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About Hepatitis B, HBV, Hepatitis B Prevention, Liver

Addressing Hepatitis B in Africa

Conference on Liver Disease in Africa

To discuss the latest advances in addressing viral hepatitis and other liver diseases in Africa,  there will be a virtual Conference on Liver Disease in Africa (COLDA) from September 10th to 12th, 2020. COLDA is organized by Virology Education on behalf of the organizing committee led by Drs. Manal Al-Sayed, Mark Nelson, and Papa Saliou Mbaye. This virtual conference will gather clinicians, patients, other healthcare professionals, and policymakers from African regions, with international experts to support and exchange innovative ideas and knowledge about liver disease. The conference will consist of lectures discussing viral hepatitis infections, hepatitis co-infections, non-viral hepatitis-related infections, non-infectious induced liver disease, hepatocellular carcinoma, and end-stage liver disease. This virtual conference is important for addressing viral hepatitis since fewer than 1 in 10 people in Africa has access to testing and treatment for viral hepatitis. The World Health Organization (WHO) states that viral hepatitis is a bigger threat to Africa than HIV/AIDS, malaria, or tuberculosis with over 1.34 million deaths a year attributed to it.1 Over 60 million people in Africa have hepatitis B which annually accounts for an estimated 68,870 deaths.1 These statistics demonstrate the need for conferences like COLDA to discuss best practices and reduce viral hepatitis in Africa.

Mother-to-Child and Early Childhood Transmission

Hepatitis B is commonly transmitted from mother-to-child and close contact with infected individuals during the first 5 years of life. These modes of infection transmission are preventable with proper birth prophylaxis. There are two types of mother-to-child and early childhood transmission of hepatitis B resulting in chronic infection: vertical and horizontal. Vertical transmission refers to the transmission of hepatitis B from an infected mother to her baby during delivery. Horizontal transmission refers to infection with hepatitis B from direct blood-to-blood contact with an infected individual. Most early childhood transmission cases in sub-Saharan Africa are from horizontal transmission especially during the first 5 years of life from contact with family members or close friends infected with hepatitis B2, though vertical transmission from a hepatitis B infected mother to her baby is also common and completely preventable with birth prophylaxis.

 The best way to prevent the transmission of hepatitis B (HBV) from mother to child is through a “birth-dose”, meaning infants are vaccinated against hepatitis B within 24 hours of birth. However, in the WHO Africa region, only 6% of infants are administered the birth-dose.1 Only three countries in Africa: Cameroon, Rwanda, and Mauritania, have national guidelines addressing mother-to-child transmission of hepatitis B.2 Additionally, healthcare providers do not routinely screen future mothers for hepatitis B which contributes to a higher burden.2 This lack of screening demonstrates the need for universal guidelines to provide information to future mothers about hepatitis B. The World Health Organization recently released updated guidelines for hepatitis B which recommends a universal birth dose for all infants, as soon as possible, preferably within 24 hours followed by an additional 2-3 doses (often fulfilled with the pentavalent vaccine). Additionally, the WHO newly recommends that pregnant women testing positive for a hepatitis B infection (HBsAg positive) with an HBV DNA ≥ 5.3 log10 IU/mL (≥ 200,000 IU/mL) receive tenofovir from the 28th week of pregnancy until at least birth, to prevent mother-to-child transmission of HBV.4 This is in addition to the three-dose hepatitis B vaccination in all infants, including the timely birth dose. The WHO also strongly recommends that in settings in which antenatal (pre-birth) HBV DNA testing is not available, HBeAg testing can be used as an alternative to HBV DNA testing to determine eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.4 Testing for hepatitis B in early pregnancy, a timely birth-dose, pentavalent vaccination, and administration of antivirals in the last trimester if needed would prevent vertical transmission and in turn, prevent horizontal transmission.

HIV/HBV Co-infection

There is a high burden of HIV/HBV co-infection in African countries because both diseases share similar transmission routes such as mother-to-child, unsafe medical and injection practices, and unscreened blood transfusions.2 Chronic HIV/HBV infection is reported in up to 36% of people who are HIV positive, with the highest prevalence reported in west Africa and southern Africa. The co-infection of HIV and HBV is especially dangerous because it accelerates liver disease such as fibrosis and cirrhosis. In fact, liver-related mortality is twice as high among people with an HIV/ HBV co-infection.2

Nosocomial Transmission

Another common way hepatitis B is transmitted in Africa is through nosocomial transmission or transmission from a hospital setting.3 The World Health Organization estimates 24% of blood donations in lower-income countries are not systematically screened for hepatitis B or hepatitis C. Additionally, countries have inconsistent screening procedures and use non-WHO prequalified test kits. Implementation of screening guidelines would significantly assist in reducing the risk of transmitting hepatitis B.

Barriers

 There are numerous barriers to eliminating hepatitis B in African countries. Screening is costly and often inaccessible, especially in rural areas. Moreover, there is an irregular supply of test kits for screening for healthcare providers.2,3 Lack of public awareness and often provider knowledge also contributes to the higher hepatitis B burden. Research has found that less than 1% of Gambian adults previously knew their status when tested positive for HBsAg.3 Additionally, there are financial constraints when it comes to hepatitis B treatment and care. The World Hepatitis Alliance and the WHO found that 41% of the world’s population live in countries where there is no public funding for hepatitis B treatments.3 This financial barrier prevents people from accessing important screening and vaccination prevention services. A collaborative effort among governments, local health officials, and community members is needed to manage hepatitis B in African countries.

