Hepatitis B

What is Hepatitis B?

Hepatitis B (formerly known as serum hepatitis) is a liver disease caused by a virus. The disease is fairly common. 4-5% of Indian population is infected with it.

Who are at Risk for Hepatitis B?

Anyone can get hepatitis B, but those at greater risk include:

  • Drug users who share needles; certain health care workers who have contact with infected blood;
  • Persons who have unprotected sex with multiple partners;
  • People in live in institutions such as developmental centers;
  • Hemodialysis patients;
  • Certain household contacts of an infected person
How is the Virus Spread?

Hepatitis B virus can be found in the blood and, to a lesser extent, saliva, semen and other body fluids of an infected person. It is spread by direct contact with infected body fluids, usually by needle stick injury or sexual contact. Hepatitis B virus is not spread by casual contact.

How is Hepatitis B Diagnosed?

The hepatitis B blood panel is made up of various tests, but you only need to give one blood sample. This test can be done easily in your doctor’s office or local health clinic.

  • Hepatitis B Surface Antigen (HBsAg): if this test is positive, then thehepatitis B virus is present in the blood. This means that you have a hepatitis B infection.
  • Hepatitis B Surface Antibody (HBsAb or anti-HBs): If this test is positive,then you are immune to hepatitis B.
  • Hepatitis B Core Antibody (HBcAb or anti-HBc): If this test is positive,then you may have been exposed to the hepatitis B virus, but it does not tell you whether you are currently infected. Once you are exposed to hepatitis B, this test will likely remain positive for life, even after you have recovered.
  • If you are positive for Hbs Ag,then futhur testing with HBeAg, anti-HBe, HBV DNA quantitication, ultrasound liver,liver function tests fibrosscan, and liver biopsy may be needed.
  • If HBsAg remains positive for >6 months, it is called chronic HBV infection.
What are the Symptoms of Hepatitis B?

The symptoms of hepatitis B include tiredness, poor appetite, fever, vomiting and occasionally joint pain, hives or rash. Urine may become darker in color, and then jaundice (a yellowing of the skin and whites of the eyes) may appear. Some individuals may experience few or no symptoms. Eventually those that become chronic are at risk of progression to cirrhosis and liver cancer.

How Soon do Symptoms Appear?

The symptoms may appear 1½ to six months after exposure, but usually within three months.

How Long is a Person Able to Spread the Virus?

The virus can be found in blood and other body fluids several weeks before symptoms appear and generally persists for several months afterward. Approximately 6 to 10 percent of infected adults become long-term or chronic hosts of the virus; this percentage is much higher (70-90%) for children infected very early in life.

What is the Treatment for Hepatitis B?

No special medicines or antibiotics are usually prescribed to treat a person with acute hepatitis B once the symptoms appear. Generally, bed rest is all that is needed for uncomplicated cases. Chronic Hepatitis B can be controlled with drugs and delay progression to irreversible liver disease such as cirrhosis.

What precautions should hepatitis B infected patients take?

Hepatitis B infected subjects should follow good hygienic practices to ensure that close contacts are not directly contaminated by their blood or other body fluids. HBV infected subjects must not share razors, toothbrushes or any other object that may become contaminated with blood. In addition, susceptible household members, particularly sexual partners, should be immunized with hepatitis B vaccine. It is important for carriers to inform their dentist and health care providers about their carrier status. Partner of Hepatitis B positive patients should get vaccinated and should avoid unprotected sex. However, in case of accidental exposure, one should get HBIG vaccine within 48hours, if previously not vaccinated. All pregnant mothers should be tested for hepatitis B. Pregnant mothers who are B positive can transmit the virus to their unborn child and should see a liver specialist for management alongside the obstetrician.

Positive patients should be vaccinated within 48hours with the HBIG vaccine. All pregnant mothers should be tested for hepatitis B. Pregnant mothers who are B positive can transmit the virus to their unborn child and should see a liver specialist for management alongside the obstetrician

Precautions to Take to Prevent Mother to Baby Transmission
  • 2 doses of vaccine (HBIG and Hepatitis B vaccine) preferably in the delivery room as soon as birth takes place. A baby who receives this precaution is 95% safeguarded against being infected with hepatitis B.
  • Additional 2 doses must also be given at one and six months of age for complete protection.
  • In addition, repeat screening for HbsAg should be done to ensure clearance of the virus.
  • Lactating mothers with hepatitis B can breast-feed their infants as benefits of breast-feeding outweigh the risks of being infected through breast milk.
How can Hepatitis B be Prevented?

