Hep B Blog

Diagnosed with Hepatitis B? Preventing Transmission to Others Learning the HBV Basics, Transmission Part II

Part I discussed how hepatitis B is transmitted and may have helped you determine how you were infected with HBV.   In Part II we will discuss the people closest to you who may be susceptible to your infection.

Anyone exposed to HBV is susceptible. This is true if you have not already been vaccinated, or are not taking precautions. HBV does not discriminate. However, those most susceptible to infection are your sexual partners, close household contacts or family members. Why are the these people more susceptible?  Remember that HBV is transmitted through blood and infected body fluids, so sexual partners will be at risk. Unfortunately even close contacts without sexual intimacy may also be at risk. These include family members or roommates that might borrow your razor, the nail clippers on the downstairs counter, or your favorite pair of pierced earrings. Such personal items may have trace amounts of blood on them.  Hepatitis B can live outside the body for a week. It just makes sense that the odds of an exposure will happen with someone you live with just due to the increased potential for daily exposure in simple grooming routines or household activities where blood could be exchanged. The good news is that HBV is preventable.

It is important to know that unvaccinated babies and young children are more susceptible to HBV. This is because they have undeveloped, immature immune systems. In fact 90% of babies and up to 50% of young children infected with HBV will have life-long infection. That is why hepatitis B vaccination is so important for babies and young children.

So what should you do? You need to do the right thing. You need to talk to sexual partners and close contacts and family members now that you know you are infected. You don’t need to tell everyone; just those that you believe are at risk. Tell them to ask their doctor to run a hepatitis B panel.

The hepatitis B panel is one blood test with 3 parts: HBsAg – surface antigen;  HBcAb – core antibody; and HBsAb – surface antibody.  When read in combination, this one test can tell your close contacts if they are currently infected, have resolved a previous infection, and whether or not they have immunity to the hepatitis B virus. Typically the blood test results are straight forward, but sometimes they can be tricky. Ask those tested to discuss their results with their doctor, and to keep a copy of the blood tests results for review.

One important factor for those that may have been exposed is the timing. There is up to a 9 week window period between an exposure to HBV and when the hepatitis B virus shows up in the blood resulting in a positive test result.  If you tell your partner and they insist on immediate testing, they need to understand that they will need to be re-tested 9 weeks later to ensure whether or not they have been infected. AND, it is essential to practice safe sex and follow general precautions until everyone is sure of their status –both the known and potentially infected.

Remember you may still be in a waiting period trying to determine if you are acutely or chronically infected. Very possibly you have not had symptoms with your HBV. Nearly 70% of those with newly infected with HBV have no notable symptoms. It’s also very likely you are unsure when you were infected.  And of course it’s possible you are chronically infected and have had HBV for quite some time. It’s stressful and little confusing not knowing the details of your infection, but you need to move forward doing the right thing and talking to those at risk and taking care of yourself.

Take a look at Part I and Part III for further discussion of HBV transmission.

Newly Diagnosed with Hepatitis B? How Did I Get this? Learning the HBV Basics, Transmission – Part I

If you have just been diagnosed with hepatitis B virus (HBV) then you need to understand how HBV is transmitted. This is the case whether you are acutely or chronically infected.  You must understand you are infectious at this time and can transmit the virus to others.

How is hepatitis B transmitted? Hepatitis B is transmitted through blood and infected body fluids. This can happen through direct blood-to-blood contact, unprotected sex, unsterile needles and unsterile medical or dental equipment, and from an infected mother to her baby.  For kids, pediatric experts report that the fluid that oozes from cuts and open sores is also highly infectious. HBV can also be transmitted inadvertently by the sharing of personal items such as razors, toothbrushes, nail clippers, and other personal items that may have trace amounts of blood on them.

HBV is not transmitted casually by sneezing or coughing, shaking hands or sharing or preparing a meal. In fact it is not contracted during most of life’s daily activities. Hugging or even kissing won’t cause infection unless there are bleeding gums or open sores during the exchange. It’s really all about trace amounts of infected blood, though the virus is in other bodily fluids in lower concentrations.  For example, it’s not about the saliva on the toothbrush that is a big concern, but rather the potential for trace amounts of blood that could be exchanged with a shared toothbrush.