Importance of Conference

Hepatitis B disproportionately affects the WHO Africa Region where 6.1% of the adult population is infected.1 The Conference on Liver Disease in Africa will address problems and discuss potential solutions for this neglected preventable disease. COLDA will help to make eliminating hepatitis B in Africa a reality by engaging the global community to collaborate on public health efforts, develop innovative ideas, and discuss best practices to reduce barriers. We hope to see you there!

Learn more and register for the conference.

 

References:

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  2. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohouès-Kouacou, M. J., Mbaye, P. S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye, A. B., … Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The lancet. Gastroenterology & hepatology, 2(12), 900–909. https://doi.org/10.1016/S2468-1253(17)30295-9
  3. Maud Lemoine, Serge Eholié, Karine Lacombe, Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach, Journal of Hepatology, Volume 62, Issue 2, 2015, Pages 469-476, ISSN 0168-8278, https://doi.org/10.1016/j.jhep.2014.10.008
  4. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

About Hepatitis B, HBV, Hepatitis B Prevention

Get Vaccinated for Hepatitis B!

 

August marks the start of National Immunization Awareness Month! This month highlights the importance of vaccines for people of all ages. Let’s talk about why you should get vaccinated for hepatitis B.

Understanding Your Status

Before becoming vaccinated for hepatitis B, it is important to understand your status. You can test through a simple triple panel blood test for HBsAg, HBcAb total and HBsAb. This will tell you if you have a current infection, have recovered from a past infection and if you need to be vaccinated. More details about the blood tests can be found here. Many people with hepatitis B do not look or feel sick so it is important to get tested. Learning your status early can help manage your hepatitis B and identify at-risk close contacts (household/family members or sexual partners) who can then be vaccinated and protected against hepatitis B.

 Why You Should Be Vaccinated

The hepatitis B vaccine is the first anti-cancer vaccine because it successfully prevents a hepatitis B infection which is the leading cause of liver cancer worldwide. It’s important for people to receive the vaccine since most people with hepatitis B are not aware they are infected. Hepatitis B is known as a silent infection as many people can live with hepatitis B for years without knowing they are infected. With chronic hepatitis B, when symptoms do finally present, often the infection may have already caused severe liver damage. The hepatitis B vaccine can prevent hepatitis B and also the health consequences that can come from hepatitis B, including the increased risk for cirrhosis, liver failure and liver cancer

It is especially important for future mothers to be tested for hepatitis B and vaccinated if needed. Mothers can easily pass hepatitis B to their infant during childbirth through either vaginal delivery or c-section. The most common mode of transmission of hepatitis B is from mother to child, so administering the vaccine to infants at birth is one of the most effective ways to reduce the number of hepatitis B cases worldwide. Read more about preventing perinatal transmission both in the U.S. and internationally.

In fact, it is very important to vaccinate children, starting with a birth dose, because greater than 90% of acute (short-term infection lasting less than 6 months) cases in infants and up to 50% of infected young children of hepatitis B will progress to chronic (lasting a lifetime) infections while only 5%-10% of adult cases will become chronic. That said, vaccination rates in adults are low and due to the nature of hep B, even those who recover from infection are at risk of reactivation. Left untreated, chronic infections can harm your liver and cause poor health outcomes. That is why the Hepatitis B Foundation calls for universal testing for hepatitis B. Luckily, you can expect to live a long and healthy life when you manage chronic infections of hepatitis B. Learn more about hepatitis B management here.

In the United States, you can get the vaccine through your healthcare provider or health clinics. Ask your doctor if you can get vaccinated today!

Hepatitis B is a preventable virus so why not take steps to become a healthier you!

About the Hepatitis B Vaccine

Hepatitis B can cause long-term serious damage to the liver like cirrhosis, fibrosis, and liver cancer. Fortunately, a safe and effective vaccine exists which can prevent a hepatitis B infection in all persons.

The World Health Organization recommends the vaccine for infants at birth and children up to age 18. Additionally, the WHO recommends high-risk groups become vaccinated for hepatitis B such as:

  • Pregnant women
  • People who frequently require blood to blood products
  • People who inject drugs
  • People in prison
  • Household and sexual contact of people with chronic HBV
  • Healthcare workers with blood to blood contact
  • People with multiple sexual partners
  • Travellers without completion of their vaccine series to endemic areas.

The WHO recommends that infants receive the vaccine within 24 hours of birth followed up with two additional doses. Children up to the age of 18 can also receive this series if they either were not vaccinated for hepatitis B at birth or did not complete the series. The series should be as followed:

  • 1st Dose: Anytime, but for infants, it should be administered at birth
  • 2nd Dose: One month (28 days) after the first dose
  • 3rd Dose: 4 months (16 weeks) after the 1st shot (and at least 2 months after the 2nd shot). Infants should be a minimum of 24 weeks old at the time of the 3rd shot.

Find out more about the vaccine schedule here!

You do not need to restart the hepatitis B vaccine series if you miss any of the shots.

In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. The vaccine is administered as two doses given one month apart.

Ask your doctor about the 2-dose vaccine. You can now find Heplisav-B at more than 1,700 Albertsons Companies’ store pharmacies across the US. For assistance accessing this vaccine, you can contact Heplisav-B’s Access Navigator at 1-844-375-4728. 

For more information on the hepatitis B vaccine, read here.

