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.
What Is The Best Way To Prevent Hepatitis B
The best way to prevent hepatitis B is by getting vaccinated. You must complete the series of shots for full protection. All infants should receive their first dose of the hepatitis B vaccine within 24 hours of birth, followed by a second dose at 1 to 2 months, and a third dose at 6 to 18 months. Infants who did not receive a birth dose should begin the series as soon as possible.
All unvaccinated children and adolescents younger than 19 years of age should get vaccinated.
All adults 19 through 59 years of age are recommended to get vaccinated.
Adults 60 years and older with risk factors should get vaccinated.
A combination vaccine that provides protection against both hepatitis A and B is available for those age 18 years and older. This vaccine is a series of 3 shots over a period of 6 months.
Immune globulin gives short-term prevention of hepatitis B in people of all ages recently exposed to hepatitis B, but the vaccine is preferred for long-term prevention.
Treatment For Chronic Hepatitis B
If blood tests show that you still have hepatitis B after 6 months, your doctor may recommend medication to reduce the risk of complications of hepatitis B and regular tests to assess the health of your liver.
Treatment is usually offered if:
- your immune system is unable to control the hepatitis B by itself
- there’s evidence of ongoing liver damage
Hepatitis B medications can help keep the virus under control and stop it damaging your liver, although they won’t necessarily cure the infection and some people need lifelong treatment.
The main medicines for chronic hepatitis B are outlined below.
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What Are The Medications For Hepatitis B
All of the following medications used to treat chronic hepatitis B are antiviral medications. They reduce the ability of the virus to reproduce in the body and give the liver a chance to heal itself. These drugs are not a cure for hepatitis B, but they do reduce the damage caused by the virus. Although these medications are similar in some ways, they differ in other important ways. Talk to your health care practitioner about the best medication for you.
Pegylated interferon alfa-2b
Pegylated interferon is used alone or in combination with other medications.
Nucleoside/nucleotide analogues
Nucleoside/nucleotide analogues are compounds that mimic normal building blocks for DNA. When the virus tries to use the analogues, it is unable to make new viral particles. Examples of these agents include adefovir , entecavir , lamivudine , Telbivudine and tenofovir .
How Many People Have Hepatitis B
In the United States, an estimated 880,000 to 1.89 million people are chronically infected with HBV. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2020, 2,157 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 14,000 acute hepatitis B infections. The rate of acute cases of HBV decreased by 32% after 2019 which may be related to the disruptions of the COVID-19 pandemic. For the most recent surveillance data visit CDC Viral Hepatitis Surveillance.
Globally, HBV is the most common blood-borne infection with an estimated 296 million people infected according to the World Health Organization .
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Who To Screen For Current Or Prior Infection
The following populations are considered at high risk of hepatitis B virus infection.
Which tests to use: Screen for current or prior infection with HBsAg, HBsAb, HBcAb Total
- Anyone born in or traveling to a region of intermediate to high HBV prevalence
- Asia: North Asia, Southeast Asia, and East Asia
- Malta and Spain
- Indigenous populations of Northern Canada
- Mexico, Guatemala, and Honduras
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 âHBsAgâ. 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 âHBcAg,â 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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Data Collection And Cleaning
Data was collected into a Redcap database. All variables were inspected for outliers, inconsistencies, missing data and distribution. Continuous variables were summarized while categorical variables were tabulated to identify inconsistencies and outliers. Visual inspection using scatter plots and histogram was also used to identify outliers and distribution of the data. No inconsistencies or outliers were identified in the data.
Ethics Approval And Consent To Participate
Ethical approval for the study was obtained from Institutional Research and Ethical Committee of Moi University/Moi Teaching and Referral Hospital. The ethical committee waived the need for written consent since this analysis was done retrospectively. All the clinical data has been de-identified as per the ethical board requirement.
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Hepatitis B Virus: Who Is At Risk And What Can We Do
Michelle Sahr, PharmDSupplements
The hepatitis B virus is spread through contact with infected blood or bodily fluids, usually passing into a host via damaged skin or mucous membranes, such as the eyes or genitalia.
The hepatitis B virus is spread through contact with infected blood or bodily fluids. The virus usually passes into a host via damaged skin or mucous membranes, such as the eyes or genitalia. HBV is viable for at least 7 days outside a host therefore, the virus can be spread for days in areas visited by an infected individual. HBV can incubate for 40 to 90 days before signs and symptoms are detected.1 With a lack of early and specific symptomology, many cases of HBV infection go undetected until severe liver damage has occurred.2 Because of these factors, vaccination for HBV is critical for almost everyone, especially anyone working or living in a high-risk environment such as a health care setting, or among household contacts or sexual partners who are infected with HBV.1,3
AVAILABLE HEPATITIS B VACCINES
Five FDA-approved hepatitis B vaccines are available. They differ in their antigen composition , dosing guidelines, and approved patient populations.6
TARGET PATIENT POPULATION
COUNSELING TIPS
Michelle Sahr, PharmD, is an assistant professor of pharmacy practice in the Pharmaceutical Sciences Department at Ferris State University College of Pharmacy in Big Rapids, Michigan.
