What
is hepatitis B (HBV)?
Hepatitis B is a virus that causes inflammation or swelling of
the liver. While most people recover, chronic or long lasting
hepatitis B can cause liver damage, which can lead to cirrhosis
(scarring of the liver) and liver cancer. Up to 5,000 people die
each year in the United States from hepatitis B.
How common is hepatitis B?
According to Centers for Disease Control and Prevention (CDC),
it is estimated that 1.25 million people in the United States
have chronic (long lasting) hepatitis B. There were (estimated)
73,000 new infections in the United States in 2003.
How can I get hepatitis B?
Hepatitis B is spread through direct contact with blood, semen
(cum), or vaginal secretions (wetness).
- Hepatitis
B can be spread through unprotected vaginal, anal, or oral sex.
In adolescents and adults, this is how the disease is most often
spread.
- Hepatitis
B can also be transmitted (passed) by injecting drug users who
share needles or other injecting equipment (pots, cookers, cottons,
water, spoons, etc) that has been contaminated (infected) with
hepatitis B infected blood.
- Mothers
who have hepatitis B can pass it on to their babies during birth.
Although
rare, hepatitis B can be spread in the following ways.
- Saliva
can be a means of transmission through bites (since bites
normally involve blood or an open wound). However, this is not
the case with other exposures to saliva, such as kissing.
- The risk
of transmission from blood transfusion is currently low in the
U.S. since blood banks test all donated blood.
- Although
un-sterilized (unclean) tattoo, body piercing, and acupuncture
needles may transmit hepatitis B, it is rare.
Hepatitis
B is found in transmittable (contagious) levels in body fluids
including:
- Semen (cum)
- Vaginal
secretions (wetness)
- Saliva
- Blood
Hepatitis
B has also been found in low amounts in other body fluids (see
below), but these fluids have NOT been associated with transmission:
- Tears
- Dark-colored
urine (pee)
- Feces (poop)
- Breast
milk
- Cerebral
(brain) and spinal (backbone) fluids
HBV
is not spread through food or water or by casual contact.
What are the signs or symptoms of hepatitis
B?
Many adults have few or no symptoms. Symptoms may mimic the flu
and can include:
- Malaise
(feeling of ill-health)
- Fatigue
(feeling tired all the time)
- Anorexia
(loss of appetite)
- Nausea
(feeling like vomiting)
- Abdominal
discomfort (stomach pain)
- Dark-colored
urine
- Jaundice
(yellow skin and eyes)
- Rash or
arthritis
A few patients
(1%) have a more severe illness and may experience sudden and
severe liver failure within a short period of time after infection.
These people may suddenly collapse with fatigue, have jaundice
(yellow skin and eyes), and develop swelling in their abdomen
(stomach). This can be deadly if not treated immediately.
How
can I find out if I have hepatitis B?
Your health
care provider can tell you by using a blood test. Special blood
tests can determine whether a person has acute (short term) or
chronic (long term) hepatitis.
Hepatitis
B is not usually included in the routine blood tests that a doctor
orders, so patients may have to ask their health care provider
(doctor) for the test.
There are three standard blood tests for hepatitis B:
- One test
checks to see if you are currently contagious.
- Another
test can tell if you have had the disease before or if you’ve
been vaccinated and are now immune to the hepatitis B virus.
- A third
test can tell if the infection is long-lasting (chronic) or
short-term (acute) hepatitis B infection.
In some cases,
a health care provider will run all 3 tests.
Hepatitis
B usually takes between 3 weeks and 2 months to show up in the
blood; so it may take up to 2 months for a test to be accurate.
If chronic
(long lasting) hepatitis B is suspected, other tests may be ordered.
These tests can help to decide treatment options and could include:
- Ultrasound
-- detects signs of liver damage and liver cancer
- Liver
Biopsy – detects signs of liver damage and cancer
- Liver
Function Tests -- indicates damage to liver cells.
- E-Antigen
Test -- detects e-antigen, a protein made by hepatitis B-infected
cells; monitors the effectiveness of some hepatitis B therapies.
Some people
who get the hepatitis B vaccine
may benefit from testing to make sure the vaccine is working.
(The test should be performed within 2 months after the last shot.)
