Hepatitis B During Pregnancy
If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.
The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.
The HBV vaccine is safe to receive while pregnant.
People with a high risk of HBV include:
- the infants of mothers with HBV
- the sexual partners of people with HBV
- people who engage in sexual intercourse without contraception and those who have multiple sexual partners
- men who have sex with men
- people who inject illicit drugs
- those who share a household with a person who has a chronic HBV infection
- healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
- people receiving hemodialysis, which is a type of kidney treatment
- people taking medications that suppress the immune system, such as chemotherapy for cancer
People can prevent HBV infection by:
- wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
- not sharing needles
- following safe sexual practices
- cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water
A vaccine against HBV has been available since 1982.
People who should receive this vaccine include:
Who Is At Risk For Hepatitis B
Anyone can get hepatitis B, but the risk is higher in:
- Infants born to mothers who have hepatitis B
- People who inject drugs or share needles, syringes, and other types of drug equipment
- Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
- Men who have sex with men
- People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
- Health care and public-safety workers who are exposed to blood on the job
- Yellowish eyes and skin, called jaundice
If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don’t have symptoms. If you are at high risk, your health care provider may suggest screening.
Exposure To A Source With Unknown Hbsag Status
Unvaccinated persons and persons with previous nonresponse to hepatitis B vaccination who have a discrete, identifiable exposure to blood or body fluids containing blood from a person with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure and the series completed according to the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated but started the series should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series who did not receive postvaccination testing require no further treatment.
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Hepatitis C: What Happens
About 25% of people who get hepatitis C defeat the virus after a short-term infection. The rest will carry the virus in their body for the long term. Chronic hepatitis C can cause very serious complications, including liver failure and liver cancer. There are effective treatments for the virus, though.
Efficacy And Safety Of Available Treatments
Currently, two types of treatment, IFNs and NAs, are approved for chronic HBV infection. The virologic responses to these therapies are summarized in Table Table11.13, 24, 25 Pegylated IFNs have a more convenient dosing schedule and improved efficacy. Among the NAs, entecavir , TDF, and tenofovir alafenamide are preferred because of their potent antiviral activity and high barrier to antiviral resistance. A 1year course of pegylated IFN results in higher rates of HBeAg seroconversion and HBsAg loss than the same duration of ETV, TDF, or TAF therapy in patients who are HBeAgpositive despite lower rates of undetectable HBV DNA . Similarly, in patients who are HBeAgnegative, a 1year course of pegylated IFN results in a higher rate of HBsAg loss than the same duration of ETV, TDF, or TAF therapy despite a lower rate of undetectable HBV DNA . Response to IFN is more durable, and rates of HBeAg and HBsAg loss continue to increase after cessation of treatment, whereas viral relapse is universal when NA is discontinued after 1 year of therapy.
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Hepatitis C: Who Is At Risk
People who have injected illegal drugs at any time, even one time, many years ago, could be walking around with chronic hepatitis C. Because there are often no symptoms, many former drug users may not realize they have the infection. People who received a blood transfusion before 1992 also have a higher risk. Before that year, donated blood was not screened for the hepatitis C virus.
How You Can Get Hepatitis B
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 youâre pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.
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How Is Hepatitis B Diagnosed
There are three main ways to diagnose HBV infection. They include:
- Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
- Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
- Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.
The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.
The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.
Hepatitis A And B Vaccines
There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.
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What Is Hepatitis B
Hepatitis B is an infection of your liver. Itâs caused by a virus. There is a vaccine that protects against it. For some people, hepatitis B is mild and lasts a short time. These âacuteâ cases donât always need treatment. But it can become chronic. If that happens, it can cause scarring of the organ, liver failure, and cancer, and it even can be life-threatening.
Itâs spread when people come in contact with the blood, open sores, or body fluids of someone who has the hepatitis B virus.
It’s serious, but if you get the disease as an adult, it shouldnât last a long time. Your body fights it off within a few months, and youâre immune for the rest of your life. That means you can’t get it again. But if you get it at birth, itâ unlikely to go away.
âHepatitisâ means inflammation of the liver. There are other types of hepatitis. Those caused by viruses also include hepatitis A and hepatitis C.
