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HEPATITIS - B

Hepatitis B is one of the world's most common serious liver infections and is caused by Hepatitis B virus (HBV). World wide there are about 400 million carriers of Hepatitis B virus and in India alone, it is estimated that there could be around 50 million carriers. Like the AIDS (acquired immunodeficiency syndrome) virus, HBV is transmitted through blood and bodily fluids that contain blood. This can occur through direct blood-to-blood contact, unprotected sex, illicit drug use, and from an infected woman to her newborn during the delivery process.

HBV is 100 times more infectious than the AIDS virus. There is no cure for HBV, yet hepatitis B can be prevented with a safe and effective vaccine. Every person in your household should be vaccinated against HBV. For the 400 million people worldwide who are already chronic carriers of HBV, the vaccine is of no use. However, the future is much brighter for carriers with the current advances in drug development.

Hepatitis B is known as the "Silent Infection" because carriers of HBV may not become noticeably sick and may not realize they have the disease. Many people do not have symptoms when they are first infected. After an incubation period (the time since entry of the virus and onset of clinical signs and symptoms) of anywhere from 40 to 140 days, about one-half of infected adults do experience some symptoms. Either way, whether they have symptoms or not, they can pass the virus onto others. It’s inside the liver cells where HBV is headquartered and conducts its destructive operation on the liver.

The following is a list of people who are at ‘high risk’ for becoming infected with the hepatitis B virus. 

• Sexually active adults and teenagers
• Individuals who have multiple sexual partners
• Health care workers (i.e. doctors, dentists, paramedics, nurses, cleaning staff, and others)
• Adoptive families (adopting children from Asian countries)
• Drug addicts or users of intravenous drugs, particularly those who share their needles
• People who live in close proximity and/or has come in contact with human bodily fluid of a known HBV infected individual
• Children born to mothers who are HBV carriers
• Men having sex with men
• People who get tattooed, ear piercing or body piercing
• People who travel to high-risk countries like Asia, Africa, South America, and Eastern and Mediterranean Europe

When a healthy adult is infected with the HBV, his or her body can respond in several different ways. HBV causes no symptoms at all in about 50% of cases. Approximately 49% of the people who are infected will have some symptoms. The following is a list of some of the possible symptoms of HBV infection.

• The usual signs and symptoms of HBV may include fever, fatigue, muscle or joint pain, loss of appetite, nausea and vomiting. Sometimes, these symptoms may be mistaken for flu
• A very small number, about 1%, develop life-threatening acute fulminant (occurring suddenly or rapidly, and with great severity or intensity) hepatitis. These people may suddenly collapse with fatigue, have yellowing of the skin and eyes (jaundice) and develop swelling in their abdomen. Acute fulminant hepatitis can be fatal if not treated immediately
• About 90% of people infected with HBV will develop antibodies against the disease and will totally clear the virus from their body. Although they may experience some symptoms, these people will recover without any complication
• About 5-10% of adults who are infected with HBV will never develop antibodies to the virus and will become chronic hepatitis B carriers, often without even knowing it. Chronic carriers have an increased risk of developing liver disease such as cirrhosis or liver cancer, because the hepatitis B virus steadily attacks the liver. Chronic carriers will usually have on going inflammation of the liver and may eventually develop cirrhosis and liver cancer

PREVENTION

There is a safe and effective vaccine against hepatitis B. You can protect yourself and your loved ones by getting vaccinated! Please be sure to tell others that hepatitis B is a vaccine-preventable disease.

1. Who should get the vaccine?

• If a chronic carrier lives in your household
• Newborn children of HBV infected mothers should receive the vaccine along with hepatitis B immune globulin (HBIG) in the delivery room.
• Anyone in the "high risk" category (see above)
• All school-age children, adolescents, and college students
• If your spouse or sexual partner is a carrier of HBV 

2. Where can you get the vaccine?

• Your family doctor can arrange for the vaccine and can inject you. Talk to your doctor about the benefits and safety of vaccination.

3. How is it given?

• The vaccine is given in a series of three injections into the muscles (upper arm).  
• First Injection - At any given time
• Second Injection - One month after the first
• Third Injection - Six months after the first

4. How much does it cost?

• The cost for the vaccine varies between manufacturers in India. For an adult it ranges from Rs.162 to 350 per dose. For a child below 10 years it is half the dose.

5. What are the brand names of Hepatitis B Vaccines available? Are they safe?

There are currently few commercial vaccines available to prevent HBV infection. These newer vaccines are manufactured using recombinant DNA technology and are prepared from yeast - no live virus particles are present in these vaccines. The vaccine cannot infect you with the disease. Some of the brands available are written below: 

• Engerix-B, produced by SmithKline Beecham
• Recombivax, produced by Merck
• Revac-B, produced by Bharath Biotech
• Shanvac-B, manufactured by Shantha Biotech
• Hepashield–BGenevak

6. How do I know the vaccine worked? 

The vaccine is extremely effective, but, if you request, your doctor can test to see if the vaccine worked for you. Following your vaccination, your doctor can do a blood test to see if you have developed antibodies to Hepatitis B surface antigen (anti-HBs) and are protected against HBV. In case not enough levels of anti-HBs are seen, then you may need to be re-injected.