These individuals include:
- A person
whose sex partner has chronic (long lasting) hepatitis B
- A person
whose immune system is compromised (i.e. someone living with
HIV or AIDS)
- A person
whose job exposes him or her to human blood
- A child
who is born to a mother with hepatitis B
What
can I do to reduce my risk of getting hepatitis B?
VACCINATION BEFORE EXPOSURE TO HEPATITIS B: Hepatitis B is
preventable through a vaccine. Since the hepatitis D virus can
only co-exist (survive) with the hepatitis B virus,
getting vaccinated against hepatitis B also protects
you against hepatitis D.
- The hepatitis
B vaccine is given in a series of three doses (shots).
- The first
and second shots must be given at least one month apart.
- The first
and third shots must be given at least four months apart.
- If a shot
is missed, it should be given as soon as possible.
- The series
should not be restarted if a shot is missed.
- HIV can
impair (weaken) the body’s response to the hepatitis vaccine.
- A combination
vaccine called TwinrixÒ is available that protects against both
hepatitis A and B in persons 18 and older. It reduces the total
number of injections (shots) for both vaccines from five to
three.
Hepatitis
B vaccine is recommended for everyone 18 years of age and younger
and for adults over 18 who are at risk of infection. (However,
anyone can be vaccinated.) Those at high risk include the following:
- Health
care professionals
- Clients/staff
of institutions for the developmentally disabled
- Sexually
active men who have sex with men
- People
who live with or have sex with chronic hepatitis B carriers
- Travelers
to and immigrants from countries with high rates of hepatitis
B (high numbers of people who get hepatitis B)
- Sexually
active heterosexual men and women, including:
- those
who have been diagnosed with another sexually transmitted
disease (STD)
- those
who have had more than one sex partner in the past six months
- those
who have received treatment in an STD clinic
- those
who are sex workers or prostitutes
- Injecting
and non-injecting drug users
- Hemodialysis
(kidney disease) patients
- Recipients
of certain blood products (like hemophiliacs)
- Prisoners
in long-term correctional facilities.
IMMUNE
GLOBULIN (IG) AFTER EXPOSURE TO HEPATITIS B: If a person
comes in contact with hepatitis B and has NOT been vaccinated,
they can receive a kind of shot called post-exposure immune globulin
(HBIG) and the hepatitis B vaccine to prevent getting sick.
- For unvaccinated
people who have come in contact with the hepatitis B virus,
a dose of hepatitis B immune globulin (HBIG) may prevent illness.
- The hepatitis
B vaccine given with HBIG is also recommended. (Getting the
hepatitis B vaccine along with the hepatitis B
immune globulin works better than the HBIG alone.)
- Both shots
(hepatitis B plus HBIG) should be given within 7 days of coming
in contact with the hepatitis B virus.
- Since 1985,
all plasma (blood) units used to make immune globulin have been
screened (tested) for HIV.
SEXUAL
PREVENTION:
- Abstinence
(choosing to not have sex) and mutual monogamy (sex between
two uninfected partners who don’t have sex with anyone
else) provides a high level of protection.
- Latex condoms
provide effective protection during vaginal and anal sex. Condoms
reduce contact with infected bodily fluids (i.e. semen (cum),
vaginal secretions (wetness) and blood).
- A non-lubricated
latex condom can be used for mouth-to-penis contact. Household
plastic wrap, dental dams or a latex condom cut lengthwise and
opened flat can reduce the risk of transmission during mouth-to-vagina
or mouth-to-anus (butt hole) contact.
NON-SEXUAL
PREVENTION:
- Avoid contact
with infected blood or other body fluids. Do not share objects
such as needles, razors, toothbrushes, etc.
- Clean surfaces
that have been contaminated (infected) with blood or other body
fluids with a mixture of 1 part household bleach and 10 parts
tap water.
- Cover cuts,
sores, and rashes with bandages.
What is
the treatment for hepatitis B?
Treatment for hepatitis B varies depending on whether the infection
is acute (short term) or chronic (long term).
Acute (newly acquired):
- No specific treatment is available for acute HBV infection.
- Most patients with acute viral hepatitis experience a self-limited illness (one that runs a defined, limited course), and go on to recover completely.
