M.Noar, M D

HEPATITIS B

    Hepatitis B is a virus that causes the liver to become inflamed. Most people fight off the infection themselves. However, approximately 5-10% of those people who are infected with the virus will become carriers, an estimated 5-10% of those people infected each year will progress to chronic liver disease, cirrhosis and possibly liver cancer.
    There are over a million carriers of the hepatitis B virus in the United States and an estimated 200,000 people contract this serious liver disease each year.
    This disease is more infectious than AIDS and is transmitted through infected blood and other body fluids (seminal fluid, vaginal secretions, breast milk, tears, saliva and open sores). However, in approximately 30-40% of cases the method of transmission is unknown.

Protection Against Hepatitis B

    You can protect yourself against hepatitis B with a safe and effective vaccine. To be fully protected three injections are required; the second one a month after the first injection and the third one six months later. Hepatitis B vaccination shots are recommended for all newborns, infants and teenagers. Shots may be given at any age. Most cases of hepatitis B occur among sexually active young adults, therefore, teenagers are an important group to be vaccinated. This vaccine provides immunity for most people for at least five years and possibly longer.
Who is at Risk for Hepatitis B?

People who are exposed to blood or body fluids of an infected person are at risk. You may also be at risk if you -

are exposed to blood on the job - first aid or emergency worker, funeral director, police personnel, dentist or dental assistant, medical personnel, etc.;

live in the same household with an infected person;

have sex with a carrier or chronically infected person;

use intravenous drugs;

have more than one sex partner;

received a blood transfusion prior to 1975 (when a test to screen blood was developed);

have hemophilia;

work or are a patient in a health or long term care facility;

work or are incarcerated in a prison;

travel to countries with a high incidence of hepatitis

Ethnic or racial groups with a high rate of infection are: Blacks, Asians, Pacific Islanders, Hispanics, American Indians and Alaskan Natives.

How To Avoid Becoming Infected

get vaccinated (make certain you get all three injections);

use condoms;

wear gloves when touching or cleaning up blood on personal items, tissues, tampons or other items;

clean area with blood on it with one part household bleach and 10 parts water;

don't share razors, toothbrushes or pierced earrings with anyone;

don't share chewing gum or pre-chew food for a baby;

make certain any needles for drugs, ear piercing or tattooing are properly sterilized.

Hepatitis B Is Not Spread By Casual Contact Such As:

holding hands;

kissing on the cheek or dry lip kissing;

eating food prepared by a carrier;

visiting an infected person;

playing with a child who is a carrier;

sneezing or coughing.

Many Don't Know How They Become Infected

    An estimated 40% of people who have been infected with hepatitis B do not know how or when they became infected.

How Do You Know You Have Hepatitis B?

    Most people who get hepatitis B have no recognizable signs or symptoms. The only way the disease can be positively identified is through a blood test. Many people are surprised to learn when they have donated blood that they test positive for hepatitis B.
    Hepatitis blood tests are not usually included in routine blood tests done when having a physical examination.

Some People Have Symptoms That Mimic The Flu

nausea and vomiting;

loss of appetite

fever;

weakness, tiredness, lasting weeks or even months;

abdominal pain;

dark urine;

yellowing skin and eyes (jaundice)

Will I Get Over Hepatitis B?

    About 90% of adults recover from hepatitis B in a few months, clearing the virus from their system and developing an immunity. They will never get hepatitis B again, however, their blood test will always show that they had been infected and blood centers will not accept their blood. This is because there is a very small chance that the test results are "false positive" for the immunity and the person might still be infected. When the anti-HBs (antibody to hepatitis B surface antigen) test is positive or reactive it means the person has recovered from a past infection, will not get it again, therefore cannot pass it on to others. This test is usually positive when a person has received the hepatitis B vaccine.

What Age Groups Are At Risk For Chronic Hepatitis?

About 10% of adults, 25-50% of young children (under 5 years) and 70%-90% of infants infected with hepatitis B who are unable to clear the infection from their bodies in six months, become carriers or are chronically infected with hepatitis B.

What Is A Carrier?

    An HBV carrier is someone who has had hepatitis B in their blood for more than six months. Children who are infected under age five have a 25%-50% chance of becoming lifelong carriers. A carrier usually has no signs or symptoms of HBV but remains infected with the virus for years or for a lifetime and is capable of passing the disease on to others. Sometimes HBV carriers will spontaneously clear the infection from their bodies, but most will not. Although most carriers have no serious problems with hepatitis B and lead normal healthy lives, some carriers do become sick because they are at significantly higher risk than the general population for liver failure or liver cancer. If you are carrying the virus you should not donate blood, plasma, body organs, tissue or sperm.

What Can A Carrier Do?

