What Are The Symptoms Of Hepatitis B
Not all individuals infected with acute hepatitis B will experience symptoms. In fact, the CDC estimates that only about 30-50% of infected people age 5 and older will have symptoms. When symptoms are present, they will develop about 3 months after exposure and will include the following:
- Fever
- Joint pain
- Jaundice
Individuals with chronic hepatitis B will generally not have any symptoms. When symptoms are present, they are generally very similar to the symptoms of acute hepatitis B. Given the serious nature of hepatitis B and the effects it can have on your liver and overall health, it is important to talk to your doctor about hepatitis B if you believe you may have been exposed to the disease.
Hepatitis B: Screening Prevention Diagnosis And Treatment
THAD WILKINS, MD, MBA RICHARD SAMS, MD, MA and MARY CARPENTER, PharmD Medical College of Georgia at Augusta University, Augusta, Georgia
Am Fam Physician. 2019 Mar 1 99:314-323.
Patient information: See related handout on hepatitis B, written by the authors of this article.
The Centers for Disease Control and Prevention estimated that in 2015 there were 21,900 cases of acute hepatitis B, with an overall incidence of 1.1 cases per 100,000.1 There are an estimated 850,000 to 2.2 million individuals in the United States with chronic hepatitis B.1,2 Approximately 25% of children and 15% of adults with chronic hepatitis B die prematurely from hepatocellular carcinoma or cirrhosis.3 However, treatment reduces morbidity and mortality from the disease.
WHAT IS NEW ON THIS TOPIC
Approximately 1,000 cases of perinatal hepatitis B occur annually in the United States, and nearly 90% of chronic hepatitis B cases in infants develop in the first year of life.
Hepatitis B vaccination is recommended for all medically stable infants weighing 2,000 g or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of hepatitis B.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Pregnant women should be screened for hepatitis B at the first prenatal visit.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Pregnant women should be screened for hepatitis B at the first prenatal visit.
eFIGURE A
eFIGURE A
What Is Hepatitis D And How Is It Associated With Hepatitis B
Hepatitis D is another virus that can cause liver infections, but only if hepatitis B is also present. A person may become infected with both viruses at the same time or may first be infected with hepatitis B and then become infected with HDV . In the U.S., the incidence of HDV is low. There is no vaccine for HDV, but since it causes infections only in the presence of HBV, it may be prevented with the HBV vaccine.
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Who Is At Risk For Hepatitis B
Anyone can contract hepatitis B. However, certain groups are at greater risk. According to the CDC, the following groups are at highest risk for contracting hepatitis B:
- Infants born to infected mothers
- People who inject drugs or share needles
- Sexual partners of people infected with hepatitis B
- Men who have sex with men
- People living in close proximity to a person with hepatitis B
- Health care workers or others exposed to blood in their work environments
- Hemodialysis patients
Is There Anything Else I Should Know
Even if you don’t have symptoms, an HBV infection can damage your liver and you can spread the infection to others. For this reason, it is important to get tested if you think you have been exposed to HBV.
Blood banks screen all donated blood for the hepatitis B virus , hepatitis B surface antigen , and hepatitis B core antibody . Donors are notified of any confirmed positive reactions. People who receive a notice regarding possible infection with hepatitis B after donating should visit their healthcare provider for further testing. The healthcare practitioner will order additional tests to make a proper diagnosis and determine if treatment is necessary.
If exposed to HBV and you haven’t been vaccinated, an infection can be avoided by getting a shot of hepatitis B immune globulin within 24 hours and typically you will also be given the first dose of the hepatitis B vaccine.
A test is available to determine the specific type of hepatitis B virus that is causing a person’s infection. This is called HBV genotyping. However, this testing is currently mainly used in research settings and not for clinical purposes.
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How Is It Used
The main uses for hepatitis B virus tests include:
Some of the secondary reasons to perform testing include: to screen for hepatitis B infection in at-risk populations or in blood donors, to determine if someone is a carrier, to detect a resolved infection, and to determine if immunity has developed due to vaccination.
Generally, one set of tests is used as an initial panel of tests to detect HBV infection or to determine the cause of acute symptoms while another set of tests may be used after a diagnosis is made to monitor possible progression of the disease, to detect chronic infection, and/or to determine carrier status.