About Hepatitis B, HBV, HDV, Hepatitis B Awareness, Hepatitis Delta (HDV)

Know Your ABCs

What is Hepatitis?

Hepatitis simply means inflammation of the liver which can be caused by infectious diseases, toxins (drugs and alcohol), and autoimmune diseases. The most common forms of viral hepatitis are A, B, C, D, and E. With 5 different types of hepatitis, it can be confusing to know the differences among them all.

The Differences

While all 5 hepatitis viruses can cause liver damage, they vary in modes of transmission, type of infection, prevention, and treatment.

Hepatitis A (HAV) is highly contagious and spread through fecal-oral transmission or consuming contaminated food or water1. This means that if someone is infected with hepatitis A they can transmit it through preparing and serving food and using the same utensils without first thoroughly washing their hands. Symptoms of HAV include jaundice (yellowing of skin and eyes), loss of appetite, nausea, fever, abnormally colored stool and urine, fever, joint pain, and fatigue1. Sometimes these symptoms do not present themselves in an infected person which can be harmful because they can unknowingly spread the virus to other people. Most people who get HAV will feel sick for a short period of time and will recover without any lasting liver damage2. A lot of hepatitis A cases are mild, but in some instances, hepatitis A can cause severe liver damage. Hepatitis A is vaccine preventable and the vaccine is recommended for people living with hepatitis B and C. Read this blog post for a detailed comparison of hepatitis B and hepatitis A!

Hepatitis B (HBV) is transmitted through bodily fluids like blood and semen, by unsterile needles and medical/dental equipment and procedures, or from mother-to-child during delivery1. HBV is considered a “silent epidemic” because most people do not present with symptoms when first infected. This can be harmful to individuals because HBV can cause severe liver damage, including cirrhosis and liver cancer if not properly managed over time3. Hepatitis B can either be an acute or chronic infection meaning some cases last about 6 months while other cases last for a lifetime. In some instances, mostly among people who are infected as babies and young children, acute HBV cases can progress to a chronic infection3. Greater than 90% of babies and up to 50% of young children will develop lifelong infection with hepatitis B if they are infected at a young age.

Hepatitis C (HCV) is similarly transmitted like HBV through bodily fluids, like blood and semen, and by unsterile needles and medical/dental equipment and procedures. Symptoms of HCV are generally similar to HAV’s symptoms of fever, fatigue, jaundice, and abnormal coloring of stool and urine1, though symptoms of HCV usually do not appear until an infected individual has advanced liver disease. Acute infections of hepatitis C can lead to chronic infections which can lead to health complications like cirrhosis and liver cancer1. Read this blog for a detailed comparison of hepatitis B and hepatitis C!

Hepatitis Delta (HDV) infections only occur in persons who are also infected with hepatitis B1,3. Hepatitis Delta is spread through the transfer of bodily fluids from an infected person to a non-infected person. Similar to some other hepatitis viruses, hepatitis Delta can start as an acute infection that can progress to a chronic one. HDV is dependent on the hepatitis B virus to reproduce3. This coinfection is more dangerous than a single infection because it causes rapid damage to the liver which can result in fatal liver failure. Find out more about hepatitis B and hepatitis Delta coinfection here!

Hepatitis E (HEV) is similar to hepatitis A as it is spread by fecal-oral transmission and consumption of contaminated food and water1. It can be transmitted in undercooked pork, game meat and shellfish. HEV is common in developing countries where people don’t always have access to clean water. Symptoms of hepatitis E include fatigue, loss of appetite, stomach pain, jaundice, and nausea. Talk to your doctor if you are a pregnant woman with symptoms as a more severe HEV infection can occur. Many individuals do not show symptoms of hepatitis E infection1. Additionally, most individuals recover from HEV, and it rarely progresses to chronic infection. Read this blog for a detailed comparison of hepatitis B and hepatitis E!

Here is a simple table to further help you understand the differences among hepatitis A, B, C, D, and E.

Prevention

Fortunately, hepatitis viruses are preventable.

Hepatitis A is preventable through a safe and effective vaccine. The Centers for Disease Control and Prevention (CDC) recommend that children be vaccinated for HAV at 12-23 months or at 2-18 years of age for those who have not previously been vaccinated. The vaccine is given as two doses over a 6-month span1. This vaccine is recommended for all people living with hepatitis B & C infections

Hepatitis B is also preventable through a safe and effective vaccine. The vaccine includes 3 doses over a period of 6 months, and in the U.S. there is a 2-dose vaccine that can be completed in 1-month1,3. Read more here, if you would like to know more about the vaccine series schedule.

Hepatitis C does not have a vaccine, however, the best way to prevent HCV is by avoiding risky behaviors like injecting drugs and promoting harm reduction practices. While there is no vaccine, curative treatments are available for HCV1.

Hepatitis Delta does not have a vaccine, but you can prevent it through vaccination for hepatitis B1,3.

Hepatitis E does not have a vaccine available in the United States. However, there has been a vaccine developed and licensed in China1,2.

 

References

  1. https://www.cdc.gov/hepatitis/index.htm
  2. https://www.who.int/news-room/q-a-detail/what-is-hepatitis
  3. https://www.hepb.org/what-is-hepatitis-b/the-abcs-of-viral-hepatitis/

 

About Hepatitis B

LGBTQ+ Risk Factors and Hepatitis B

As June wraps up Pride Month, it is still important to address LGBTQ+ health and risk factors for hepatitis B. Many resources are available regarding gay and bisexual men’s risk factors for hepatitis B, but information discussing lesbian, bisexual women, and transgender folx for hepatitis B is lacking. 

Gay, bisexual, and men who have sex with men (MSM) have a higher chance of getting hepatitis B. It can be spread through body fluids like semen or blood from an infected person to an uninfected person during unprotected sex. 

A research study found that lesbian, bisexual women, and womxn who have sex with womxn (WSW) had significantly higher rates of hepatitis B than the control group due to risk factors like multiple sexual partners, injection drug use, and sex work1. Additionally, potential mothers need to know their hepatitis B status because it can easily transmit from mother-to-child during childbirth.

Being transgender is not a risk factor for hepatitis B (HBV), but some transgender folx may have a higher risk due to discrimination surrounding their gender identity.  Discrimination in workplaces or health care facilities can lead transgender individuals to engage in risky behaviors like sex work and exposure to unsterile needles which can put some transgender individuals more at risk than others2. While there is insufficient information regarding hepatitis B and transgender folx,  much information exists about hepatitis C (HCV)  and its co-infection with hepatitis B. Since both viruses have similar modes of transmission it is not uncommon for someone to be co-infected with HCV and HBV.  It is important to get tested for HBV because hepatitis C can become a dominant liver disease which leaves HBV levels virtually undetectable and can cause further liver damage if hepatitis B is not addressed3. This is especially true for individuals being treated with hepatitis C curative Direct Acting Antivirals (DAAs), which can lead to hep B reactivation. 

For LGBTQ+ individuals living in the United States and who want to know their hepatitis B status, here is a list of LGBTQ+ friendly healthcare providers. If you identify as LGBTQ+, ask your provider to be tested for hepatitis B today. The great news is that if you are not infected, there is a safe and effective vaccine that can prevent you from getting hepatitis B in the future!

On the other side; healthcare professionals have a duty to provide culturally competent care to LGBTQ+ individuals and encourage hepatitis B testing and vaccinations. The Centers for Disease Control and Prevention (CDC) has recommendations and guidelines for health professionals here.

 

Citations:

  1. Fethers, K., Marks, C., Mindel, A., & Estcourt, C. S. (2000). Sexually transmitted infections and risk behaviours in women who have sex with women. Sexually transmitted infections, 76(5), 345–349. https://doi.org/10.1136/sti.76.5.345
  2. https://hepfree.nyc/hep-c-transgender-health/
  3. https://www.hepb.org/what-is-hepatitis-b/hepatitis-c-co-infection/

About Hepatitis B, HBV

Hepatitis B Transmission for Those Newly Diagnosed

Being diagnosed with hepatitis B can be a confusing experience and may leave you with many questions. Understanding your diagnosis is essential for your health, and understanding how hepatitis B is transmitted can help prevent transmission to others. 

How is it Spread? 

Hepatitis B is transmitted through direct contact with infected blood. This can happen through direct blood-to-blood contact, unprotected sex, unsterile needles, and unsterile medical or dental equipment. Globally, hepatitis B is most commonly spread from an infected mother to her baby due to the blood exchange during childbirth. It can also be transmitted inadvertently by the sharing of personal items such as razors, toothbrushes, nail clippers, body jewelry, and other personal items that have small amounts of blood on them.

Hepatitis B is not transmitted casually by sneezing or coughing, shaking hands, hugging or sharing or preparing a meal.  In fact, hepatitis B is not contracted during most of life’s daily activities. You don’t need to separate cups, utensils, or dishes. You can eat a meal with or prepared by someone with hep B. Hugging, or even kissing won’t cause infection unless there are bleeding gums or open sores during the exchange. As an infection that is spread through the blood, standard precautions such as covering all wounds tightly, practicing safe sex (using a condom), and cleaning up all blood spills with gloves and a solution of one part bleach to nine parts water will protect against transmission. The best tool we have to prevent transmission is the hepatitis B vaccine!

Most of those who are newly infected have no notable symptoms. This is why it is important to encourage family members and sexual partners to get tested if you test positive. Often, it remains undetected until it is caught in routine blood work, blood donation, or later in life after there is liver inflammation or disease progression. 

Dealing with a Possible Exposure:

One important factor for those that may have been exposed is the timing. There is a 4-6 week window period between an exposure to hepatitis B and when the virus shows up in the blood (positive HBsAg test result).  If you go for immediate testing, please understand that you will need to be re-tested 9 weeks later to confirm whether or not you have been infected. It is essential to practice safe sex and follow general precautions until everyone is sure of their status –both the known and potentially infected.

You may still be in a waiting period trying to determine if you are acutely or chronically infected. It is possible that you have not had symptoms with your hepatitis B. It’s also very likely you are unsure  as to when you were infected. Not knowing the details of your infection can be stressful and confusing, but the most important thing to do now is to educate yourself so that you can take the proper steps to protect your liver and prevent transmission. 

Preventing Future Transmission: 

  1. Always cover open wounds. Keep cuts, bug bites – anything that bleeds or oozes – covered with a bandage. It’s also a good idea to carry a spare bandage.  
  2. Be sure to practice safe sex (use a condom) until you are sure your partner has completed their hepatitis B vaccine series. Be aware that multiple sex partners and non-monogamous relationships can expose you to the potential of more health risks and even the possibility of a co-infection, so it is best to use a condom. Co-infections are when someone has more than one serious chronic condition (like HBV and HCV , HBV and HIV or HBV and HDV).  Co-infections are complicated health conditions that you want to avoid. Therefore, practice safe sex by using a latex or polyurethane condom if you have multiple partners.
  3. Keep personal items personal.  Everyday items that are sharp may contain small amounts of blood. This includes things like razors, nail clippers, files, toothbrushes and other personal items where microscopic droplets of blood are possible. This is good practice for everyone in the house. Simple changes in daily habits keep everyone safe!

If a person has been tested and their results show that they are not already vaccinated or have not recovered from a past infection, then they should start the series as soon as possible. This includes sexual partners and close household contacts and family members. The HBV vaccine is a safe and effective 2 or 3-shot series.  

If you wish to confirm protection, the timing of the antibody titre test should be 4-8 weeks following the last shot of the series. If titers are equal to or above 10 mIU/mL, then there is protection for life.  If someone has been previously vaccinated a titer test may show that their titers have waned and dipped below the desired reading. There is no reason to panic, as a booster shot can be administered and then a repeated titer test 1-2 months later can ensure adequate immunity. Once you know you have generated adequate titers, there is no need for concern of transmission!

When recovering from an acute infection, if your follow up blood test results read: HBsAg negative, HBcAb positive and HBsAb positive then you have resolved your HBV infection and are no longer infectious to others and you are no longer at risk for infection by the HBV virus again.

However if your follow up blood tests show that you are chronically infected or your infection status is not clear, you will want to take the precautionary steps to prevent transmitting your HBV infection to others. You will also need to talk to your doctor to be sure you have the appropriate blood work to determine your HBV status and whether or not you are chronically infected.

Please be sure to talk to your doctor if you are unsure, and don’t forget to get copies of all of your lab results!

 

About Hepatitis B, Hepatitis B Prevention

Hepatitis B is NOT A Genetic Disease – And Here’s Why

There are many misconceptions about the hepatitis B virus. One recurring one is the myth that hepatitis B is a genetic or hereditary disease. The belief is that because multiple family members can be infected by hepatitis B, it must be a virus that runs in families. This is not true. Hepatitis B is NOT genetic. Hepatitis B is spread through direct contact with infected blood. Although transmission can occur a number of different ways, it does not happen at conception or while the child is developing in the uterus. 

Let’s start by breaking down what it means for something to be genetic or hereditary: 

A genetic disease is caused by an error in a person’s genes and is   carried by an individual in their genes. This type of disease may be passed on to a person’s child (which means it is hereditary) or it can occur spontaneously as a result of a gene mutation while a child is growing in the womb. Genes – which make up each of our unique DNA strands – are passed on to a child from both the mother and the father. Therefore, if a mother or father carries a certain hereditary disease or genetic trait, such as brown hair or green eyes, the child has the ability to have that as well. 

Hepatitis B is not a genetic disease because it does not exist in a person’s genes. It is not carried in the egg of a woman or the sperm of a man. The hepatitis B virus exists in the liver cells and circulates in the bloodstream. Unlike a genetic disease, a person is not born with the hepatitis B virus already in their bodies. Instead, the virus is passed from mother to baby during childbirth through infected blood passing from the mother to the child during the physical delivery process. If a pregnant woman tests positive for hepatitis B, she can pass the virus to her newborn through infected blood and tiny tears in the skin that occur during childbirth. Oftentimes, these tears are unable to be seen by the human eye but can still allow for the virus to pass through and make direct contact with mucous membranes (“wet skin”) of the eyes, ears, nose, and mouth of the infant

A number of different factors play a role in determining if a newborn will contract hepatitis B from their mother: the mother’s viral load levels, the mother’s knowledge of her infection, and if the newborn receives post-exposure prophylaxis. Post-exposure prophylaxis is the key to preventing mother-to-child transmission and consists of two parts: the first dose of the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG). Both shots need to be administered 1) in two different limbs and 2) within 12 hours of birth in order to be as effective as possible. Once the shots have been given, the infant should complete the standard hepatitis B vaccine schedule in order to ensure that they are protected for life! *Please note that HBIG is not recommended by WHO, so it may not be recommended or available in all countries.

Commonly Asked Questions: 

It can be difficult to understand facts when they do not align with what you have been told for many years, so we’ve answered some of the most common responses to our information below: 

  1.  If it is not genetic, how is it sexually transmitted? 

 This question goes back to the topic of genes. A genetic disease differs from a sexually transmitted disease because of where the virus is hosted during transmission from one individual to another. A genetic disease is given to a person via cellular DNA while a baby is developing in the mother’s womb. Sexual transmission occurs because the virus is present in blood and sexual fluids and can be transmitted through very tiny, microscopic tears as a result of sexual intercourse.

2.  If it’s not genetic, why do multiple members of my family have it? 

Families tend to share objects – and that’s okay! However, sharp objects like earrings and body jewelry or personal care items like razors, nail clippers, or toothbrushes, can make tiny, microscopic cuts and abrasions in our skin that bleed. Sometimes, we don’t even notice! When a family member uses an object with trace amounts of infected blood and they also have a wound, such as a mouth sore,  cut, or freshly shaved skin, the virus can spread to the uninfected individual. Because hepatitis B is so infectious (at least 50 times more infectious than HIV!), even small amounts of infected blood can cause a person to become infected. Therefore, it is recommended that personal items and sharp objects are not shared – even between family members, or ensure all family members are properly vaccinated for hepatitis B and confirm they are protected

Accidents also occur frequently in households, and sometimes blood is spilled. The virus can live on surfaces outside of the body, so it is essential to properly clean up any blood spills. The key to safely cleaning up blood and killing the virus is to wear gloves and use a fresh diluted bleach solution of 1 part bleach mixed with 9 parts water. 

