What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus (HBV). The hepatitis B virus is transmitted through contact with the blood and body fluids of somebody who is infected. For most people this is a very mild infection, often times subclinical, that is the patient doesn't even know they have hepatitis and present as if they have the flu or a cold. In other cases it can be more acute with more severe symptoms and even transient jaundice. You are especially at risk if you are an IV drug user who shares needles or other paraphernalia, have unprotected sexual contact with an infected partner or were born in or travel to parts of the world where hepatitis B is widespread. In addition, women with HBV can pass the infection onto their babies during childbirth. Most people infected as adults recover fully from hepatitis B and only a small percentage, 6-8%, develop a chronic infection.

Signs and Symptoms

For most people hepatitis B infection appears 4-6 weeks after you are infected and can range from mild to more severe though often times it is mild. Symptoms can include loss of appetite, nausea, vomiting, weakness, fatigue, nonspecific abdominal cramping discomfort, dark urine, yellowing of the skin (jaundice) or joint pain. Hepatitis B can damage your liver and spread to other people so even if you don't have signs or symptoms and you know you are exposed to somebody with hepatitis B, it is important to be tested.

Modes of Transmission

In the United States you are most likely to become infected with hepatitis B in the following ways:

• Sexual transmission. You can become infected if you have unprotected vaginal, anal or oral sex with an infected partner whose blood, saliva or other secretions enter your body.
• Transmission through needle sharing. The hepatitis B virus is easily transmitted through needles and syringes contaminated with infected blood. That is why sharing IV paraphernalia puts you at high risk for hepatitis B. Your risk increases if you inject drugs frequently or also engage in high risk sexual behavior.
• Transmission through accidental needle sticks. Hepatitis B is a concern for healthcare workers or anyone else who comes in contact with human blood. If you follow into these categories you certainly need to be vaccinated against hepatitis B and follow routine precautions.
• Transmission from mother to child. Pregnant women infected with hepatitis B can pass the virus to their babies. If you have hepatitis B having your baby receive a shot of hepatitis B immunoglobulin at birth along with the first series of three hepatitis B vaccines will greatly reduce your baby's risk of getting the virus.

Rsik Factors

• Having unprotected sex with more than one partner. You are at risk whether you are heterosexual, homosexual or bisexual.
• Sharing needles through intravenous drug use.
• Share a household with someone who has chronic hepatitis B.
• Have a job that exposes to human blood.
• Receive a blood transfusion or blood products before 1970 which was before we able to test for hepatitis B.
• Receive dialysis for end stage liver disease.
• Travel to regions in the world where there are high infection rates for HBV such as Africa, Southeast Asia, Amazon Basin, Pacific Islands and the Middle East.
• An adolescent or young adult residing in a U.S. correctional institution.

When to seek Medical Advice?

Seek medical care if you have signs or symptoms of hepatitis B or at risk of the disease and have not yet been vaccinated or do not know you are protected. Most children in the United States now receive HBV vaccine along with routine shots but some children especially those who do not have access to regular medical care or whose parents come from countries with high infection rates may be overlooked.

Screening and Diagnosis

If your are pregnant it is important to be checked for HBV early in your pregnancy. Also get tested if you have had unprotected sex with frequent partners, share needles or spend time in an area where hepatitis B is widespread. People who adopt children from areas where hepatitis B is common will want to have their children tested when they arrive in the United States. You and your children can be tested at your doctor's office, hospital or a public health center.

Infection Diagnosis

Because many people with hepatitis B don't have signs or symptoms, doctors diagnose the disease on the basis of one or more blood tests and these include:

• Hepatitis B surface antigen.
• Antibody to hepatitis B surface antigen.
• Antibody to hepatitis B core antigen.
• E antigen test.
• Liver enzymes.
• Alpha fetoprotein test.
• Liver ultrasound or CT scan.

Complications

Most people with acute hepatitis B fight off the infection themselves like any other virus. Once your body has successfully eradicated the virus from your symptom you are then immune to the hepatitis B virus and can no longer contract it. Only a small percentage of people exposed to the hepatitis B virus develop chronic hepatitis B, that is the virus stays in your system. This number is estimated to be from 6-8%. Anybody with chronically infected hepatitis B is also susceptible to the development of scarring of the liver and eventual chronic liver disease and/or cirrhosis. Once you have cirrhosis this puts you at higher risk for developing cancer of the liver.

Treatment

If you have been exposed to hepatitis B and it becomes chronic then you may be a candidate for treatment. There are a number of treatments available for hepatitis B which includes Interferon, Lamivudine, Adefovir, and Entecavr. There is a large amount of research being done on treatment for hepatitis B as well as a number of ongoing treatment protocols and these are changing all of the time. Therefore a discussion as to what the current and popular treatment for hepatitis B cannot be given today. It is important that anybody with chronic hepatitis B gets an evaluation with a hepatologist (liver specialist), particularly somebody who has an emphasis in experience on treating hepatitis B. The recommendations for treatment are changing all of the time.

For More Information

You can also get information about hepatitis B from these groups:

American Liver Foundation
Hepatitis Foundation International (HFI)