What is hepatitis B?
Hepatitis B (HBV) is a liver disease that causes inflammation of the liver. This inflammation can cause liver cell damage, which can lead to scarring of the liver (cirrhosis) and an increased risk of liver cancer. Each year in the U.S. more than 100,000 people contract HBV. Approximately 90-95% of adults will recover within six months and not contract HBV again.
However, blood tests will always show that they have been infected with HBV and blood banks will not accept their blood. Approximately 5-10% of adults and 25- 90% of children under the age of five that are infected with HBV are unable to clear the virus within six months and are considered to be chronically infected, commonly called hepatitis B carriers.

What are the symptoms?
Many people with acute hepatitis B have no symptoms at all, or they may be very mild and flu-like: loss of appetite, nausea, vomiting, diarrhea, fatigue, muscle or joint aches and mild fever. About 25 - 35% of the patients may notice dark urine, yellowing of the skin and eyes (jaundice), or light colored stools. A few patients have a more severe course of illness and may die of fulminant (overwhelming) hepatic failure within a short period of time after getting sick.

How is HBV passed from one person to another?
HBV is transmitted through contact with body fluids containing HBV, such as blood, semen and vaginal secretions (menses). Thus, anyone who is exposed to blood or body fluids of an infected person is at risk of contracting HBV. Hepatitis B is most commonly passed from person to person through sexual contact. It can also be passed through exposure to sharp instruments contaminated with infected blood, such as tattooing, body piercing and acupuncture needles, sharing of razors or toothbrushes with an infected person, or human bites and through blood given before hepatitis B testing was available (1975). In about 30%-40% of cases, the method of passing the virus to others is unrecognized. The virus can survive outside of the body for at least 7 days on a dry surface and is 100 times more contagious than HIV (the virus that causes AIDS).
 

People Who Are At Risk For Hepatitis B:

• injection drug users;
• hemophiliacs and hemodialysis patients;
• sexually active homosexual and bisexual men; 
• blood transfusion recipients (before 1975);
• those who live in a household with an infected person;
• babies born to infected mothers;
• anyone having sexual contact with an HBV carrier; or
• prisoners and others in long-term facilities;
• anyone with multiple sex partners;
• travelers to developing countries; persons in occupations that have contact with blood
• adoptees from countries with high rates of HBV.

How will I know if I have hepatitis?
The only way to know if you are currently infected with HBV or if you are a carrier of the virus is to have a specific blood test for HBV. The test will not show positive during the incubation period (45 to 60 days, average 120 days). Ask your doctor to test you for HBV as it is not usually included in routine blood tests. There are three standard blood tests for HBV.
 

• HBsAg (hepatitis B surface antigen): when this test is positive or reactive, you are infected with HBV and are infectious.
• Anti-HBc or HBc-Ab (antibody to hepatitis B core antigen): when you test positive, it means you are currently infected with HBV or have been infected some time in the past.
• Anti-HBs (antibody to HBsAg) when this test is positive, it means that you are immune to hepatitis B either as a result of having had the disease or from having had hepatitis B vaccine.

Will hepatitis B always become chronic (long lasting)?
People who have not cleared HBV from their blood within 6 months are considered to be chronically infected and are called hepatitis B carriers. There are about 1 million persons chronically infected with HBV in the U.S. at the present time. Babies born to HBV-infected mothers are at high risk of becoming chronically infected with HBV compared to a much lower risk for adults. Usually a person with chronic HBV infection has no signs or symptoms of infection and can unknowingly pass HBV to others. In some patients HBV continues its silent attack on the liver, eventually causing cirrhosis (scarring) or cancer of the liver. Cirrhosis slows the blood flow through the liver and causes greatly increased pressure in the portal vein that carries nutrients from the stomach and intestines to the liver. As a result, varicose veins may develop in the stomach and esophagus and, without warning, these large veins can break, causing a person to vomit blood or have black, tarry stools (bowel movements). A pregnant woman who is an HBV carrier can pass the infection on to her newborn baby at birth. Eighty-five - 90% of babies infected at birth will become carriers or chronically infected, reducing their life expectancy. About 4,000 people die each year in the U.S. due to liver problems related to HBV.

What should you do if you are chronically infected with HBV?
Remember that your blood and other body fluids can pass HBV to others although you may not feel sick. You should never have unprotected sex unless your sex partner has had hepatitis B vaccine or is already immune. All members of your household should receive hepatitis vaccine. You should cover sores and rashes with bandages and do not let anyone use your toothbrush, razor, or other sharp instruments that you have used. Any household surfaces that become contaminated with your blood or body fluids should be cleaned with a diluted household bleach solution (l cup of bleach to 10 cups of water).  You should not drink alcohol as it may cause additional damage to your liver. Avoid combining drugs, prescribed or over-the-counter with alcohol. Don’t share chewing gum or pre-chew food for babies. Tell your physician what medications you are taking. An HBV carrier should see a physician every six months to a year to have liver function tests.

Is there a treatment for HBV?
While there is no treatment for acute hepatitis B, there are two approved treatments for chronic hepatitis B: interferon alfa-2b and lamivudine. Only patients with active HBV replication are candidates. The drugs should not be given together. Overall, about 35% of patients treated with injections of interferon for 4 to 6 months will have a long-term response. The response to oral lamivudine, given for at least one year, may be somewhat lower but the most effective duration of therapy remains uncertain. Lamivudine is very well tolerated but viral resistance to treatment may occur. Interferon therapy often results in a number of side effects including: flu-like symptoms, fatigue, headache, nausea and vomiting, loss of appetite, depression, and hair thinning. Because interferon may depress the bone marrow, blood tests are needed to monitor white blood cells, platelets. Liver enzymes are monitored during treatment with both drugs. Patients with chronic hepatitis B should consider being vaccinated against hepatitis A. Other treatments for HBV are under study.

What can I do if I am exposed to HBV?
If you have not been vaccinated and have been exposed to an HBV infected person’s blood through sex or other contact; you should receive hepatitis B immune globulin (HBIG) within 14 days of exposure. The vaccine series should also be started. Newborns exposed to HBV at birth should receive HBIG plus the hepatitis B vaccine within 12 hours of birth and two or three additional doses of vaccine within 6 - 12 months. Check with your doctor or local health department if you think you have been exposed to HBV through sexual contact or other types of exposure.

Is there a vaccine for HBV?
There are safe and effective vaccines for hepatitis B. The usual schedule is: first injection, then a second one in 1 month, and a third one 5 months later. Children receiving the second and third injections may be given a combined vaccine that includes Haemophilus influenza type b (Hib) and HBV. The HBV vaccine provides protection for at least 14 years, and possibly alifetime. It will not "cure" a person who is already infected. The Centers for Disease Control and Prevention recommend that all newborns receive hepatitis B vaccine. Babies born to infected mothers should also receive hepatitis B immune globulin (HBIG) within twelve hours of birth. All children should be vaccinated by 11 years of age; however, all adolescents should be vaccinated. Your doctor should have the vaccine, however, call first to find out.