How did I get this? If you have been diagnosed with hepatitis B virus you are likely racking your brain trying to figure out how you could have gotten HBV. Some can immediately track their likely exposure to a recent event, or perhaps a time period in their life where they were more likely to have been exposed. They may fit into an at-risk category for hepatitis B due to lifestyle choices, country of origin, frequent travel and exposure in endemic areas of the world, high risk employment, or unsafe blood or medical or dental procedures without adequate infection control. (Sadly, this is common in many parts of our world, but accidents can happen anywhere).

Since HBV is a silent infection there can be years before it is detected.  Many individuals born in endemic parts of the globe find out later in life that they are hepatitis B positive, even though they have likely had HBV since birth or early-childhood. Children are especially vulnerable to chronic HBV. 90% of babies and up to 50% of young children infected with HBV will remain chronic, and most will have no symptoms.  Often it remains undetected until it is caught in routine blood work or later in life when there may be liver disease progression. In Asia, vertical transmission from mother to child is very common; whereas in Africa, horizontal transmission at a young age is often the culprit.

Although not casually transmitted, there are inadvertent opportunities for exposure to hepatitis B. If you are from an area where HBV is very common, then the odds of exposure, transmission, and infection will be higher. If you do, or have participated in high-risk activities at some point in your life, you are also at greater risk. People are often quick to point out that they have never injected drugs or participated in more obvious high-risk activities, but let’s face it – multiple sex partners? Certainly sexual experimentation in college or early adulthood is not that unique. Things happen, people change, or sometimes they don’t. This isn’t a time for judging, it’s a reflection of what happened yesterday or 20 years ago that may have exposed you to HBV and resulted in infection.  That being said, unless it happened just recently and you can definitively identify your exposure, I would advise that you let it go and move forward. I spent a number of years wondering about the details of my daughter’s infection, but ultimately, it really doesn’t matter.

Time to move forward.

The next step – preventing transmission to others, Part II

Diagnosed With Hepatitis B? Symptoms? Learning the HBV Basics

The tricky part about hepatitis B symptoms is that there are often no symptoms. That is why hepatitis B is referred to as a “silent infection”. This can be a little confusing to people newly diagnosed with HBV – whether it is determined you have an acute or chronic infection.

If you have a new, acute infection, there is a good chance you will be one of the roughly 69% with no notable symptoms. You may feel a little under-the-weather or a little more tired then usual, or you may notice no difference at all. You may learn about your infection through blood work following a possible exposure, or following screening from a blood donation. Since 90% of adults infected with hepatitis B will clear the infection – most with no medical intervention, it is possible for you to be infected, clear the virus, and never even know until blood work shows evidence of a past infection.

Then again you may be one of the roughly 30% who do have symptoms. You may experience flu-like symptoms such as achy muscles and joints, a low-grade fever and fatigue. Because your liver plays a role in digestion, you may experience a loss of appetite, feel a little nauseous, or experience pain in the upper right quadrant of your abdomen. You may have dark, tea colored urine. Then again, these symptoms may not be so severe that you take much notice. It’s okay, because these symptoms typically do not require treatment. However, if you are symptomatic, or you are concerned, please see your doctor, so blood tests can be run to be sure your liver is safe.

Here are the important symptoms that you need to have checked-out immediately: jaundice, severe nausea and vomiting, and bloating or swelling of the abdomen. If you have any of these symptoms, you need to seek immediate medical attention. Your doctor will want to run blood work, which will likely need to be repeated while you are symptomatic and as you recover, to monitor your condition and be sure you are safe. At this time, your doctor will determine the next steps –perhaps you will need to be admitted to the hospital for fluids and observation if you are severely dehydrated, or more likely, you’ll recover at home with regular lab work and follow-up with your doctor.

If you notice that your skin or the whites of your eyes are yellow, then you are suffering from jaundice. This is due to a build-up of bilirubin in the blood and tissues. Your liver is an amazing organ and one of its responsibilities is the filtering out of your body’s bi-products or other toxins from your blood, maintaining them at healthy levels. Jaundice is very unsettling to those that have it because it is noticeable by others. Normal coloring will return once the body is able to rid itself of the buildup of these toxins.

Although rare, (approximately 1%) acute hepatitis B can result in life-threatening, fulminant hepatitis, which can lead to liver failure. Fulminant hepatitis requires immediate medical attention.

