Hepatitis B
Hepatitis B Is A Vaccine Preventable Blood Borne Virus (BBV) And A Sexually Transmissible Infection (STI)
What Is Hepatitis B?
Hepatitis B is a liver infection that is caused by the hepatitis B virus. It is the most common hepatitis virus in the world. It is major global health issue and it is estimated that nearly 260 million people are living with chronic hepatitis B.
The hepatitis B virus enters through the blood or bodily fluids and travels to the liver via the bloodstream. Once in the liver the virus attaches to healthy liver cells and multiplies.
People are often unaware they have hepatitis B. If not diagnosed and managed appropriately, hepatitis B can lead to cirrhosis (scarring of the liver), liver cancer, or liver failure.
In Australia a safe and effective vaccine is widely available.
Who Is At Risk Of Chronic Disease?
In Infants And Children:
80 – 90% of infants infected during the first year of life develop chronic infections; and
30 – 50% of children infected before the age of 6 years develop chronic infections.
In Adults:
Less than 5% of otherwise healthy persons who are infected as adults will develop chronic infections; and
20 – 30% of adults who are chronically infected will develop cirrhosis and/or liver cancer.
Prevention
Hepatitis B is a vaccine preventable blood borne virus (BBV) and a sexually transmitted infection (STI). It is present in semen, vaginal fluids and blood. Prevention relies on avoiding the risk factors associated with the transmission of the virus.
To avoid hepatitis B:
Get vaccinated
Practice safer sex (use condoms and dental dams)
Use new and sterile injecting equipment each time
Avoid backyard tattooing and piercings
Avoid sharing toothbrushes, razors, hair and nail clippers and other personal hygiene products
Cover open wounds with a bandaid or bandage
Always wear disposable gloves when cleaning up blood or body fluids or giving someone first aid
Wipe up any blood spills then clean the area with bleach
Throw away personal items such as tissues, menstrual pads, tampons and bandages in a sealed plastic bag
People who have been exposed to hepatitis B and are not vaccinated should:
receive hepatitis B immunoglobulin (HBIG) within 72 hours of exposure, and
a dose of hepatitis B vaccine within 7 days
Transmission
Hepatitis B is found in blood and body fluids including semen and vaginal fluids.
Risk Factors
Mother to baby, although the risk is reduced through the Australian vaccination program and the administration of hepatitis B immunoglobulin and vaccination within 12 hours of birth
Unprotected sex with a person who has hepatitis B
Sharing of unsterile injecting equipment (including, water, tourniquets, unclean hands and surfaces)
Unsterile medical, surgical, dental, tattooing or body art procedures
Child-to-child transmission through household contact such as biting
Sharing razors, toothbrushes, hair and nail clippers or other personal effects
Unsterile cultural practices involving blood
Needle stick injury
Having received blood products in Australia before 1991
Fighting
Hepatitis B Is NOT Spread By:
contaminated food or water
through casual or social contact such as kissing, sneezing, coughing or hugging
eating food prepared by a person with hepatitis B
sharing food with a person who has hepatitis B
sharing bathrooms, showers or toilets
Testing
Hepatitis B is complex and a number of blood tests may need to be carried out, these blood tests can happen all at once.
The results of these tests can indicate:
an acute (recent) infection
if you are immune to hep B
resolved (cleared and immunity to hep B) infection or
chronic (long term) infection
Further tests in chronic hepatitis B infection can indicate whether the virus is:
‘actively’ replicating (active infection), or
‘inactive’ (replicating at a much lower rate)
All test results and an explanation of their meaning should be provided by the doctor in person.
Symptoms
The symptoms of hepatitis B can depend on whether a person has acute or chronic hep B. About half of adults infected with hep B and almost all children will not experience symptoms at all. If a person believes they may have been exposed to hep B, it is important to see a doctor for testing.
Acute (Short Term) Hepatitis B
Symptoms in adults include:
jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces/poo) occurring approximately 12 weeks after initial contact
loss of appetite
nausea and vomiting
tiredness
abdominal pain and
muscle and joint pain
Many people with acute hepatitis B have no symptoms and never realise they had the virus. A very small percentage of people with acute hepatitis B become very sick in a short period of time. This happens if there is massive damage to the liver and it stops working. This is called ‘fulminant hepatitis’.
Chronic (Long Term) Hepatitis B
Often results in no symptoms, meaning people can feel healthy and not be aware they have hepatitis B. However, other people may experience symptoms that are similar to those experienced with other forms of hepatitis.
These can include:
tiredness
depression and irritability
pain in the liver (upper, right side of abdomen)
nausea and vomiting
loss of appetite
joint aches and pains
People with chronic hep B have a higher risk of developing liver cancer.
It is important that people know their hepatitis B status. In some cases, a diagnosis of hepatitis B may explain why a person has been feeling ill or fatigued, or why certain foods or alcohol may make them feel unwell. Monitoring (regular check-ups) and treatment for hepatitis B is used to manage the effects of hep B, but is not a cure.
Treatment for hepatitis B helps maintain good health, but it is not a cure
Not all people with hepatitis B will need treatment but will need monitoring by their doctor. People who are chronically infected, but do not have any liver damage do not need treatment but need close monitoring with regular (6 monthly) liver function tests
Regular liver check-ups to monitor your health will help determine when/if you need treatment
If a person has liver damage they should speak to their doctor about starting treatment
The Australian Government through the Pharmaceutical Benefits Scheme (PBS) funds several different medications to treat chronic hepatitis B
The Decision On When To Start Treatment Is Complex And Should Be Made In Consultation With A Gastroenterologist Or Specialised GP.
Hepatitis B treatment is suitable for people who are classified as being in a particular stage of hepatitis B infection, dependent on a person meeting the following criteria:
Increased virus activity and liver inflammation are demonstrated by elevated liver enzymes (ALT)
Inflammation and activity in the liver as seen in the results of a liver biopsy
High levels of hepatitis B virus (HBV DNA) in the blood
Treatment Aims:
To stop the hepatitis B virus from multiplying or to reduce the rate of multiplication as much as possible
Decrease the risk of serious liver disease
Make it possible for the liver to repair some of the damage and to work better
During treatment, the patient’s blood tests are monitored very carefully to look for signs of antiviral resistance. If there are signs of resistance such as elevated liver enzymes and high levels of hepatitis B virus in the blood, the antiviral tablets will be changed.
Vaccination
The hepatitis B vaccine is safe and effective
You cannot get hepatitis B from the vaccine
Newborns should be vaccinated against hepatitis B at birth. Further doses at 2, 4 and 6 months are important to ensure immunity
Adults at greater risk for contracting hepatitis B should have a blood test before being vaccinated to check whether they have hepatitis B and to check their immunisation status
Children born after 1 May 2000 should have been given the hepatitis B vaccine shortly after they were born
Your doctor or sexual health service will have the hepatitis B vaccine available
Vaccination consists of three injections over a six-month period and it is important to ensure you receive all three injections
Most people don’t experience side effects from the hepatitis B vaccine
In the ACT, the hepatitis B vaccination is funded through Australia’s National Immunisation Program (NIP) where it is available for all babies at birth.
Free Hepatitis B Vaccinations Are Also Available In The ACT For:
Sexual and / or household contacts of a person with hepatitis B
People who inject drugs
Refugees and humanitarian entrants into Australia who have no history of hepatitis B immunisation
List Of People Recommended To Get The Hepatitis B Vaccine.