- There is no accepted therapy and no restrictions on diet or activity.
- In most cases, hospitalization should be avoided, to prevent spread of the virus to other patients. It should, however, be considered for patients who are severely ill.
- Your health care provider can recommend the best options based on your individual needs for care.
Chronic (persistent):
- Interferon is used to help stop the replication of HBV. It is called an antiviral agent. Interferon has been 40 percent effective in eliminating chronic HBV infection. Persons who became infected during adulthood were most likely to respond to this treatment. Long-term follow up of treated patients suggests that remission of chronic HBV from treatments with interferon is of long duration. Talk to your health care provider about the use of Interferon.
- Lamivudine (Epivir) is now available to treat chronic HBV. It is the first medication specifically formulated to do so. Talk to your health care provider for more information about lamivudine and to learn if it is right for you.
- Adefovir dipivoxil (Hepsera™), is the first nucleotide analog approved to treat chronic HBV. Adefovir dipivoxil slows the progression of chronic HBV by interfering with the virus' replication process within the body. Results show that adefovir dipivoxil can significantly reduce liver inflammation and scarring. It has been shown to work in people who have resistance to the drug lamivudine. Consult your health care provider for more information about adefovir dipivoxil and to learn it is right for you.
- Entecavir (Baraclude™) slows the progression of chronic hepatitis B by interfering with viral reproduction. In clinical studies, patients treated with entecavir showed significant improvement in the liver inflammation caused by HBV and an improvement in the degree of liver fibrosis (scarring). It is important to stay under your doctor's care while taking entecavir. Baraclude™ was approved by the Food & Drug Administration (FDA) in March 2005. Talk to your doctor to learn more about this treatment.
- Peginterferon (Pegasys®) is the first and only pegylated interferon approved for the treatment of chronic hepatitis B, including both variations of the virus. Peginterferon has a dual mode of action; it slows replication of the hepatitis B virus and boosts the immune system. Pegasys® was approved by the FDA to treat chronic hepatitis B in May 2005. Talk to your doctor to learn more about peginterferon.
Why
worry about hepatitis B?
Hepatitis B can cause:
- Chronic
(long lasting) infection
- Cirrhosis
(scarring) of the liver
- Liver cancer
- Death
The good news
is that hepatitis B is preventable through vaccination (shots).
A person can choose to be vaccinated and no longer have to worry
about being infected with HBV.
Do I need to talk to my partner (boyfriend
or girlfriend) about hepatitis B?
Yes. If you have hepatitis B, you should discuss it with your
partner so that he or she can learn how to protect his or herself
from becoming infected.
Do I need to talk to my health care provider about hepatitis
B?
Yes. Since hepatitis B is a preventable disease through vaccination,
it is a good idea to talk to your health care provider about whether
the vaccine is right for you.
If you find out you have been exposed to hepatitis B, talk to
your health care provider as soon as possible to discuss the best
options to help prevent infection.
Where can I get more information?
If you have additional questions about hepatitis B, call the National
STD and AIDS Hotlines at 1-800-342-2437
or 1-800-227-8922. The hotlines are open 24 hours a day, seven
days a week. For information in Spanish call 1-800-344-7432, 8:00
a.m. to 2:00 a.m. Eastern Time, seven days a week. For the Deaf
and Hard-of-Hearing call 1-800-243-7889, 10:00 a.m. to 10:00 p.m.
Eastern Time, Monday through Friday. The hotlines provide referrals
and more answers to your questions. Be sure to request free printed
information on hepatitis B when you call the hotlines.
For more information
about the hepatitis B vaccine, call the National Immunization Information Hotline
at 1-800-232-2522 or 1-800-232-0233 for information in Spanish.
The hotline is open Monday through Friday from 8:00 a.m. to 11:00
p.m., Eastern Time. For the Deaf and Hard-of Hearing Call 1-800-243-7889,
10:00 a.m. to 10:00 p.m. Eastern Time, Monday through Friday.
Other Resources
CDC’s
Division of Viral Hepatitis
CDC’s
National Immunization Program
Hepatitis Foundation International
American Liver Foundation
Immunization
Action Coalition (IAC)
Parents
of Kids with Infectious Diseases (PKID)