REFERENCES
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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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What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
Acute
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
Chronic
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
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.
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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 you’re pregnant and have hepatitis B, you can also pass it onto your baby during pregnancy or birth.
What Causes Hepatitis B
Hepatitis B is caused by the hepatitis B virus. It can happen through exposure to infected blood and other bodily fluids in the following situations:
- sharing needles and other injecting drug equipment
- sharing razors, toothbrushes or nail clippers
- tattooing with unsterilised needles and equipment
- close family contact with someone who has hepatitis B
- being born to a mother with hepatitis B
- accidental exposure such as a needle stick injury or being splashed with infected blood or body fluid
- blood transfusion this is now very rare as blood in Australia is screened for hepatitis B
You cannot catch hepatitis B through being coughed or sneezed on by infected people or by consuming contaminated food and drink. You cannot catch the virus from saliva, breast milk or tears.
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How Is Hepatitis B Diagnosed
Hepatitis B is diagnosed via blood tests. Blood tests can help your clinician determine whether you have hepatitis B and if its acute or chronic.
In some cases, your clinician might also suggest a liver ultrasound. An ultrasound can show whether your liver is damaged and to what extent.
The hepatitis B vaccine is the most effective way to prevent infection. You might have to have two or three shots depending on the type of vaccine you receive.
The now recommends the hepatitis B vaccine for:
- all infants within 24 hours of birth
- children and adolescents who werent vaccinated at birth
- unvaccinated adults under the age of 59
- unvaccinated adults ages 60 and older who are at risk of hepatitis B
You can also reduce your risk of exposure to hepatitis B by:
- using condoms and other barrier methods during sexual activity
- avoiding exposure to other peoples blood
- avoiding sharing razors, needles, and toothbrushes with others
If youre concerned about hepatitis B exposure, consider speaking with a healthcare professional about getting the vaccine.
What Are The Treatments For Hepatitis B
If you think you may have been exposed to hepatitis B, its important to talk with a healthcare professional as soon as possible.
A doctor or other healthcare professional may administer the first dose of the hepatitis B vaccine and a shot of hepatitis B immunoglobulin. This is a combination of antibodies that provide short-term protection against the virus.
Though both can be given up to a week after exposure, theyre most effective at preventing infection if administered within 48 hours.
If you receive a diagnosis of acute hepatitis B, a doctor may refer you to a specialist. They may advise you to get regular blood tests to ensure you dont develop chronic hepatitis.
Many people with acute hepatitis B dont experience serious symptoms. But if you do, it can help to:
- get plenty of rest
- take over-the-counter pain mediation, like naproxen, when needed
Other lifestyle changes may also be needed to manage your infection, such as:
- eating a nutritious, balanced diet
- avoiding substances that can harm your liver, such as:
- certain herbal supplements or medications, including acetaminophen
If blood tests show you still have an active infection after 6 months, your doctor may recommend further treatment, including medications to help control the virus and prevent liver damage.
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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.
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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Treatment For Acute Hepatitis B
If you’re diagnosed with hepatitis B, your GP will usually refer you to a specialist, such as a hepatologist .
Many people don’t have any troublesome symptoms, but if you do feel unwell, it can help to:
- get plenty of rest
- take over-the-counter painkillers, such as paracetamol or ibuprofen, for abdominal pain
- maintain a cool, well-ventilated environment, wear loose clothing, and avoid hot baths or showers if itching is a problem
- take medication such as metoclopramide to stop you feeling sick and chlorphenamine to reduce itching your doctor can give you a prescription for these if necessary
Most people recover completely in a couple of months, but you’ll be advised to have regular blood tests to check that you’re free of the virus and haven’t developed chronic hepatitis B.
What Should I Do If I Have Been Exposed To Hepatitis B Or Get Sick With Hepatitis B
If you are exposed to hepatitis B or get sick with it, call your healthcare provider or local health department. If you haven’t been vaccinated against hepatitis B and you’ve been exposed recently, you can get hepatitis B vaccine or immune globulin. You need to do this within 24 hours to help prevent infection with the hepatitis B virus.
There is no medical treatment for acute hepatitis B. Doctors recommend a sick person rest, get good nutrition, and drink fluids. Some people may need to be hospitalized.
People with chronic hepatitis B need to be under the care of a doctor who has experience treating hepatitis B. They need regular monitoring for signs of liver disease and evaluation for possible treatment. Chronic hepatitis B is treated with several approved medications, but once medication is started, the infected person will need to take medication for life.
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