What Is Acute Fulminant Hepatitis
Rarely, individuals with acute infections with HAV and HBV develop severe inflammation, and the liver fails . These patients are extremely ill with the symptoms of acute hepatitis already described and the additional problems of confusion or coma , as well as bruising or bleeding . In fact, up to 80% of people with acute fulminant hepatitis can die within days to weeks therefore, it is fortunate that acute fulminant hepatitis is rare. For example, less than 0.5% of adults with acute infection with HBV will develop acute fulminant hepatitis. This is even less common with HCV alone, although it becomes more frequent when both HBV and HCV are present together.
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.
How Is It Spread
Hepatitis A is spread when a person ingests fecal mattereven in microscopic amountsfrom contact with objects, food, or drinks contaminated by feces or stool from an infected person.
Hepatitis B is primarily spread when blood, semen, or certain other body fluids- even in microscopic amounts from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus can also be transmitted from:
- Birth to an infected mother
- Sex with an infected person
- Sharing equipment that has been contaminated with blood from an infected person, such as needles, syringes, and even medical equipment, such as glucose monitors
- Sharing personal items such as toothbrushes or razors
- Poor infection control has resulted in outbreaks in health care facilities
Hepatitis C is spread when blood from a person infected with the Hepatitis C virus even in microscopic amounts enters the body of someone who is not infected. The hepatitis C virus can also be transmitted from:
- Sharing equipment that has been contaminated with blood from an infected person, such as needles and syringes
- Receiving a blood transfusion or organ transplant before 1992
- Poor infection control has resulted in outbreaks in health care facilities
- Birth to an infected mother
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Chronic Hepatitis B And C
Most people with hepatitis B clear the virus from their bodies as they get better. But some dont clear the virus these people have chronic hepatitis B. Some people with chronic hepatitis B stay well for a long time and then get very sick many years later. People with chronic hepatitis B can spread the virus to others even if they do not look or feel sick.
Many people with chronic hepatitis C have no symptoms and dont know they have the disease. However, because the virus is in their bodies, they can spread it to other people. Chronic hepatitis C is a long term illness that can lead to serious liver problems, including scarring of the liver or liver cancer.
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Chronic Hepatitis B Symptoms
Most patients with chronic hepatitis B are asymptomatic unless their disease progresses. Others might have nonspecific symptoms, such as fatigue.
Some patients experience worsening of the infection and develop signs and symptoms similar to acute hepatitis.
If patients with chronic hepatitis B progress to cirrhosis they will develop signs and symptoms of liver failure, including:
- Jaundice
- Ascites
- Peripheral edema
- Encephalopathy
- Hepatocellular carcinoma
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Is Hepatitis A Bacterial
A number of factors can be responsible for hepatitis, including physical injury, infections, or adverse drug reactions. currently identified five kinds of viruses called hepatitis hepatitis A, B, C, D and E that directly destroy the liver and cause Viral hepatitis to develop or to trigger immune response to prevent or cure it.
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.
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What Happens After A Hepatitis B Infection
Some people carry the virus in their bodies and are contagious for the rest of their lives. They should not drink alcohol, and should check with their doctor before taking any medicines to make sure these won’t cause more liver damage.
Anyone who has ever tested positive for hepatitis B cannot be a blood donor.
Hepatitis B In The United States
In the United States, about 862,000 people have chronic hepatitis B.6 Asian Americans and African Americans have higher rates of chronic hepatitis B than other U.S. racial and ethnic groups.10 Researchers estimate that about half of the people living with chronic hepatitis B in the United States are Asian Americans and Pacific Islanders.11 Chronic hepatitis B is also more common among people born in other countries than among those born in the United States.7
The hepatitis B vaccine has been available since the 1980s and, in 1991, doctors began recommending that children in the United States receive the hepatitis B vaccine. The annual rate of acute hepatitis B infections went down 88.5 percent between 1982 and 2015.12 In 2017, the annual number of hepatitis B infections rose in some states.13 Experts think the rise was related to increases in injection drug use. Injection drug use increases the risk of hepatitis B infection.
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Where Is The Hepatitis B Virus Found And How Is It Transmitted
Blood is the major source of the hepatitis B virus in the workplace. It can also be found in other tissues and body fluids, but in much lower concentrations. The risk of transmission varies according to the specific source. The virus can survive outside the body for at least 7 days and still be able to cause infection.
