History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
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.
What Is My Risk
Your risk depends of several factors: destination, length of stay, what you do when you are travelling and whether you have direct contact with blood or other body fluids. In certain destinations, your risk may be higher, as some areas have higher numbers of people with chronic hepatitis B in the general population.
The risk increases with certain activities, such as unprotected sex, sharing needles, tattooing and acupuncture.
Aid and health care workers and anyone who receives medical or dental care with unsterilized or contaminated equipment in a country where hepatitis B occurs are also at greater risk.
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Recommendations For Frequency Of Repeat Testing In An Asymptomatic Patient
The frequency of testing depends on the history of sexual exposure and number of sexual partners. However, in the case of hepatitis A and B, once the patient has completed a course of vaccination no further repeat testing is required.
For those at continuing risk and who have not received a course of vaccination, the following is recommended.
About The Hepatitis B Virus
The hepatitis B virus is a small DNA virus that belongs to the Hepadnaviridae family. Related viruses in this family are also found in woodchucks, ground squirrels, tree squirrels, Peking ducks, and herons.
Structure of the Hepatitis B Virus The hepatitis B virus contains an outer envelope and an inner core.
- The outer envelope of the virus is composed of a surface protein called the hepatitis B surface antigen or “HBsAg”. The HBsAg can be detected by a simple blood test and a positive test result indicates a person is infected with the hepatitis B virus.
- The inner core of the virus is a protein shell referred to as the hepatitis B core antigen or “HBcAg,” which contains the hepatitis B virus DNA and enzymes used in viral replication.
Life Cycle of the Hepatitis B Virus
The hepatitis B virus has a complex life cycle. The virus enters the host liver cell and is transported into the nucleus of the liver cell. Once inside the nucleus, the viral DNA is transformed into a covalently closed circular DNA , which serves as a template for viral replication . New HBV virus is packaged and leaves the liver cell, with the stable viral cccDNA remaining in the nucleus where it can integrate into the DNA of the host liver cell, as well as continue to create new hepatitis B virus. Although the life cycle is not completely understood, parts of this replicative process are error prone, which accounts for different genotypes or genetic codes of the hepatitis B virus.
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Who Should Not Get The Hepatitis B Vaccine
Hepatitis B is a safe vaccine that does not contain a live virus.
However, there are some circumstances in which doctors advise against getting the HBV vaccine.
You should not receive the hepatitis B vaccine if:
- youve had a serious allergic reaction to a previous dose of the hepatitis B vaccine
- you have a history of hypersensitivity to yeast or any other HBV vaccine components
Prognosis Of Hepatitis B
The risk that an acute hepatitis B infection will become chronic decreases as a person gets older. About 90 percent of infants who get hepatitis B will develop a chronic infection, according to the CDC the virus will become chronic in about 25 to 50 percent of children ages 1 to 5. Of the people who get hepatitis B as a child, about 25 percent may die from cirrhosis or liver cancer.
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Clinical Outcomes Of Dual Chronic Hepatitis C And B Are Usually Worse
Several hospital or community-based studies demonstrated that in patients co-infected with chronic hepatitis C and B, the disease outcomes are usually worse than those with either chronic HCV or HBV infection 1-7. Patients with HCV/HBV co-infection may exhibit various fluctuating virological profiles basically HCV and HBV can alternate their dominance during long-term follow-up. In Italy, a longitudinal follow-up study revealed the patterns and dynamics of virological dominance in these cases 11. Of 103 untreated HBV/HCV coinfected patients, active infection with HBV and HCV was revealed in 24 cases, inactive infection of both viruses was seen in 15 cases, active HBV and inactive HCV infection was seen in 15 cases, and active HCV and inactive HBV infection was found in 49 cases. During one year follow-up, fluctuation of HBV and/or HCV viremia levels was documented in 32 subjects . Based on these findings, careful evaluation of serum HBV DNA and HCV RNA levels is essential before the diagnosis of the viral dominance which will influence the therapeutic strategies in the co-infected patients.
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What Is The Treatment For Hepatitis B
Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea are present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic.
If a person has chronic hepatitis B, they should see their health care provider and determine if medical treatment is appropriate.
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Hepatitis B Virus Infection In Newborns
, MD, University of Rochester School of Medicine and Dentistry
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Newborns may become infected at birth or rarely after birth.
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Newborns who develop symptoms have jaundice, lethargy, and failure to thrive.
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The diagnosis is typically based on blood tests.
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Children are at risk of liver problems later in life.
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The hepatitis B vaccine and sometimes hepatitis B immune globulin are given to newborns to protect them against the infection.
The infection occurs during delivery if the mother is infected. However, newborns may become infected after birth from other sources, such as the mother’s saliva, stool, urine, or breast milk.