    A carrier should never have unprotected sex unless the other person is immune to hepatitis B or has been vaccinated. Remember the virus is present in blood, semen, vaginal fluids and saliva. Annual liver function tests and a test for liver cancer are recommended. Alcohol can harm the liver and should be avoided. Drugs, even over-the-counter ones, should be used under a doctor's supervision as they too may cause liver damage. A well balanced diet and regular exercise are important.

What If I Am Told I Am Chronically Infected?

    Anyone who has not cleared the virus after six months and has elevated liver enzymes is considered to have chronic hepatitis.
    This means the virus is infecting living liver cells and damaging them. Scar tissue, called cirrhosis, replaces the damaged cells. The build up of cirrhosis causes the liver to become hard and bumpy and distorts the blood flow through this vital organ. This causes a back pressure in the veins bringing nutrients from the stomach and intestines. Varicose veins form in the stomach and esophagus that can burst causing a hemorrhage resulting in vomiting blood or passing black stools. About 5,000 people die in the United States each year related to hepatitis B, 1,000 die of hepatitis B related liver cancer.
    See your doctor yearly or more frequently as recommended. Tell your doctor, dentist and sex partner you are a carrier of hepatitis.

Can Hepatitis B Be Cured?

    Currently there is only one approved treatment for hepatitis B called interferon alpha 2-b. About 15%-20% of those treated will have a lasting response. Many other medications and types of therapy are being tested to find more effective and less toxic treatments.

Link to The Hepatitis Study Center
What About Pregnancy And Hepatitis B?

    Up to 90% of pregnant women who are carriers of hepatitis B can pass it on to their newborns at delivery. All pregnant women should be tested for hepatitis B and all babies should be vaccinated at birth to protect the child from being infected and to provide immunity for at least 10 years.

Can You Get Hepatitis B A Second Time?

    There are several different hepatitis viruses, A,B,C,D & E. They all attack the liver and can cause liver cell injury. Once infected and recovered from one of these infections you will not get it a second time.

Where Do You Get The Vaccine?

    Many doctors have the vaccine available, but public health departments will vaccinate children (any uninsured children under 18) free and will charge a nominal fee for anyone including older adults. Small children need smaller doses of vaccine so the shots will be less expensive than adults. Prices vary for the 3 shots.
    Hepatitis B vaccine is only for people who are not infected chronically. Once infected, the vaccine is of no use. This does not apply to people acutely exposed, infected newborns or those infected by needle sticks.

Hepatitis B                 Possible Interpretations Of Screening Results

Test Results Interpretation Recommendation

HBsAg
anti-HBc neg.
neg. susceptible to infection/
never exposed to virus consider vaccination

HBsAg
anti-HBc pos.
pos. or neg. acute or chronic
infection further evaluation

HBsAg
anti-HBc neg.
pos. Multiple interpretations
*see below consider vaccination

HBsAg
anti-HBc therapy
anti-HBs
HBeAg (last 2
not part of screening pos.
pos.
neg.
pos.
. carrier with chronic
infection (if HBsAg
6 mos. or more),
highly infectious
. further evaluation/
consider interferon
therapy
.
.

HBsAg
anti-HBc
anti-HBs
HBeAg (last 2 not
part of screening) pos.
pos.
neg.
neg.
. carrier with chronic
infection (if HBsAg pos.
6 mos. or more), less
infectious
. further evaluation/no
interferon therapy
.
.
.

*If an individual is positive for anti-HBc and negative for anti-HBs, there are four possible interpretations:

recovering from acute HBV infection, with loss of HBsAg, but anti-HBs yet to appear (serologic window);

immune to HBV, but anti-HBs never appeared or has fallen below the level of detection;

chronic HBV infection, with low level of HBsAg that is undetectable in serum; or

false positive anti-HBc, with susceptibility to HBV infection.

Interpretations 2 and 4 are the most common explanations for this serologic pattern.

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The American Liver Foundation is the only national voluntary health organization dedicated to preventing, treating, and curing hepatitis and all other liver and gallbladder diseases through research and education.
American Liver Foundation 1425 Pompton Avenue, Cedar Grove, NJ 07009 1-800-223-0179 Copyright 1995

Please submit any questions or comments to: Endoscopic Microsurgery Associates

Test	Results	Interpretation	Recommendation
HBsAg anti-HBc	neg. neg.	susceptible to infection/ never exposed to virus	consider vaccination
HBsAg anti-HBc	pos. pos. or neg.	acute or chronic infection	further evaluation
HBsAg anti-HBc	neg. pos.	Multiple interpretations *see below	consider vaccination
HBsAg anti-HBc therapy anti-HBs HBeAg (last 2 not part of screening	pos. pos. neg. pos. .	carrier with chronic infection (if HBsAg 6 mos. or more), highly infectious .	further evaluation/ consider interferon therapy . .
HBsAg anti-HBc anti-HBs HBeAg (last 2 not part of screening)	pos. pos. neg. neg. .	carrier with chronic infection (if HBsAg pos. 6 mos. or more), less infectious .	further evaluation/no interferon therapy . . .