Hepatitis B

Hepatitis B is a viral infection of the liver. Over half the people who become infected with hepatitis B never feel sick. However, some may later develop long-term liver disease (chronic hepatitis). There are 2 phases of the disease: sudden (acute) and longstanding (chronic).

CAUSES

Hepatitis B is caused by the hepatitis B virus (HBV). It can enter the body by sharing needles contaminated with blood from an infected person, by sharing intimate items such as toothbrushes and razors, or by sex with an infected person. A baby can get HBV from its birth mother. A caregiver may also get it from exposure to the blood of an infected patient by way of a cut or needle stick.

SYMPTOMS

Acute Phase

Many cases of acute HBV infection are mild and cause few problems. Some people may not even realize they are sick. Symptoms in others may last a few weeks to several months and include:

  • Loss of appetite.

  • Feeling very tired.

  • Nausea.

  • Vomiting.

  • Abdominal pain.

  • Dark yellow urine.

  • Yellow skin and eyes (jaundice).

Chronic Phase

  • About 5% of people who get HBV infection become "chronic carriers." They often have no symptoms, but the virus stays in their body. They may spread the virus to others and can get long-term liver disease. The younger a child is when the infection starts, the more likely that child will be a carrier.

  • About 25% of chronic HBV carriers get a disease called "chronic active hepatitis." These people may develop scarring of the liver (cirrhosis), liver failure, or liver cancer.

DIAGNOSIS

Your caregiver can do a blood test to see if you have the disease.

TREATMENT

Acute hepatitis B does not usually require any drug treatment. It is important to avoid medicines such as acetaminophen that may cause increasing liver damage.

Treatment with many antiviral drugs is available and recommended for some patients with hepatitis B infection. The goal is to reduce the risk of progressive chronic liver disease, transmission of infection to others, and other long-term complications such as cirrhosis, liver failure, and liver cancer. Drug treatment is often advised for people with:

  • Acute liver failure.

  • Clinical complications of cirrhosis.

  • Cirrhosis or advanced fibrosis with high serum measurements of viral DNA.

  • Reactivation of chronic HBV after chemotherapy or immunosuppression.

Immediate drug treatment is not often advised for patients who have chronic infection but normal liver enzyme tests or patients who have a positive hepatitis B DNA test in blood but no other signs of active infection. Patients may have other circumstances that suggest a need or potential benefit from drug treatment.

Successful treatment currently requires taking treatment drugs over a long period of time. An injected drug (interferon) may be given daily, 3 times a week, or once weekly for up to 1 year. An oral drug treatment plan may require daily dosing for many years or indefinitely, in order to prevent infection reactivation and worsening of liver disease. Side effects from these drugs are common and some may be very serious. Your response to treatment must be carefully monitored by both you and your caregiver throughout the entire treatment period.

PREVENTION

Hepatitis B vaccine is highly effective in preventing a hepatitis B infection. The vaccine is recommended worldwide for all newborns of hepatitis B infected mothers, and in many countries for all newborns. Hepatitis B vaccine is also recommended in the U.S. for other people at higher than normal risk of getting an infection, including:

  • Sexually active people with multiple sex partners.

  • Homosexual and bisexual men.

  • People who live with someone who has hepatitis B.

  • Injection drug users.

  • Healthcare workers.

  • Patients on chronic hemodialysis and patients who need repeated blood or blood product transfusions.

  • Patients with chronic liver disease due to any cause.

  • Unvaccinated people traveling to areas with high levels of local HBV infection.

  • Patients with diabetes.

Hepatitis B immune globulin (HBIG) is often given with hepatitis B vaccine to people who have been exposed to blood contaminated with HBV. The HBIG protects you from the virus for the first 1 to 3 months. After that, the hepatitis B vaccine takes over and gives you long-term protection. Your caregiver will help you decide whether and when to get these shots following exposure to HBV.

Healthcare workers need to avoid injuries and wear appropriate protective equipment such as gloves, gowns, and face masks when performing invasive medical or nursing procedures.

HOME CARE INSTRUCTIONS

  • Rest when you feel tired, and eat when you are hungry.

  • Avoid a sexual relationship until advised otherwise by your caregiver.

  • Avoid activities that could expose other people to your blood. Examples include sharing a toothbrush, nail clippers, razors, and needles.

  • This infection is contagious. Follow your caregiver's instructions in order to avoid spread of the infection.

  • Do not take any medicines until your caregiver says it is okay. This includes over-the-counter drugs such as acetominophen that are usually taken for fever or pain.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You are unable to eat or drink.

  • You feel sick to your stomach (nauseous) or throw up (vomit).

  • You feel confused.

  • Jaundice becomes more severe.

  • You have trouble breathing, a rash, or swelling of the skin, throat, mouth, or face. You may be having an allergic reaction to the medicine in the shot.

  • You start twitching or shaking (seizure).

  • You become very sleepy or have trouble waking up.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.