The Australian Immunisation Handbook3 (ATAGI 2018) recommends that the following groups of people get the hepatitis B vaccine:
Infants, children and adolescents
Aboriginal and Torres Strait Islander people
People who are immunocompromised, including:
people living with HIV
dialysis patients and people with severely impaired kidney function
people about to receive an organ transplant
people who have received a stem cell transplant
People with other medical conditions, including:
people with chronic liver disease and/or hepatitis C
people who receive certain blood products
people with developmental disabilities who attend day-care facilities
People who are at risk because of their job, including:
people who work in any occupation that involves direct patient care, handling human tissue, blood or bodily fluids, or used needle and syringes
healthcare workers
police, members of the armed forces, emergencies services staff, and correctional facilities staff
funeral workers, embalmers
staff involved in care of people with development disabilities
workers who perform skin penetrating procedures, such as tattooists and body piercers
People travelling to countries with higher levels of hepatitis B
Other groups:
household or other close contacts of people living with hepatitis B
sexual contacts of people living with hepatitis B
men who have sex with men
migrants from countries with higher levels of hepatitis B
people who inject drugs
inmates in correctional facilities
sex industry workers
Pregnancy, Children And Hep B
Newborns infected with hepatitis B rarely experience symptoms of acute infection, but 80 - 90% will develop chronic or lifelong infection
Children infected with hepatitis B rarely experience symptoms of acute infection, but 30% will develop chronic or lifelong infection
Adults or adolescents infected with hepatitis B commonly experience symptoms of acute infection, however less than 5% develop chronic or lifelong infection (Dore, G; et al; 2006)
Pregnancy And Hepatitis B
All pregnant women should be tested for hepatitis B
It is very important that pregnant women who have hepatitis B discuss monitoring the hep B with their doctor
It may be beneficial for some pregnant women who have hepatitis B to take antiviral medications during their pregnancy to reduce the chances of passing the hepatitis B onto their baby, discuss this with your doctor
Pregnant women who are unsure if they have been vaccinated against hepatitis B should be checked
The most common way people contract hepatitis B is through childbirth when they are born
Babies who are born to women who have hepatitis B can be given hepatitis B immunoglobulin and hepatitis B vaccination at birth. This greatly reduces the risk of transmission from mum to baby
Children And Hepatitis B
The most common way children contract hepatitis B is when it is passed on during pregnancy and birth from their mother
When children have the hepatitis B virus for longer than 6 months, this is known as a chronic hepatitis B infection
Most children living with hepatitis B do not show any symptoms and are well and healthy children
A child’s liver function, growth and development are usually not affected
A child living with hepatitis B may be at risk of long-term complications
Monitoring of children with hepatitis B should be discussed with their doctor
There is no need to exclude children with hepatitis B from day-care or school or to advise staff of the child’s hepatitis B status
Hepatitis B And Hepatitis C Co-Infection
Hepatitis B and hepatitis C is the most common co-infection in people living with chronic hepatitis B in Australia
This co-infection is most commonly associated with exposure through unsafe injecting drug practices. People with hepatitis B and hepatitis C co-infection can either be exposed due to this shared mode of transmission or have an independent risk factor for chronic hepatitis B such as country of birth, Aboriginal and Torres Strait Islander status, or sexual risk
Hepatitis B and C co-infection may cause more severe liver disease with an increased risk of cirrhosis and liver cancer and higher mortality rates - 3 times higher than just having hepatitis B or C alone
Acute (short term) co-infection, which is usually acquired through unsterile injecting drug use, has been associated with an increase of fulminant (rapid loss of liver function) hepatitis
References:
ACT Health: Hepatitis B Factsheet: https://health.act.gov.au/
ASHM Complex situations Co-infection and Immunosuppression: https://www.hepatitisb.org.au/complex-situations-co-infection-and-immunosuppression/
Australian Government Department of Health: https://www.health.gov.au/health-topics/hepatitis-b
Australian Government Department of Health -Immunisation: https://campaigns.health.gov.au/immunisationfacts
Australian Government Department of Health: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-f-routine-maternal-health-tests/hepatitis-b
Hepatitis Australia: https://www.hepatitisaustralia.com/what-is-hepatitis-b
Hepatitis Australia: https://www.hepatitisaustralia.com/Pages/FAQs/Category/hepatitis-b-faqs
Hepatitis Australia: https://www.hepatitisaustralia.com/hepatitis-b-vaccinations
The Sydney Children's Hospital Network (SCHN): https://www.schn.health.nsw.gov.au/fact-sheets/hepatitis-b-virus-infection-in-infants-and-children
World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