The following table summarizes the set of tests typically used for initial testing:
The following table summarizes tests that may be used as follow-up after initial tests detect an HBV infection:
Understanding Your Test Results
Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.
Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.
More Detailed Information About Hepatitis B Blood Tests
An acute hepatitis B infection follows a relatively long incubation period – from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .
The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.
According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.
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When Is It Ordered
Hepatitis B tests may be ordered when someone has signs and symptoms associated with acute hepatitis to determine if they are due to infection with HBV. Some of these include:
- Fever
- Joint pain
- Jaundice
Hepatitis B tests may be done as follow up when routine tests results such as ALT and/or AST are elevated. Sometimes acute forms of hepatitis may be detected this way since they may cause only mild symptoms that can be confused with the flu. Chronic hepatitis more often has no symptoms and is more commonly detected when routine test results are abnormal.
A test for hepatitis B surface antigen may be used for screening when someone falls into one of the high-risk categories for chronic hepatitis B. Joint guidelines from the Centers for Disease Control and Prevention and American College of Physicians were published in December 2017 and recommend the following groups be tested for HBsAg:
When hepatitis B tests are used to monitor people with chronic hepatitis B infections, they may be performed on a regular basis. Hepatitis B surface antigen and hepatitis B e antigen , often along with HBV DNA, are usually measured about every 6 months to a year since, in some people, HBeAg will go away on their own. In those who are being treated for chronic HBV, HBeAg and HBV DNA tests can be used to determine whether the treatment is successful.
What Is Hepatitis B Surface Antibody
When you are exposed to hepatitis B, your body mounts an immune reaction against it as an invader. This happens whether you are exposed due to blood or sexual contact or if you are vaccinated with the hepatitis B vaccine.
The hepatitis B virus has proteins on its surface that cause your immune system to produce antibodies. With the vaccine, the sample contains the protein only and not the virus itself.
The first response your body will make when exposed to hepatitis B is to manufacture hepatitis B IgM antibodies. These early antibodies are produced to fight against several parts of the virus including its core. These antibodies are seen in the initial response, but they eventually fade away.
Your immune system then begins to produce IgG antibodies. It continues to produce these antibodies for the rest of your life. In this way, your immune system is always ready to attack hepatitis B virus when it is exposed to it.
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Transmission Symptoms And Treatment
How is HBV transmitted?
HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids , including
- sex with an infected partner
- injection-drug use that involves sharing needles, syringes, or drug-preparation equipment
- birth to an infected mother
- contact with blood from or open sores on an infected person
- exposures to needle sticks or sharp instruments and
- sharing certain items with an infected person that can break the skin or mucous membranes , potentially resulting in exposure to blood.
How long does HBV survive outside the body?
HBV can survive outside the body and remains infectious for at least 7 days .
What should be used to clean environmental surfaces potentially contaminated with HBV?
Any blood spills should be disinfected using a 1:10 dilution of one part household bleach to 10 parts of water. Gloves should be worn when cleaning up any blood spills.
Who is at risk for HBV infection?
The following populations are at increased risk for becoming infected with HBV:
- Infants born to infected mothers
- Sex partners of infected people
- Men who have sex with men
- People who inject drugs
- Household contacts or sexual partners of known people with chronic HBV infection
- Health-care and public-safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Hemodialysis patients
Who should be screened for HBV?
CDC recommends that the following people be screened for HBV :
- fever,
Negative But Other Hepatitis Tests Are Positive
Your HBsAb test may be negative even when other hepatitis B tests are positive, showing active or chronic infection. Further testing is necessary, especially for the hepatitis B surface antigen , which shows that the virus itself is circulating in your bloodstream and that you have an active or chronic infection.
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Persons With Inadequate Immunization Records
Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.
How Do You Get Hepatitis B
Hepatitis B is really contagious. Its transmitted through contact with semen , vaginal fluids, and blood. You can get it from:
-
having vaginal, anal, or oral sex
-
sharing toothbrushes and razors
-
sharing needles for shooting drugs, piercings, tattoos, etc.
-
getting stuck with a needle that has the Hep B virus on it.
Hepatitis B can also be passed to babies during birth if their mother has it.
Hepatitis B isnt spread through saliva , so you CANT get hepatitis B from sharing food or drinks or using the same fork or spoon. Hepatitis B is also not spread through kissing, hugging, holding hands, coughing, sneezing, or breastfeeding.