How Do You Know If You Have Hepatitis B
Signs and symptoms can vary, in particular by the age of the individual. Many individuals may not show symptoms . When symptoms develop, they include fever, joint pain, abdominal pain, fatigue, lack of appetite, nausea, vomiting, dark urine, clay-coloured bowel movements, or jaundice.
Most infections are asymptomatic or mild. Occasionally, people with serious cases of hepatitis B require hospitalization. A very small proportion of these patients develop a critical form of the disease called “fulminant” hepatitis B. This condition results from a sudden breakdown of liver function.
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What Is Hepatitis B
Hepatitis B is the most common serious liver infection in the world. It is caused by the hepatitis B virus that attacks and injures the liver. Two billion people have been infected and about 300 million people are living with a chronic hepatitis B infection. Each year up to 1 million people die from hepatitis B despite the fact that it is preventable and treatable.
The hepatitis B virus is transmitted through blood and infected bodily fluids. It can be passed to others through direct contact with blood, unprotected sex, use of illegal drugs, unsterilized or contaminated needles, and from an infected woman to her newborn during pregnancy or childbirth.
Hepatitis B is a silent epidemic because most people do not have symptoms when they are newly infected or chronically infected. Thus, they can unknowingly spread the virus to others and continue the silent spread of hepatitis B. For people who are chronically infected but dont have any symptoms, their liver is still being silently damaged which can develop into serious liver disease such as cirrhosis or liver cancer.
The good news is that hepatitis B is preventable and treatable. There is a simple blood test to diagnose a hepatitis B infection. Testing is the only way to know for sure if you are infected. There is a safe vaccine to prevent hepatitis B. There are effective drug therapies that can manage a chronic hepatitis B infection, and a cure is within sight.
How Serious Is It
- People can be sick for a few weeks to a few months
- Most recover with no lasting liver damage
- Although very rare, death can occur
- 15%25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer
- More than 50% of people who get infected with the hepatitis C virus develop a chronic infection
- 5%-25% of people with chronic hepatitis C develop cirrhosis over 1020 years
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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.
How Is It Treated
Hepatitis A is treated using supportive methods. These can include things like rest, fluids, and healthy foods. Medications can also help to ease some symptoms like fever, aches, and pains.
Theres a vaccine available to protect against infection with HAV. This is typically recommended for children as well as for people at an increased risk for contracting the virus.
Also, receiving a single dose of the hepatitis A vaccine may prevent you from becoming ill if youve been exposed to HAV. For it to be effective, the vaccine needs to be given of exposure.
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Is Surgery A Treatment For Hepatitis B
There is no surgical therapy for hepatitis B.
If liver damage is so severe that the liver starts to fail, liver transplant may be recommended:
- Liver transplant is a major process and surgery with an extended recovery period.
- It also depends on the availability of a matching donor liver.
- If liver transplant becomes a possibility for an individual, a health care practitioner will discuss the risks and benefits with them.
Hepatitis B Antibody Escape Mutants
Production of antibodies to the group antigenic determinant amediates cross-protection against all sub-types, as has been demonstrated bychallenge with a second subtype of the virus following recovery from an initialexperimental infection. The epitope a is located in the regionof amino acids 124148 of the major surface protein, and appears tohave a double-loop conformation. A monoclonal antibody which recognizes a regionwithin this a epitope is capable of neutralizing theinfectivity of hepatitis B virus for chimpanzees, and competitive inhibitionassays using the same monoclonal antibody demonstrate that equivalent antibodiesare present in the sera of subjects immunized with either plasma-derived orrecombinant hepatitis B vaccine.
During a study of the immunogenicity and efficacy of hepatitis B vaccines inItaly, a number of individuals who had apparently mounted a successful immuneresponse and become anti-surface antibody -positive, later becameinfected with HBV.
The region in which this mutation occurs is an important virus epitope to whichvaccine-induced neutralizing antibody binds, as discussed above, and the mutantvirus is not neutralized by antibody to this specificity. It can replicate as acompetent virus, implying that the amino acid substitution does not alter theattachment of the virus to the liver cell.
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Reduce Your Chance Of Infection
You can reduce your chance of hepatitis B infection by
- not sharing drug needles or other drug materials
- wearing gloves if you have to touch another persons blood or open sores
- making sure your tattoo artist or body piercer uses sterile tools
- not sharing personal items, such as toothbrushes, razors, or nail clippers
- using a latex or polyurethane condom during sex
What Are The Symptoms
- Symptoms can take 2 to 6 months to appear.
- Many people who are infected with hepatitis B have either no symptoms or only mild symptoms.
- Symptoms of acute hepatitis B can include fatigue, loss of appetite, joint pain, abdominal pain, nausea, vomiting, fever, and dark urine. A small number of people will develop jaundice .
- Some people develop chronic hepatitis B and most remain contagious for the rest of their lives. Chronic infection may lead to cirrhosis and/or liver cancer. Most people with chronic hepatitis B are unaware of their infection.
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Common Symptoms Of Hepatitis
If you are living with a chronic form of hepatitis, like hepatitis B and C, you may not show symptoms until the damage affects liver function. By contrast, people with acute hepatitis may present with symptoms shortly after contracting a hepatitis virus.
Common symptoms of infectious hepatitis include:
It is crucial to understand what is causing hepatitis in order to treat it correctly. Doctors will progress through a series of tests to accurately diagnose your condition.
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Treatment Options For Antiviral Resistant Pathogens
If a virus is not fully wiped out during a regimen of antivirals, treatment creates a bottleneck in the viral population that selects for resistance, and there is a chance that a resistant strain may repopulate the host. Viral treatment mechanisms must therefore account for the selection of resistant viruses.
The most commonly used method for treating resistant viruses is combination therapy, which uses multiple antivirals in one treatment regimen. This is thought to decrease the likelihood that one mutation could cause antiviral resistance, as the antivirals in the cocktail target different stages of the viral life cycle. This is frequently used in retroviruses like HIV, but a number of studies have demonstrated its effectiveness against influenza A, as well. Viruses can also be screened for resistance to drugs before treatment is started. This minimizes exposure to unnecessary antivirals and ensures that an effective medication is being used. This may improve patient outcomes and could help detect new resistance mutations during routine scanning for known mutants. However, this has not been consistently implemented in treatment facilities at this time.
Despite their successes, in the United States there exists plenty of stigma surrounding vaccines that cause people to be incompletely vaccinated. These “gaps” in vaccination result in unnecessary infection, death, and costs. There are two major reasons for incomplete vaccination:
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How Can I Avoid Getting Hepatitis B
There is a safe and effective vaccine that can protect you from getting hepatitis B. The vaccine is usually given in three doses over a six month period. The vaccine will give you long-lasting protection. A combined vaccine for hepatitis A and hepatitis B is also available.
Other ways to protect yourself or your loved ones include:
- Adopt safe sex practices.
- Avoid sharing personal hygiene items
- If you have been exposed to the hepatitis B virus , an injection of hepatitis B immune globulin may help protect you.
- If you are pregnant, make sure you are screened for hepatitis B. If the test result shows that you have the virus, make sure your baby receives the free hepatitis B vaccine. If you have hepatitis B, breastfeeding is safe if the baby has received both protective antibody called immune globulin, and the first dose of hepatitis B vaccine within the first 12 hours of life. Talk to your doctor about having your newborn immunized .
- If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single-use needles and inks and/or follows proper sterilization procedures.
When Do You Initiate Hepatitis B Virus Therapy In The Setting Of Hiv
HBV/HIV coinfection represents a significant problem in HIV care. As HAART has improved the prognosis in HIV/AIDS, significant increases in morbidity and mortality due to liver disease have been observed. HBV and HIV are acquired by similar mechanisms and thus coinfection is common. Patients with coinfection of HIV and HBV have higher HBV DNA levels and are less likely to convert from HBeAg+ to HBeAb+, indicating a poorer response to HBV therapy. Patients with a HBV DNA greater than 2000 and F2 or greater fibrosis on biopsy should have HBV treatment. If a patient has cirrhosis, he or she should be treated if HBV DNA is greater than 200. For patients with a high CD4 count, HBV monotherapy that is not active against HIV should be first-line therapy. When initiating HAART, HBV also should be treated with two antiviral agents active against HBV. If CD4 counts are between 350 and 500 cells/mL, one can elect to treat both HIV and HBV. HAART with two agents active against HBV should be used instead of HBV monotherapy in these individuals.
Kyong-Mi Chang, in, 2012
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