A vaccine to prevent hepatitis B has been available for several years. The vaccine is safe and effective. It is given to all babies when they are born and also is recommended for people in high-risk settings who have not already been infected. A special hepatitis B immune globulin is also available for people who have been exposed to the virus. It may help prevent the disease if it is given within two weeks of exposure. In the event of exposure to hepatitis B, consult a doctor or the local health department.

Hepatitis B: A Cause of Jaundice in Pregancy

What is hepatitis B?

“Hepatitis” means inflammation of the liver. Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. When a person becomes infected, the Hepatitis B virus can stay in the person’s body for the rest of his or her life and cause serious liver problems.

Can Hepatitis B be spread to babies?
Yes. The Hepatitis B virus can be spread to a baby during childbirth. This can happen during a vaginal delivery or a c-section.
Why should pregnant women be concerned about Hepatitis B?

Hepatitis B is a serious liver disease that can be easily passed to others. It is important for a woman to find out if she has Hepatitis B, so she can get medical care. It is also possible for a pregnant woman with Hepatitis B to pass the virus to her baby at birth. Fortunately, there is a vaccine to prevent babies from getting Hepatitis B.

How else is Hepatitis B spread?
Hepatitis B can also be spread when blood, semen, or other bodily fluids from a person with the virus enter the body of someone who is not infected. The virus is very infectious and is passed easily through breaks in the skin or in soft tissues such as the nose, mouth, and eyes. This can happen through direct contact with blood from an infected person, even in tiny amounts too small to see. Hepatitis B can also be spread through sex with an infected person.
How serious is Hepatitis B?
When babies become infected with Hepatitis B, they have a 90% chance of developing a lifelong, chronic infection. As many as 1 in 4 people with chronic Hepatitis B develop serious health problems. Hepatitis B can cause liver damage, liver disease, and liver cancer.
Can doctors prevent a baby from getting Hepatitis B?
Yes. Babies born to women with Hepatitis B get two shots soon after birth. One is the first dose of the Hepatitis B vaccine and the other shot is called HBIG. The two shots help prevent the baby from getting Hepatitis B. The shots work best when they are given within 12 hours after being born.
Are pregnant women tested for Hepatitis B?
Yes. Many women do not know they are infected, since people with Hepatitis B often have no symptoms. As a result, all pregnant women are given a blood test for Hepatitis B as part of their prenatal care. The test is usually performed during the first prenatal visit. If a woman has not received prenatal care, then she will be tested at the hospital before she delivers her baby.
Why are women tested for Hepatitis B?
Pregnant women are routinely tested for Hepatitis B, along with other diseases. These tests are done to find health problems that can be prevented or treated in both a woman and her baby.
Can Hepatitis B be prevented?
Yes. A vaccine for Hepatitis B has been used for about 20 years. The vaccine has been recommended for infants beginning in 2002 in few states, now free all over India since 2011.
What is HBIG?
HBIG is a medicine that gives a baby’s body a “boost” or extra help to fight the virus as soon as he or she is born. The HBIG shot is only given to babies of mothers who have Hepatitis B.
How many Hepatitis B vaccine shots does my baby need?
Your baby will get 4 shots, all free of cost. After the first dose is given in the hospital which is known as birth dose, the next doses are given at 6, 10 and 14 weeks of age. Ask your doctor or nurse when your baby needs to come back for each shot.
Does my baby need all the shots?
All the Hepatitis B shots are necessary to help keep your baby from getting Hepatitis B.
Hepatitis B is not spread by:
  • Breastfeeding : It is safe for you to breastfeed your baby. You cannot give your baby Hepatitis B from breast milk.
  • Cooking and eating : It is safe for you to prepare and eat meals with your family. Hepatitis B is not spread by sharing dishes, cooking or eating utensils, or drinking glasses.
  • Hugging and kissing : You can hug and kiss your baby, family members, or others close to you. You cannot give anyone Hepatitis B from hugging and kissing them. Also, Hepatitis B is not spread through sneezing or coughing.
How can I make sure my family is protected from Hepatitis B?
Get everyone tested for Hepatitis B

Your baby’s father and everyone else who lives in your house should go to the doctor or clinic to be tested. Testing your family members helps to tell if they have Hepatitis B. If they do not have Hepatitis B, the doctor will talk to them about getting the Hepatitis B vaccine to protect them from getting the infection.

Cover cuts and sores

Since Hepatitis B is spread through blood, people with Hepatitis B should be careful not to expose other people to things that could have their blood on them. It is important not to share personal items such as razors, nail clippers, toothbrushes, or glucose monitors. Cuts and sores should be covered while they are healing.