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What Are The Benefits Of The Titer Test
Titer test acts as a prerequisite before receiving vaccinations or any boosters. The titer test helps determine the immunity of your employees to particular diseases.
Another benefit of the titer test is highlighting the employees who already have immunity levels from previous vaccinations. If every employee undergoes the same vaccinations without being tested, he possibly has done an expensive and inefficient deed.
As you have most certainly experienced before, vaccines are costly and require multiple doses to accomplish. A titer test is way too cheaper. By eliminating the need for revaccinating for people who already have immunity, the titer test can prevent the waste of time and money.
Another benefit of the titer test is protecting employees and the public from diseases that affect a high number of people. A recently written article in Forbes highlights the importance of protecting employees and communities from such outbreaks.
Response From The Expert
Richard S. Ferri, PhD, ANP, ACRN, FAAN
Vaccination against hepatitis B virus is extremely safe and efficacious. In fact, routine infant HBV vaccination was first recommended by the Advisory Committee on Immunization Practices in 1991, and this practice has significantly reduced HBV infection in children and young adults.
The Centers for Disease Control and Prevention recommends HBV vaccination be given by intramuscular injection at 0, 1, and 6 months. Postvaccination testing is not a routine practice except for infants born to mothers with HBV, immune compromised persons, healthcare workers, and sex partners of persons with chronic HBV. For the adult, a titer should be drawn 1 to 2 months after completing the vaccination series. For infants born from HBV-positive mothers, the testing should be done 3 to 9 months after receiving the vaccination series.
The CDC does not currently recommend revaccination in persons with intact immune systems. However, there is a 15-year span after vaccination where antibodies decline but protection is still afforded . If a person who took the series never had a test to check for immunity, it may be wise to assess for adequate hepatitis B surface antibody levels, indicating protection against hepatitis B antigen . If the patient tests HBsAb negative, indicating a lack of protection from HBV infection, a second series is recommended.
Cite this: Richard S. Ferri. What Should I Know About a Hepatitis B Titer? – Medscape – Jul 25, 2005.
Tables
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The Correlation Between The Anti
We evaluated correlations between the anti-HBs titers at 1 and 2 years after vaccination and the anti-HBs titer at the primary response . The anti-HBs titers at 1 and 2 years after vaccination were significantly correlated with the anti-HBs titer at the primary response . Age, sex, and primary response were included in a multivariate linear regression analysis to identify factors associated with anti-HBs titers at 1 and 2 years after vaccination the primary response was the only significant factor .
How To Get Tested
Hepatitis B testing is typically prescribed by a doctor and performed in a hospital, lab, or other medical setting. Taking a hepatitis B test requires a blood sample, which can be collected by a health care professional.
For laboratory-based testing, blood is drawn from a patientâs vein. After blood is collected, the sample is sent to a laboratory for analysis.
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The Immunological Effect Of Booster Vaccination In Non
To confirm the efficacy of booster HBV vaccination in non-responders and low-responders, we evaluated 33 subjects at 1 year after booster vaccination and 10 subjects at 2 years after booster vaccination. Although the anti-HBs titer increased significantly after booster vaccination, this response was not sustained .
Serial changes in the anti-HB titers of subjects who received a booster vaccination. The vertical axis shows the change in anti-HB titer over time. The horizontal axis shows the indicated time points at which the anti-HB titer was measured at 1 year and 2 years after vaccination. Statistical significance was evaluated using the Friedman test. P values of < 0.05 were considered to indicate statistical significance. n.s.: not significant
Questions For Your Doctor About Test Results
Patients may find it helpful to ask questions about their hepatitis B test results. Questions that may be helpful include:
- What was my test result?
- Do I have an acute or chronic hepatitis B infection?
- Does the test result suggest that I have immunity for hepatitis B?
- Would I benefit from hepatitis B vaccination?
- Do I need any follow-up tests based on my hepatitis B test results?
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Why It Is Done
You may need testing if:
- You have symptoms of hepatitis.
- You may have been exposed to the hepatitis B virus. You are more likely to have been exposed to the virus if you inject drugs, have many sex partners, or are likely to be exposed to body fluids .
- You’ve had other tests that show you have liver problems.
- You are pregnant.
- You or your doctor wants to know if you are protected from getting the disease.
The tests also are done to help your doctor decide about your treatment and see how well it’s working.