Hepatitis B Causes and Risks:
In the general population, hepatitis B is considered primarily a sexually-transmitted disease. It is also transmitted in blood (hence the name serum hepatitis ) and, prior to the availability of hepatitis B vaccine, health care professionals such as doctors, nurses, and emergency personnel were at risk for contracting hepatitis B. Because it is very easily transmitted by blood (one virus particle can cause disease), intravenous drug users who share needles and syringes are at extremely high risk. The other common mode of transmission is from hepatitis B infected mothers to the fetus prior to birth.
There are many different viruses that cause hepatitis including hepatitis A , hepatitis C , Delta factor hepatitis, and hepatitis E. The initial course for hepatitis A and B may be similar but it is hepatitis B that can have long term consequences. Once infected with the hepatitis B virus, approximately 10% of the people develop a chronic permanent infection (chronic carrier state). In this group, a small proportion of people will develop slow but progressive liver damage leading to cirrhosis or hepatocellular cancer . Hepatitis B is thought to be the leading cause of liver cancer in the United States.
Hepatitis B has a long incubation period, occasionally taking up to 6 months to manifest itself. Early symptoms may be a variety of skin rashes and achy joints ( arthralgia ). Systemic symptoms include fever , malaise , and abdominal pain or discomfort . Ultimately the yellow color of jaundice appears, first in the whites of the eyes and then the skin. Jaundice is usually associated with dark urine and light or clay colored stools . Hepatitis B is a serious disease and mortality (death rate) during the acute stage is approximately 1%.
The overall incidence of reported hepatitis B is 2 per 10,000 individuals, but the true incidence may be higher, because many cases do not cause symptoms and go undiagnosed and unreported. Pregnant women are now routinely screened for hepatitis B and, as it is a reportable disease , more accurate figures are available. One in 1,000 pregnant women are chronic carriers of hepatitis B. (Note: the incidence is higher in people of Southeast Asian heritage.)
People at highest risk for acquiring hepatitis B infection continue to be those who are homosexual or bisexual, IV drug users, and female partners of these individuals. Because hepatitis B immunization (vaccine) is available, the risk to health-care workers, hemodialysis patients, individuals requiring multiple blood transfusions, and newborn infants has been reduced.
Prevention:
Hepatitis B is a public health problem because of the acute illness, the long term disability, and increased rate of liver cancer resulting from chronic infection. Mandatory reporting of this disease allows state health care workers to track people who have been exposed and to immunize contacts who have not yet developed the disease.
Screening of all donated blood has reduced the likelihood of developing hepatitis B following a blood transfusion. Donors are now required to fill out a questionnaire about their sexual and drug use activities (this is also for protection against AIDS transmission) which acts as an initial screen. After the blood is collected, several serologic tests are done on the blood to insure that hepatitis B will not be passed to the recipient of the transfusion.
The hepatitis B immunization (vaccine) is available for people in high risk groups. Early hepatitis B vaccine was made from human blood products and was not received well by the public. The new hepatitis B vaccines are entirely artificial with NO human products and have NO chance of transmitting either hepatitis B or the AIDS virus. They are both safe and effective.
Although a vaccine is available, many high-risk groups have not taken advantage of this availability. IV drug users and individuals practicing high risk sexual behavior often are either unaware of the dangers of their practices, unaware of the benefits of immunization, or unwilling to be immunized for whatever reason.
As a routine safety precaution, you should avoid contact with human blood if the carrier state of the individual is unknown (this also applies to safety concerning AIDS). Sexual contact with a person infected with hepatitis B should be avoided unless you have been immunized or have previously had hepatitis B. Always practice safer sex behaviors .
Condoms can reduce or eliminate the spread of hepatitis B when used consistently and properly. If you are unimmunized and unsure of the status of a potential sexual partner, a condom should always be worn.
Infants born of mothers who are hepatitis B positive receive a special immunization series to prevent them from becoming infected. This includes hepatitis B immune globulin, a hepatitis immunization immediately after birth, and a repeat hepatitis immunization several weeks later.
Symptoms:
Additional symptoms that may be associated with this disease:
Signs and Tests:
Signs of hepatitis B include: This disease may also alter the following test results:
Treatment:
There is no specific treatment for acute hepatitis. Rest is recommended during the acute phase of the disease when the symptoms are most severe. People with acute hepatitis should avoid alcohol and any substances that are toxic to the liver (hepatotoxic). Some people with chronic hepatitis may respond to alpha-interferon therapy.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See liver disease - support group .
Prognosis:
The acute illness usually subsides after 2 to 3 weeks, and the liver returns to normal within 16 weeks. 10% of people infected may develop chronic hepatitis . There is a higher incidence of hepatocellular carcinoma in those who have had hepatitis B virus infection than in the general population. Hepatitis B is fatal in approximately 1% of cases of acute hepatitis B.
Complications:
Call Your Healthcare Provider:
Call your health care provider if symptoms of hepatitis B develop.
Call for an appointment with your health care provider if hepatitis B symptoms do not resolve in 2 or 3 weeks, or if new symptoms develop.
Call your provider if you belong to a high risk group for hepatitis B and have not yet been vaccinated against the disease. Remember that vaccination is safe and free of adverse effects.
Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact. It is seen with increased frequency among intravenous drug users who share needles and among the homosexual population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Courtesy of the Centers for Disease Control.)
This illustration shows the major organs of the digestive system. Their relative sizes and positioning in the body are also demonstrated.
This person has a yellowish cast to the skin (jaundiced). (Courtesy of the Centers for Disease Control.)
Gianotti-Crosti disease is associated with hepatitis B infection and is also called acrodermatitis of childhood. These red, elevated lesions (papules) do not contain pus (non-pruritic) and can occur on the extremities, buttocks, face, and neck. A similar appearing condition is associated with other types of infection an is referred to as a syndrome rather than a disease. (Other diseases include RSV, EBV, cytomegalovirus, coxsackie, streptococcus and several others)
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