Hepatitis

What is hepatitis B?

Hepatitis B is a serious liver disease that is caused by the hepatitis B virus (HBV). It is extremely infectious and can be transmitted sexually or from contact with infected blood or body fluids. Although HBV can infect people of all ages, young adults and adolescents are at greatest risk. HBV directly attacks the liver and can lead to severe illness, liver damage, and in some cases death. Although there is no cure for hepatitis B, there is a safe and effective vaccine that can prevent the disease.

HBV is highly infectious and is spread through contact with the blood and other body fluids (including semen, vaginal secretions, and breast milk) of infected individuals. It can be transmitted through:

• Sexual contact (vaginal, anal, or oral) with an infected person
• Sharing needles, IV drugs, and drug paraphernalia
• Use of contaminated razors or tattooing needles
• Pregnancy and/or birth resulting in perinatal exposure (exposure of the baby to the virus)
• Occupational exposure to blood or other body fluids of an infected person (e.g. needlestick injuries)

Hepatitis B can also be transmitted by other means, such as blood transfusion, intranasal cocaine use with shared straws, shared items such as toothbrushes, and use of unclean skin-cutting tools or surgical equipment. 

Unlike hepatitis A, a related virus, hepatitis B is not spread through food or water.

Risk Factors

The primary risk factors for hepatitis B include:

• Engaging in sex without a barrier, particularly unprotected receptive anal sex
• Having sex with more than one partner or with a partner who has or has had more than one partner or who uses or has used IV drugs
• Sharing needles, IV drugs, and drug paraphernalia
• Recent history of STD infection
• Having a blood transfusion or treatment with infected blood products
• Getting a tattoo or piercing
• Having a job (such as a health care worker) that exposes one to blood or other body fluids
• Traveling or living in areas with high rates of HBV infection (including Southeast Asia, the Amazon basin in South America, the Pacific Islands, the Middle East

Although there is no cure for the HBV, there is a safe and effective vaccine that can prevent hepatitis B. This vaccine has been available since 1982 and is given in a series of three shots. It provides protection against hepatitis B in 90-95% of those vaccinated.

Getting vaccinated is the best way to reduce your risk of getting hepatitis B. It is recommended the vaccine be administered to:

• Individuals who engage in high-risk behaviors (including unprotected sex, sex with multiple partners, sharing needles)
• All babies
• Adolescents
• Individuals who live with people infected with HBV
• Individuals who live in areas with high rates of HBV infection

In addition, other ways to reduce your risk include: 

• Using latex or polyurethane condoms during sex (whenever there is a chance that a sex partner is susceptible to HBV, including unvaccinated or previously uninfected regular partners)
• Limiting the number of your sex partner
• Avoiding sharing needles, IV drugs, and drug paraphernalia
• Avoiding skin-piercing or tattoos
• Practicing standard precautions if you are a health care worker
• Using care when handling any items that may have HBV-infected blood on them (such as razors, toothbrushes, nail clippers, sanitary napkins, and tampons

Symptoms

Many people with hepatitis B have no or only mild symptoms. However, some people experience flu-like symptoms or may develop jaundice (yellowing of the skin).  

Symptoms of hepatitis B include:

• Fatigue
• Nausea or vomiting
• Fever and chills
• Dark urine
• Light stools
• Yellowing of the eyes and skin (jaundice)
• Pain in the right side, which may radiate to the back

Impact on Pregnancy

Women with advanced liver disease are at increased risk for suffering complications during pregnancy. Pregnant women with hepatitis B can transmit the virus to their babies. Transmission is believed to occur during delivery. Most infected babies who are not treated promptly will become chronic carriers and be at increased risk for liver cirrhosis, liver failure, and liver cancer. Therefore, all pregnant women should be tested for HBV. If a pregnant woman is found to be positive for the virus, treatment for the baby should begin immediately after delivery. Treatment includes the hepatitis B vaccine as well as HBV immune globulin. In addition, the baby will receive the additional two vaccination shots during follow-up visits. Pregnant women seeking STD treatment who have not been previously vaccinated and test negative for hepatitis B, should receive the hepatitis B vaccine. This vaccine can be given during pregnancy.

Testing, Reporting & Treatment

State law mandates that all pregnant women be tested for hepatitis B surface antigen (HBsAg).  Positive results must be reported to the County of Riverside Community Health Agency Department of Public Health on a Confidential Morbidity Report (CMR) by fax or mail.  Reports may also be made by telephone.  When Disease Control receives the CMR, a referral is made to the Perinatal Hepatitis B Prevention Program Coordinator within the Immunization Branch.  The coordinator then does follow-up to ensure these infants receive appropriate preventive treatment.  Close household contact are also referred for evaluation and immunization if indicated.   

Hepatitis B can be diagnosed by blood tests. Routine blood work, which includes testing for liver function, may indicate infection. In addition, a specific blood test for the virus can give a definitive diagnosis of hepatitis B. 

There is no specific treatment or cure for acute hepatitis B and no drugs have been shown to alter the course of infection once someone becomes ill. However, for individuals with chronic hepatitis B, interferon therapy may help. Sometimes, liver transplantation is necessary for severe cases.

Symptoms of hepatitis B can be treated. For example, restricting fat and drinking clear liquids can help relieve symptoms such as nausea, vomiting, and diarrhea. In addition, it is recommended that individuals with hepatitis B:

• Get plenty of rest
• Drink plenty of fluids
• Eat a high-protein diet to repair damaged cells
• Eat a high-carbohydrate diet to protect the liver
• Avoid alcohol

Keep in mind that HBV can be transmitted to others via sex or contact with items that are contaminated with blood (such as razors, toothbrushes, nail clippers, sanitary napkins, and tampons). Remember that most infections are self-limiting and the virus is cleared from the body. A blood test can confirm if the virus has been cleared from one's body.