who has recovered from an acute hepatitis B infection, a taken six-months after initial diagnosis will show that there is no more hepatitis B virus in your blood.
Being diagnosed with acute hepatitis B can be difficult. As you move through the initial six-month period, there are tips and strategies to help.
Until your health care provider confirms that the blood test shows that there is no more hepatitis B virus in your blood, it is important to protect others from a possible infection.
It is also important to have your sexual partner and family members get tested for hepatitis B. If they have not been infected and have not received the hepatitis B vaccine then they should also start the hepatitis B vaccine series.
Be sure to follow-up with your health care provider for any additional blood tests that are needed to confirm your recovery from an acute infection.
Specific Therapy For Acute Hepatitis Delta Virus Infection
Since the start of vaccination against HBV, a decline in the incidence of acute hepatitis delta virus infection has been observed in many regions . HDV requires ongoing expression of HBV surface genes to be able to infect a host, but it does not require HBV replication. Simultaneous coinfection with both HBV and HDV is associated with more severe disease and higher risk for fulminant hepatitis than acute HBV alone however, HDV superinfection may also present as acute hepatitis . In general, coinfection is more likely to lead to severe acute presentation, but rarely leads to chronicity, while superinfection of HDV usually leads to chronicity . For example, 2 of 218 HDV coinfected patients but none of 128 HDV superinfected patients died from consequences of acute hepatitis .
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How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
Treatment Of Acute Liver Failure Due To Hepatitis B
No placebo-controlled trial has been published in the setting of established acute liver failure, but several cases series have suggested lower mortality in patients with fulminant hepatitis B compared to case series of patients who did not receive antiviral therapy. Most of these studies recruited patients before they had progressed to more advanced hepatic encephalopathy . In a study recruiting patients with more advanced liver failure, no benefit of nucleoside on survival was observed , but those authors still concluded that nucleoside analogues would be indicated in such patients to reduce viral load prior to potential liver transplantation. It is likely that early intervention is crucial. N-acetyl cysteine, which is highly effective in preventing death from liver failure from paracetamol/acetaminophen overdosing, has limited efficacy once hepatic encephalopathy is present. While early antiviral intervention is likely to be more effective when given early, we suggest that it should also be given at later time points, as it at least diminishes the risk of HBV reinfection should liver transplantation be required. In case of transplantation, it is unclear whether antiviral therapy can be stopped soon after or if long-term antiviral treatment is required. If transplantation can be avoided, antiviral treatment should be continued at least until HBsAg clearance.
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Enhancing Healthcare Team Outcomes
As hepatitis B infection is highly transmissible via accidental needlesticks, healthcare providers involved in taking care of a patient with HBV should exercise caution and practice proper preventative measures such as vaccination. Patient education should also include counseling about HBV transmission. The interprofessional team’s role is crucial in ensuring the best patient outcomes.
The vaccination rate is low in many developing countries, and the majority of patients are undiagnosed. Educational programs and improved awareness among the general public and healthcare providers are necessary to improve the identification of the patients, reduce transmission of the disease, and reduce the complications of hepatitis B infection.
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 Symptoms Of Hepatitis B
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.
Treatment Of Acute Symptomatic Hepatitis B With Mere Jaundice
In the absence of coagulopathy, antiviral therapy is currently not recommended in the AASLD or EASL guidelines outside of studies . However, patients with jaundice may get hospitalized for several days and may benefit from antiviral therapy. A recent study from Germany found a trend towards earlier decline of bilirubin, ALT normalization, and HBsAg clearance in treated patients, but failed to demonstrate a significant benefit due to lack of power. We calculated 140 patients would have been needed, which we presume would have been possible to recruit within 18 months based on the annual reported incidence of 1,400 cases per year in Germany at that time. However, likely due to the majority of such reported cases being less severely ill than anticipated, only 40 patients could be recruited over a 25-month period, leading to early termination of the trial .
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Natural Course Of Acute Hepatitis B Virus Infection
Hepatitis B virus is highly contagious with an estimated 3-200 DNA copies being sufficient to cause infection, depending on the HBV strain . Newborns with HBeAg-positive mothers have a high risk of HBV acquisition without vaccination and a very high rate of chronicity . However, newborn infection can be prevented by active-passive vaccination in most if mothers with a high viral load receive antiviral therapy during the last trimester of pregnancy, transmission can likely be prevented in all when combined with active passive vaccine . Symptoms during acute infection can likely vary between asymptomatic infection to fatal disease. Acute hepatitis B is a vaccine-preventable disease. The introduction of universal newborn and risk group vaccination has led to a decline in the incidence of HBV infection in most countries .
Infection with HBV frequently remains unnoticed, and might only be noticed by seroconversion to HBsAg-positive or anti-HBc-positive results, or mild-to-moderate elevation of transaminases . Several vaccine trials comparing vaccine to placebo arms have indicated that the majority of patients contracting HBV actually will have some liver enzyme elevation however, jaundice was not mentioned in these publications, suggesting significant jaundice is indeed a relatively infrequent event.
1. Mild HBV infection without clinical manifestation.
a. Asymptomatic HBV infection without transaminase elevation or jaundice.
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.
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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.
Epidemiology Of Hdv Infection
HDV infection is a significant source of healthcare and economic burden. Globally, it is estimated that 510.6% of individuals with chronic HBV are coinfected with HDV, representing up to 72 million people worldwide . The prevalence of HDV/HBV coinfection varies geographically. HDV coinfection is highly endemic in the Mediterranean basin, Vietnam, Pakistan, Iran, Mongolia, Romania, Central Africa, West Africa, and the Amazon Basin, with estimates of prevalence exceeding 20% in these regions . The prevalence of HDV coinfection has been reported to be as high as 42% in the Brazilian Amazon , and 75% among HIV-infected injection drug users in Taiwan . In the US, HDV/HBV coinfection is associated with higher healthcare utilization and costs than HBV monoinfection .
As a result of HBV vaccination, the prevalence of HDV infection has declined since the 1990s in certain parts of Europe, particularly Italy , Spain , and Turkey , where the prevalence has stabilized around 811% . However, a resurgence of HDV infection has been observed in some countries due to increases in injection drug use, unprotected sex, and immigration of persons from highly endemic regions .
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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: