Hepatitis B

Hepatitis B is a severe form of hepatitis caused by a virus referred to as HBV. It is contagious and is spread by four major routes of transmission:

• Perinatal - An infected mother passes the virus to her child during birth. The risk of this type of exposure has been reduced 95 percent by the induction of hepatitis B vaccination and immunoglobulin therapy at the time of delivery.
• Household contacts - The passing of the virus from person to person within the same household. This is usually spread via infected saliva, blood or other body fluids through scratches or other lesions.
• Blood - The penetration of the skin by an object infected with the hepatitis B virus. The most common source of infection is HBV infected blood transmitted via intravenous drug abuse, tattooing, ear piercing, accidental needle stick injuries etc.
• Sexual - HBV is spread through having sex with an infected person without using a condom. Homosexual men and those with multiple sexual partners are at increased risk of hepatitis B due to their increased exposure to potentially contaminated body fluids such as blood, semen and vaginal secretions.

Hepatitis B is not spread through food or water or by casual contact. Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus or HIV.

Outcome

The outcome of infection is variable ranging from asymptomatic (without symptoms; 30%) through to severe hepatitis which may result in death in a small number of cases. Following infection some individuals become chronic carriers of the virus. Those who become chronic carriers are at risk from long-term health problems such as cirrhosis of the liver and primary liver cancer and are a source of infection to others.

Signs and symptoms are less common in children than adults and include: jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting and joint pain.

People at Risk

People at risk include: injection drug users, people who have sex with an infected person, men who have sex with men, persons with multiple sex partners or diagnosis of a sexually transmitted disease, children of immigrants from disease-endemic areas, people who live with an infected person, infants born to infected mothers, health care workers, those who travel to areas where hepatitis B is common and hemodialysis patients.

Prevention and Advice

• Hepatitis B vaccine is the best protection.
• If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. [The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.]
• If you are pregnant, you should get a blood test for hepatitis B; Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
• Do not inject drugs; if you inject drugs, stop and get into a treatment program; if you can't stop, never share needles, syringes, water, or "works", and get vaccinated against hepatitis A and B.
• Do not share personal care items that might have blood on them (razors, toothbrushes).
• Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.
• If you have or had hepatitis B, do not donate blood, organs, or tissue.
• If you are a health care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps.
• All sexually active individuals should be vaccinated for hepatitis B prevention.

Vaccine Recommendations

The hepatitis B vaccine has been available since 1982 and is the best protection against HBV. Three doses are commonly needed for complete protection. In May 2001, the Food and Drug Administration (FDA) licensed a combined hepatitis A and B vaccine (Twinrix®) for use in persons aged over 18 years. Use of hepatitis B vaccine and other vaccines is strongly endorsed by the medical, scientific and public health communities as a safe and effective way to prevent disease and death.

Treatment and Medical Management

• There are medications available to treat long-lasting HBV-infection. These work for some people, but there is no cure for hepatitis B when you first get it.
• HBV infected persons should be evaluated by their doctor for liver disease.
• Alpha interferon and lamivudine are two drugs licensed for the treatment of persons with chronic hepatitis B. These drugs are effective in up to 40% of patients.
• Pregnant women should not use these drugs.
• Drinking alcohol can make your liver disease worse

Trends and Statistics

Hepatitis B is a serious disease, responsible for an estimated 4,000 to 5,000 deaths each year in the United States due to cirrhosis and liver cancer. The number of new infections per year has declined from an average of 450,000 in the 1980s to about 180,000 in 1998. It is estimated that there are 1.3 million chronically infected Americans, of whom 20 to 30 percent acquired their infection in childhood; over half are Asian Americans who immigrated to the United States. People of all ages get hepatitis B, with the highest rate of disease occurring in 20-49 year-olds. Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination.

The disease is a major public health problem worldwide. It is estimated that 5 percent of the world's population, approximately 350 million, are chronic carriers of the hepatitis B virus (260 million reside in Asia) and that the virus is responsible for 1 million deaths each year [World Health Organization, 1996]. In Asia and sub-Saharan Africa 10% (5-20%) of the population are HBV carriers.

Complications of Hepatitis B

The majority of adults who contract hepatitis B will recover fully and develop life long immunity to the disease. One third of infections are totally without symptoms and this is referred to as a sub-clinical infection. One third will experience a flu-like illness without jaundice and very often this goes undiagnosed. One third however will present with a full-blown hepatitis with high fever, abdominal pain, vomiting and jaundice and of these less than one per cent will develop a severe hepatitis. This form of hepatitis is referred to as the fulminant form and is often fatal.