It’s extremely important to note that infected blood must come into contact with uninfected blood or a mucous membrane for transmission to occur. A person cannot become infected from skin-to-skin contact such as shaking hands or hugging, sharing utensils or food prepared by an infected individual, or even kissing.

Prevention: 

The best thing to remember is that hepatitis B is preventable, even if a child is born to a mother living with chronic hepatitis B! Always remember to wash your hands thoroughly with soap and hot water after any possible exposure to blood. In addition, any family members and loved ones who test negative for the hepatitis B surface antigen (HBsAg) and did not recover from a past infection (HBcAb total negative) should get vaccinated to prevent any possible transmission. The vaccine is one of the most effective vaccines in the world! 

About Hepatitis B

What’s the difference: Hepatitis B vs. Hepatitis E

With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is the final installment in a three-part series. You can click the links to view more about hepatitis A and hepatitis C.

What is Hepatitis?

Hepatitis means “inflammation of the liver”. A liver can become inflamed for many reasons, such as too much alcohol, physical injury, autoimmune response, or a reaction to bacteria or a virus. The five most common hepatitis viruses are A, B, C, D, and E. Some hepatitis viruses can lead to fibrosis, cirrhosis, liver failure, or even liver cancer. Damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins.

Hepatitis B vs. Hepatitis E

Globally, hepatitis E is a common liver infection. The World Health Organization estimates that 20 million people are infected each year. The virus has 4 known types: genotype 1, genotype 2, genotype 3, and genotype 4. Genotypes 1 and 2 are primarily spread through  fecal-oral transmission or by consuming food or water that has been contaminated and are only found in the human population. Typically, these genotypes are found in Africa, Asia, and Mexico. Poor sanitation and lack of clean water infrastructure contribute to the spread of genotypes 1 and 2.

Image Courtesy of Canva

Genotypes 3 and 4 are found in animal populations and can be passed on to a human if their meat is undercooked and consumed. Pigs, deer, boar, and chickens have all been found to carry the hepatitis E virus, but studies have shown that consuming undercooked infected pig (pork) and wild boar have commonly been the main source of animal-to-human transmission. Although less common, shellfish has also been found to carry the hepatitis E virus as well. Genotypes 3 and 4 are most generally found in China, Taiwan, Japan, and other developed countries.

It is important to remember that hepatitis B is not spread by contaminated food or water. You cannot get hepatitis B by sharing utensils or eating food prepared by someone who is infected. The hepatitis B virus is a blood-borne pathogen, which means that it is only spread through direct blood contact with an infected person’s blood.

Unlike hepatitis B, hepatitis E usually does not progress to a life-long infection. However, the Centers for Disease Control and Prevention (CDC) reports that the number of genotype 3 cases that lead to chronic liver disease are on the rise. In most cases, the infection typically resolves itself after a few weeks. Globally, young people aged 15-40 are considered to be the most at-risk population. Children under 15 generally have no symptoms or develop a mild illness. Young adults will often experience symptoms such as jaundice, vomiting, reduced appetite, and fatigue. At the moment, there are no specific treatment options for hepatitis E. Recommendations include getting plenty of rest and staying hydrated. In extreme cases, hospitalization may be required. Hepatitis E can also lead to fulminant hepatitis, or acute liver failure. Fulminant hepatitis most often occurs with hepatitis E infections in pregnant women and those with weakened immune systems.

Pregnant Women and Hepatitis B/E

Image Courtesy of Canva

Both hepatitis B and E can be transmitted from mother-to-child. This type of transmission is rare for hepatitis E patients but occurs frequently in mothers living with chronic hepatitis B. This is because hepatitis B is a “silent infection”; it often has no symptoms so many mothers do not know that they are infected. It is much less common for hepatitis E to be spread from mother to child because the infection typically resolves itself in 4-6 weeks. The danger with hepatitis E and pregnancy lies within the complications that it can cause. Research has shown that pregnant women have a higher risk of developing fulminant hepatitis than other patients, although more studies need to be conducted to discover the reason why this occurs. Hepatitis E tends to be most dangerous for women in their second and third trimester.  According to the CDC, maternal death rates from hepatitis E can reach 10% – 30% in the final trimester. Mothers can also experience severe illness, premature delivery, and the loss of their pregnancy.

With hepatitis B infection, approximately 90% of infants born to hepatitis B infected mothers will develop chronic hepatitis B and have an increased risk of developing liver disease and liver cancer later in life. This can be avoided, however, if certain precautions are taken once the child has been born!  By making sure the doctor is aware of the mother’s hepatitis B and having the delivery staff administer 1) the first dose of the hepatitis B vaccine and 2) one dose of the Hepatitis B Immune Globulin (HBIG, if available) in the delivery room, the newborn has more than a 95% chance of being protected for life! After the initial shots are given, it is extremely important to follow through with the vaccination schedule for a lifetime of protection.

Prevention

Hepatitis B can be prevented with a 3-dose vaccine or a 2-dose vaccine for adults where available! While you wait to complete the vaccine series, simple steps to prevent transmission include washing your hands thoroughly with hot water and soap, cleaning surfaces that come  into contact with blood with a diluted bleach solution, and not sharing objects that may have trace amounts of blood on them such as razors, toothbrushes, nail clippers and body jewelry. Although there is no vaccine approved for hepatitis E in the United States, there is one available in China. For hepatitis E, genotypes 1 and 2 can be prevented by thoroughly washing your hands after using the bathroom and by boiling water before drinking it. Transmission of genotypes 3 and 4 can be prevented by thoroughly cooking all meat and avoiding undercooked meats. Pregnant women should exercise caution when consuming pork, deer meat, and wild boar.

About Hepatitis B, Hepatitis B Prevention

What’s the Difference: Hepatitis A vs Hepatitis B

With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is part two in a three-part series.

What is Hepatitis?

Hepatitis means “inflammation of the liver”. A liver can become inflamed for many reasons, such as too much alcohol, physical injury, autoimmune response, or a reaction to bacteria or a virus. The five most common hepatitis viruses are A, B, C, D, and E. Some hepatitis viruses can lead to fibrosis, cirrhosis, liver failure, or even liver cancer. Damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins.

Hepatitis A vs. Hepatitis B

While hepatitis A and B both impact the liver, the two viruses differ greatly from one another. Hepatitis B is a blood-borne pathogen; its primary mode of transmission is through direct blood-to-blood contact with an infected person. In contrast, hepatitis A can be spread by fecal-oral transmission or by consuming food or water that has been contaminated. It is important to note that a person cannot contract hepatitis B through casual interactions such as holding hands, sharing a meal with, or eating foods prepared by someone who is infected. There is no need to keep plates and utensils separate. However, hepatitis A can be spread through food that is prepared by an infected person. Hepatitis A is primarily caused by poor sanitation and personal hygiene. Poor sanitation and hygiene can be the result of a lack of essential infrastructure like waste management or clean water systems. It can also result from a lack of education.

Hepatitis A is an acute infection; the virus typically stays in the body for a short amount of time and most people make a full recovery after several weeks. Recently, the United States has seen a rise in hepatitis A infections. The rise is partially attributed to a growing homeless population and increases in injection drug use. You can track hepatitis A outbreaks in the United States by using this map.

Unlike hepatitis B, which rarely has symptoms, people infected with hepatitis A generally develop symptoms four weeks after exposure. However, children under the age of 6 often do not show any symptoms. Oftentimes, an infected adult will experience nausea, vomiting, fever, dark urine, or abdominal pain. Older children and adults with hepatitis A will typically experience jaundice, according to the Centers for Disease Control and Prevention (CDC). Once a person makes a recovery, they cannot be reinfected. Their body develops protective antibodies that will recognize the virus and fight it off if it enters their system again. Hepatitis A rarely causes lasting liver damage, but in a small percentage of individuals, it can cause acute liver failure called fulminant hepatitis. Some people with hepatitis A feel ill enough that they need to be hospitalized to receive fluids and supportive care.

On the other hand, hepatitis B begins as a short-term infection, but in some cases, it can progress into a chronic, or life-long, infection. Chronic hepatitis B is the world’s leading cause of liver cancer and can lead to serious liver diseases such as cirrhosis or liver cancer. Most adults who become infected with hepatitis B develop an acute infection and will make a full recovery in approximately six months. However, about 90% of infected newborns and up to 50% of young children will develop a life-long infection. This is because hepatitis B can be transmitted from an infected mother to her baby due to exposure to her blood. Many infected mothers do not know they are infected and therefore cannot work with their physicians to take the necessary precautions to prevent transmission. It is extremely important for all pregnant women to get tested for the hepatitis B – if they are infected, transmission to their baby can be prevented!

There are vaccines to protect people against both hepatitis A and hepatitis B. If you are unvaccinated and believe that you have been exposed to hepatitis A, you should contact your doctor or local health department to get tested. If you were exposed by consuming contaminated food, the health department can work with you to identify the source of exposure and prevent a potential outbreak. Depending on the situation and when you were exposed, your doctor may administer postexposure prophylaxis (PEP) to help prevent the infection or lessen its impact. For hepatitis A, PEP is given in the form of one dose of the vaccine or immune goblin.

For unvaccinated individuals, PEP is also recommended after a possible exposure to hepatitis B and is usually given as a dose of the vaccine. In certain cases, a physician will recommend that a patient receive both the vaccine and a dose of hepatitis B immune globulin (HBIG) for additional protection. As recommended by the CDC, all infants born to hepatitis B surface antigen positive mothers (HBsAg positive) should receive both a dose of the hepatitis B vaccine and a dose of HBIG within 12 hours of birth in order to prevent transmission. As timing is crucial in the prevention of disease, a healthcare provider should be notified as quickly as possible after a potential exposure.

Prevention

Hepatitis A and B vaccines can protect you for life! The hepatitis A vaccine is given in 2-doses over the span of six months and the hepatitis B vaccine is given in 3-doses over the course of six months; there is even a 2-dose hepatitis B vaccine now available in the U.S.! You can also ask your doctor about getting the combination vaccine for hepatitis A and B together, which will reduce the number of shots you need.

The CDC recommends that people living with chronic hepatitis B also get vaccinated for hepatitis A to protect themselves against another liver infection and potential liver damage. While the hepatitis A vaccine is routinely given to children in the United States, other countries have different vaccine recommendations, so check with your doctor to see if you have been vaccinated. Hepatitis A can also be prevented by good hygiene practices like washing your hands with soap and hot water after using the bathroom or before preparing food, but the best form of prevention is always vaccination!