American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
After a period of treatment consolidation , consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. If antiviral therapy is stopped, monitor the patient every 3 months for a minimum of 1 year for recurrent viremia, ALT flares, seroreversion, and clinical decompensation.
Adults with HBeAg-negative immune-active chronic HBV infection
Inpatient care
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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.
Hepatitis B Treatment: What We Know Now And What Remains To Be Researched
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
Address Correspondence and Reprint Requests To:
Anna S. Lok, M.D., 1500 East Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
Address Correspondence and Reprint Requests To:
Anna S. Lok, M.D., 1500 East Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109
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Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
What Occupations Have Increased Risk Of Hepatitis B
In general, occupational groups with increased risk include:
- Health-care workers repeatedly exposed to blood or blood products or those who are at risk of needlestick injury.
- Pathologists, laboratory personnel, or embalmers.
- Dentists, dental assistants, and dental hygienists.
- Certain staff members of institutions for the developmentally handicapped.
- Staff of institutions where workers may be exposed to aggressive, biting residents.
Travellers to regions with intermediate or high rates of endemic HBV infection may also consider being vaccinated.
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Who Should Be Vaccinated For Hepatitis B
All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:
- People who have more than one sexual partner.
- Men who have sex with men.
- Adults with diabetes.
- Sexual partners of infected people and people who share households with infected individuals.
- People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who cant take care of themselves.
Hepatitis B Surface Antigen Test
A hepatitis B surface antigen test shows if you have an active infection. A positive result means you have hepatitis B and can transmit the virus to others. A negative result means you dont currently have hepatitis B.
This test doesnt distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection.
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Prognosis Improvement After Hbsag Clearance
These related studies provide clear recommendations that patients who achieve HBsAg clearance have favourable clinical outcomes compared to patients who achieve only HBV DNA suppression and HBeAg seroconversion. HBsAg clearance leads to biochemical, virological and liver histological improvements, and it significantly reduces the risk of HCC. However, HCC may occur after HBsAg seroclearance despite it being the ultimate treatment endpoint recommended by current guidelines. The risk factors associated with HCC include the presence of cirrhosis, male sex, and age50 years at the time of HBsAg clearance . Closer attention should be given to patients with one or more of these risk factors.
These high-risk patients should be re-examined in a timely manner even if HBsAg clearance is obtained. These results also suggest that achieving a functional cure early in the absence of cirrhosis results in a better prognosis .
Disclosing Your Child’s Diagnosis
If you decide to disclose your child’s hepatitis B, remain calm, provide literature to reinforce the facts, and give the school a letter from your child’s doctor stating that s/he is healthy and poses no risk to the other children if appropriate precautions are maintained. Most states require hepatitis B vaccination prior to school entry, so this reduces any potential risk to other students.
We recommend the following when disclosing your child’s hepatitis B to school officials:
- Stress the importance of confidentiality and universal precautions to protect your child from social discrimination.
- Remind school officials that hepatitis B is transmitted through exposure to blood it is not transmitted casually.
- Explain that hepatitis B is not the only blood-borne disease that puts children at risk.
- Consider saying “Treat my child as you should treat every child – with care. You know what risk my child poses, but you don’t know the risk that other children might present.”
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Administration Eyes National Hepatitis C Treatment Plan
- SANDHYA RAMANCQ-Roll Call
WASHINGTON The Biden administration is preparing a comprehensive initiative to fight hepatitis C that would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic.
Francis Collins, special project adviser to President Joe Biden and former longtime director of the National Institutes of Health, said this week that the administration hopes to secure some funding this year for the yet to be formally unveiled initiative.
He said he briefed Biden on the plan, and the Office of Management and Budget is enthusiastic about figuring out how to fit this into the budgetary requests.
The plan, he said, would include agencies including the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, the Indian Health Service, Food and Drug Administration and the Federal Bureau of Prisons.
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Hepatitis B: What Happens
Many adults who get hepatitis B have mild symptoms for a short time and then get better on their own. But some people are not able to clear the virus from the body, which causes a long-term infection. Nearly 90% of infants who get the virus will carry it for life. Over time, hepatitis B can lead to serious problems, such as liver damage, liver failure, and liver cancer.
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