Do not chew food for your baby

Tiny amounts of blood can sometimes be in a person’s mouth. Do not pre-chew foods before you feed it to your baby.

Hepatitis B Screening, Counseling and Education (HBSCE) Program

Need of family screening when a familymember has Hepatitis B Infection

Who in the family should be tested for Hepatitis B?

Spouse, parents (especially mother), and siblings need to be tested for Hepatitis B. If spouse, comes positive then children should also be screened.

Ideally anyone who lives with or is close to someone who has been diagnosed with Hepatitis B infection should get tested. Hepatitis B can be a serious illness, and the virus can be spread from an infected person to other family and household members, caregivers, and sexual partners.

What are the different viral markers that need to be tested during screening?

There are four viral markers that need to be tested: - Hepatitis B surface Antigen (HBsAg), Antibody to Hepatitis B core antigen (Anti-HBc) (Total), Antibody to Hepatitis B envelope antigen Anti-HBe and Antibody to Hepatitis B surface antigen (Anti-HBs). These tests help a doctor determine if a person has never been infected, has been infected and recovered, or is currently infected.

HBsAg tells about the active disease and HBsAg positive individuals need evaluation and may need treatment. However Anti-HBc (Total) and Anti-HBe positivity indicates past infection or past exposure to Hepatitis B Virus. Anti-HBs point towards immunity against Hepatitis B infection, either through past exposure or through vaccination.

Why is it important to get tested for Hepatitis B?

Testing sexual partners and household contacts of people with Hepatitis B infection helps determine what is needed to ensure their health. For example, if a person has never been infected with Hepatitis B virus (i.e. all viral markers are non reactive), then the HBV vaccine will protect them against the disease. However, if a person has been infected, recovered (i.e. HBsAg non reactive but Anti-HBc or Anti-HBe positive), and immune to Hepatitis B (.i.e. Anti HBs titre >10), they do not need the vaccine. For anyone who has chronic Hepatitis B (i.e. HBsAg reactive >6mnths), testing helps identify the disease early so they can benefit from medical care.

Can Hepatitis B be prevented? Who should be vaccinated against Hepatitis B?

Yes. The best way to prevent Hepatitis B is by getting vaccinated.

In India, under National Immunization Program, all infants should be given Hepatitis B vaccine (Birth dose followed by three doses at 6, 10 and 14 weeks). Vaccinating newborns can prevent them from getting the infection during birth or early childhood.

In addition, the vaccine is recommended for anyone who has never been infected and is at risk for getting Hepatitis B. This could include family members, caregivers, sexual partners, and other contacts. This includes 3 doses of vaccine (at 0, 1 and 6 months) with booster every 5 year.

Is it possible to have been vaccinated against Hepatitis B but still be infected?
Yes. If someone was vaccinated as a child or adult and not as a newborn, it is possible that he or she got Hepatitis B from his or her mother before getting vaccinated. In this instance, a doctor will want to conduct a blood test to determine if they unknowingly became infected with Hepatitis B before vaccination.
How Hepatitis B spreads?

Hepatitis B is usually spreads when blood, semen, or other body fluids from a person infected with Hepatitis B virus enter the body of someone who is not infected. The virus is very infectious and is transmitted easily through breaks in the skin or mucus membranes (nose, mouth, eyes and other soft tissues).

This can happen through:

  • Sexual contact with an infected person, multiple sexual partners, with sexually transmitted diseases.
  • Direct contact with infected or contaminated blood, even in tiny amounts too small to see.
  • Sharing personal items, such as toothbrushes, razors, syringes, or glucose monitors that have even microscopic amounts of blood on them.
  • Direct contact with open sores of an infected person.
  • An infected mother passing it to her baby at birth.
  • Hepatitis B is not spread through sneezing, coughing, hugging, or breastfeeding.
  • Although the virus can be found in saliva, it is not believed to be spread through kissing or sharing utensils.
Diagnosis & treatment of Hepatitis B

Hepatitis B is diagnosed with specific blood tests that are not a part of routine blood investigations typically done during routine medical examination. Acute Hepatitis B infection should be suspected in a family through sexual spread or introduction of small amount of blood from infected family member into other memebrs blood. Adequate nutrition, fluids, and close medical monitoring is advised, and if needed hospitalization. Most often it subsides. One needs to differentiate from reactivation of virus B, for which source of past transmission from infected mother or other family memebrs needs to be investigated.

Those living with chronic Hepatitis B should be evaluated for liver problems and monitored on a regular basis. Even though a person may not have symptoms or feel sick, damage to the liver can still occur. Several new treatments are available that can significantly improve health and delay or reverse the effects of liver disease.