About Hepatitis B, Living with Hepatitis B

What’s the Difference: Hepatitis B vs Hepatitis C?

With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is part one in a three-part series.

What is Hepatitis?

Hepatitis means “inflammation of the liver”. A liver can become inflamed for many reasons, such as too much alcohol, physical injury, autoimmune response, or a reaction to bacteria or a virus. The five most common hepatitis viruses are A, B, C, D, and E. Some hepatitis viruses can lead to fibrosis, cirrhosis, liver failure, or even liver cancer. Damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins.

Both hepatitis B and C are blood-borne pathogens, which means that their primary mode of transmission is through direct blood-to-blood contact with an infected person. Also, both hepatitis B and C can cause chronic, lifelong infections that can lead to serious liver disease. Hepatitis B is most commonly spread from mother-to-child during birth while hepatitis C is more commonly spread through the use of unclean needles used to inject drugs.

 

Hepatitis B vs. Hepatitis C

Despite having an effective vaccine, hepatitis B is the world’s most common liver infection; over 292 million people around the world are estimated to be living with chronic hepatitis B. While hepatitis C tends to get more attention and research funding, hepatitis B is considerably more common and causes more liver-related cancer and death worldwide than hepatitis C. Combined, chronic hepatitis B and C account for approximately 80% of the world’s liver cancer cases. However, studies show that those with chronic hepatitis B are more likely to die from liver-related complications than those who are infected with hepatitis C. With hepatitis C, most people develop cirrhosis, or scarring of the liver, before liver cancer. In certain cases of hepatitis B, liver cancer can develop without any signs of cirrhosis, which makes it extremely difficult to predict the virus’ impacts on the body, and makes screening for liver cancer more complicated.

The hepatitis B virus is also approximately 5-10 times more infectious than hepatitis C, and far more stable. It can survive – and remain highly contagious – on surfaces outside of the body for at least seven days if it is not properly cleaned with a disinfectant or a simple bleach solution. A new study suggests that the hepatitis B virus has the ability to survive in extreme temperatures, whereas the hepatitis C virus has been known to survive outside of the body for a short period of time on room-temperature surfaces. However, more research will need to be done on the topic.

Another major difference between the two forms of hepatitis is how the virus attacks a cell. The hepatitis C virus operates like other viruses; it enters a healthy cell and produces copies of itself that

Hepatitis C Virus
Courtesy of Google Images

go on to infect other healthy cells. The hepatitis B virus reproduces in a similar fashion, but with one large difference – covalently closed circular DNA. Covalently closed circular DNA (cccDNA) is a structure that is unique to only a few viruses. Unlike a typical virus, hepatitis B’s cccDNA permanently integrates itself into a healthy cell’s DNA – a component of the cell that allows it to function properly and produce more healthy cells. The cccDNA resides within an essential area of the cell called the nucleus and can remain there even if an infected person’s hepatitis B surface antigen (HBsAg) levels are undetectable. Its presence means that a person with chronic hepatitis B may have a risk of reactivation even if the HBsAg levels have been undetectable for a long period of time. The complex nature and integration process of cccDNA contributes to the difficulties of finding a cure for hepatitis B. The cccDNA’s location inside of the nucleus is especially troublesome because it makes it difficult to isolate and destroy the cccDNA without harming the rest of the cell.

Hepatitis C, on the other hand, has a cure! Approved by the FDA in 2013, the cure is in the form of an antiviral pill that is taken once a day over the course of 8-12 weeks. For hepatitis C, a cure is defined as a sustained virologic response (SVR), which means that the virus is not detected in a person’s blood 3 months after treatment has been completed. In the United States, an affordable, generic version of the hepatitis C cure is set to be released by Gilead Sciences, Inc. in January 2019.

People living with chronic hepatitis B are susceptible to hepatitis Delta. Only people with hepatitis B can contract hepatitis D as well. Hepatitis Delta is considered to be the most severe form of hepatitis because of its potential to quickly lead to more serious liver disease than hepatitis B alone. Of the 292 million people living with chronic hepatitis B, approximately 15-20 million are also living with hepatitis D. Unlike HIV and hepatitis C coinfections, there are currently no FDA approved treatments for hepatitis Delta. However, there are ongoing clinical trials that are researching potential treatments!

Hepatitis B/C Coinfection

It is possible to have both hepatitis B and C at the same time. The hepatitis C virus may appear more dominant and reduce hepatitis B to low or undetectable levels in the bloodstream. Prior to curative treatment for hepatitis C, it is important for people to get tested for hepatitis B using the three-part blood test (HBsAg, anti-HBc total and anti-HBs). People currently infected with hepatitis B (HBsAg positive) or those who have recovered from past infection (HBsAg negative and anti-HBc positive) should be carefully managed according to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines in order to avoid dangerous elevation of liver enzymes resulting in liver damage.

How to Protect Yourself   

The hepatitis B vaccine is the best way to protect yourself and your family against hepatitis B. Although there is no vaccine for hepatitis C, you can protect yourself from both liver infections by following simple precautions! Simple steps such as not sharing personal items such as razors or toothbrushes, thoroughly washing your hands, and disinfecting surfaces that have been in contact with blood, can keep your liver healthy!

 

Baruch S. Blumberg Institute