Prevent Hepatitis B Infections In Newborns
If you are pregnant and have hepatitis B, talk with your doctor about lowering the risk that the infection will spread to your baby. Your doctor will check your virus levels during pregnancy. If virus levels are high, your doctor may recommend treatment during pregnancy to lower virus levels and reduce the chance that hepatitis B will spread to your baby. Your doctor may refer you to a liver specialist to find out if you need hepatitis B treatment and to check for liver damage.
When it is time to give birth, tell the doctor and staff who deliver your baby that you have hepatitis B. A health care professional should give your baby the hepatitis B vaccine and HBIG right after birth. The vaccine and HBIG will greatly reduce the chance of your baby getting the infection.
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Could There Be A Link With Covid
The COVID-19 virus is one of the possible infections under scrutiny. Some of the children who have contracted hepatitis have recently been infected with COVID-19, although experts caution that this is to be expected given the high COVID-19 infection rates in this age group.
Experts are also stressing that there is no link between these incidences of hepatitis and the COVID-19 vaccine2. This is because no vaccinations were given to the children who were under 5 years of age – the age group which makes up over 75% of current hepatitis cases.
Why has there been an increase of hepatitis in children?
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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.
References
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What Causes Hepatitis In Children
There are a number of causes for hepatitis in children and adults alike. Different causes correspond to different types of hepatitis, which are treated differently.
Prevention Of Hepatitis B
Hepatitis B can be prevented through vaccination. The hepatitis B vaccine typically is given as a series of three or four injections, administered over the course of six months. The first dose of the vaccine is sometimes called the birth dose, since it frequently is given within the first 24 hours of birth. The vaccine is 90 to 95 percent effective in preventing hepatitis B.
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How Do You Get Hepatitis C
Hepatitis C is only contracted through contact with another person who is infected with the hepatitis C virus . It is not acquired through contact with animals or insects.
Hepatitis C is present primarily in the blood, and to a lesser degree in specific other body fluids, of an infected person. Today, it is passed most commonly through the sharing of used needles by injection drug users. Prior to 1990, it was commonly passed through blood transfusions. However, since 1990, all donated blood is tested for hepatitis C virus, so it is extremely rare for hepatitis C to be acquired through a blood transfusion.
Transmission of hepatitis C occasionally occurs in healthcare settings, such as hospitals and clinics, when established infection control protocols are not followed. Health care professionals who do not follow these protocols can become infected if they sustain a needle stick from a patient who carries hepatitis C virus.
While uncommon, one mode of transmission is through organ transplantation when the donated organ comes from a person who carries the hepatitis C virus. The use of HCV-positive organs is currently reserved for the most serious cases requiring transplantation.
How Does Hepatitis C Spread?
Tattooing and body piercing have been documented to transmit the hepatitis C virus when recommended sterilization and infection control procedures are not followed.
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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.
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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.
IFNGR1 gene
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.
IFNAR2 gene
IL1OR2 gene
Variations in vaccine response
What Laboratory Tests Are Available For Hepatitis B
Tests are available to detect the types of antigens used to identify the hepatitis B virus. The tests determine if the virus is present in the body tissue or blood. The amount of each type of antigen present indicates how advanced the disease is and how infective the individual has become.
Other tests are available to detect the body’s reaction to the viral infection or the body’s reaction to vaccination against the virus. These tests work by measuring the number of antibodies present in the blood.
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How Common Is Hepatitis B
Hepatitis B is fairly common in Africa and the western Pacific region. Throughout the world, there are about 292 million people who are infected with chronic hepatitis B. In the U.S., the figure exceeds 2 million people.
The number of infections had been falling in the U.S., but fewer vaccinations among adults combined with the onset of the opioid crisis and injected drug usage has resulted in the numbers rising again. Infected women can pass the infection on to their babies. Children who are infected before age 5 are more likely to have chronic infection than those infected later in life.
What Are The Risk Factors For Getting Hepatitis B
Due to the way that hepatitis B spreads, people most at risk for getting infected include:
- Children whose mothers have been infected with hepatitis B.
- Children who have been adopted from countries with high rates of hepatitis B infection.
- People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
- People who live with or work in an institutional setting, such as prisons or group homes.
- Healthcare providers and first responders.
- People who share needles or syringes.
- People who live in close quarters with a person with chronic hepatitis B infection.
- People who are on dialysis.
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What Happens With Hepatitis C
Is hepatitis C a virus? Yes. With acute hepatitis C, the virus is eliminated in 25% of people. The rest of the people become chronically infected and later may develop serious complications such as liver failure and liver cancer. There is treatment, however, for hepatitis C that usually can prevent the complications.