7. Are there side effects?

The common side effects that have been reported from the vaccine include soreness, swelling and redness at the injection site. Remember, you cannot get hepatitis B from the vaccine.

8. Once infected with HBV, is there any treatment?

Currently there are 2 drugs available for the treatment of chronic hepatitis B infection. They are Interferon alfa-2b and Lamivudine. Both have their own advantages and disadvantages. Getting vaccinated and preventing HBV infection is by far the best way. Other newer drugs are in the pipeline. The treatment depends on the various laboratory parameters. Your family doctor can decide the best as to when to start the treatment.

ADVICE TO ADOPTIVE PARENTS

There are many issues you need to be aware of when adopting a child. One of these is hepatitis B. It is essential, if you plan to adopt a child, that you are informed about hepatitis B and how it may affect the life of the child and your family.

Potential adoptive families need to be aware that the hepatitis B virus is highly prevalent in Asia. Children are often infected with the virus from their birth mothers who have HBV and unknowingly pass the disease on to their children during delivery. Children of intravenous drug users are also at risk for being carriers of HBV, as their mothers can pass the disease on to them at birth.

Your adoption agency should be able to tell you if the child has been tested for HBV. However, results of the test should not adversely influence your decision to adopt. If you are concerned about the results of the test, you can discuss with your family doctor.

Finding out that the child you wish to adopt is a carrier of HBV can be upsetting, but should not be a cause for alarm. You can be reassured that your child will most likely enjoy a long and healthy life. Most carriers of the disease experience no symptoms for decades.

The key to successful adoption of a child with HBV is to be prepared with accurate information about the disease and to protect you with the HBV vaccine prior to the child's arrival.

PROTECTING YOUR FAMILY

If your child is a carrier of HBV you need to protect your family from the virus. All parents, siblings, extended family members, childcare providers and others coming into close contact with the carrier should be vaccinated.

TELLING OTHERS

Know the facts

If people are unfamiliar with HBV, there is a possibility they will become alarmed when told your child is a carrier. The key to minimizing this is to know the facts. It is essential to know that HBV is not transmitted casually, but only through blood, sex and needles. Precautions should be taken in the handling of everyone's blood and secretions --not just your child's. Inform people that there is a readily available vaccine against HBV and all children under 16 years of age need to be vaccinated.

Know the risk

You need to consider whether your child is at high or low risk for exposing others to his or her blood (e.g. consider age, frequency of accidents, nosebleeds, biting, etc.), the possible adverse impact of such a disclosure could have on your child's life, and the degree of risk a caretaker has for exposure (frequent vs. occasional contact).

What Should You Say?

Know your facts, use simple explanations, and remain calm. Emphasize that your child is healthy and poses no risk if all blood spills are handled carefully, and that the blood of all children should be handled carefully.

DISINFECTION

Wear rubber or latex gloves when cleaning up spills. Keep a spray bottle filled with a diluted solution of bleach (one part bleach to nine parts water). If blood, vomit, or other bodily fluids are spilled, spray the area with the bleach; allow standing for one minute and then wiping clean. If blood is spilled on clothing, the clothing should be washed in a diluted solution of bleach. Household alcohol, such as spirit, will also kill the virus. Discard the towels or cleaning materials in a plastic bag and tie the bag securely. Wash your hands thoroughly with soap and water after cleaning spills.

Disinfection procedures should be followed when accidents happen with anyone's blood and secretions, not just the carrier's blood and secretions.

ADVICE TO SEXUALLY ACTIVE ADULTS

1. How is HBV transmitted through sex?

Like the AIDS virus, HBV may be found in blood, semen, or vaginal secretions. Following "safe sex" procedures, such as using condoms, can reduce the likelihood of transmitting of the disease. Unlike the AIDS virus, however, there is a vaccine against the hepatitis B virus. People, who are engaging in sexual activity, or sexual partners of people with HBV, should be vaccinated against the disease.

2. Your partner can infect you and not even know it!

Hepatitis B is known as the "Silent Infection" because carriers of HBV may not become noticeably sick and may not realize they have the disease. Many people do not have symptoms when they are first infected. It should be remembered that whether they have symptoms or not, they can pass the virus onto others.

A small percentage of people who are infected with HBV develop acute hepatitis B which can be life threatening. Others may develop chronic hepatitis B or become carriers of the virus themselves. In the mean time, they can be passing it on to others through sexual activity without even knowing it. Having multiple sexual partners increases your risk of contracting the virus from someone who may not even be aware that they have hepatitis B.

I compile these suggestions and these are not conclusive recommendations, but rather, guidelines, which may help you, decide how best to approach your personal situation. Each family is unique, and each community is different, so adjust your decisions accordingly. 

Have a good health and enjoy life. Take care. If you happen to have any queries, please do not hesitate to ask this friendly doctor.