The other possibility is that you are actually chronically infected, and that your infection is not new. You may have been living with HBV since birth or early childhood. Your hepatitis B infection may be a complete surprise to you.  You might ask, “How could I have this infection all of these years and not even know it?” Once again, HBV is a silent infection.  For those chronically infected, obvious symptoms may not occur for decades. The liver is a hard-working, non-complaining organ, but you don’t want to ignore your HBV and put yourself at increased risk for cirrhosis, liver failure or liver cancer. Believe it or not, the sooner you learn about your HBV infection, the better, so that you get regular monitoring, seek treatment if necessary, and make lifestyle changes that are good for your liver and overall health.

Whether you have symptoms or not, there are a few things you need to remember. You must go back to your doctor for further lab work to determine if your HBV infection is acute or chronic. If you are still surface antigen positive (HBsAg+) after 6 months, then you have a chronic infection and need to see a liver specialist to learn more about your hepatitis B infection. The other thing you must do is take precautions so you do not transmit hepatitis B to sexual partners and close household contacts.  And finally, be sure to take care of your liver by eating a well-balanced diet, avoiding alcohol, and talk to your doctor or pharmacist about prescriptions or OTC drugs that may be hard on your liver.

A Capitol Celebration: US Leaders in Hepatitis B Celebrate World Hepatitis Day

Hep B United (HBU), a coalition established by the Hepatitis B Foundation (HBF) and the Association of Asian Pacific Community Health Organizations (AAPCHO), held its fifth annual Hep B United Summit from July 26th to 28th in Washington D.C. The summit was held to promote screening and prevention strategies and advocate for a cure to further HBU’s mission to eliminate hepatitis B in the United States.

The summit is the largest gathering of hepatitis B leaders from around the country including public health agencies, national non-profit organizations, community coalitions, and individuals and family members affected by hep B. Catherine Freeland, MPH, Public Health Manager of HBF, said, “The summit is like a family reunion.” It’s an opportunity for HBU members to convene, share best strategies, and celebrate their wins over the past five years. The partnerships within HBU ensures that best practices and resources are shared as well. “Once we have a cure, we are committed to making sure chronically infected Americans get it,” Chari Cohen, DrPH, MPH, co-chair of HBU mentioned during the summit. Over the past year, HBU screened 22,556, educated 52,194, and reached over 6 million people with in-language hepatitis B messaging! That’s a win for sure!

As a part of the summit, HBU partners visited Capitol Hill to discuss with federal legislators the need to support hepatitis B and liver cancer research, education, screening, and treatment programs. A Congressional reception was also held to highlight the “#justB: Real People Sharing their Stories of Hepatitis B” storytelling campaign, which increases awareness of hepatitis B through personal stories. There were also meeting sessions focusing on capacity building, sustaining local hepatitis B coalitions, and best ways to utilize resources like the “Know Hepatitis B” campaign from the CDC and Hep B United and the #justB campaign. The Hep B United Summit is a way to celebrate World Hepatitis Day, which is on July 28th every year. Partners celebrated and raised awareness for World Hepatitis Day around Capitol Hill with a scavenger hunt!

At the Summit, HBU and its CDC partners presented five community leaders with the 2017 Hep B Champion Awards in recognition of their outstanding commitment to eliminating hepatitis B and liver cancer in their communities:

 Cathy Phan, the Health Initiatives Project Manager at HOPE Clinic in Houston, Texas, is recognized for her dedication to reducing health disparities, advocating for access to health care and health equity for underserved populations. Cathy brings unique perspectives, best practices and creative, innovative ideas from the local community clinics to the national level.

Vivian Huang, MD, MPH, the Director of Adult Immunization and Emergency Preparedness for the New York City Department of Health and Mental Hygiene and the medical director for the NYC Department of Health Immunization Clinic is recognized for her commitment to reducing the burden of vaccine-preventable diseases locally and globally including hepatitis B and liver cancer. Dr. Huang is a strong, tireless advocate for hepatitis B prevention, education, and treatment and health equity through health department engagement.

Hong Liu, PhD, the Executive Director of the Midwest Asian Health Association in Chicago, Illinois, is recognized for her innovative approaches to educating the public on hepatitis B and her willingness to share her best practices and experiences with others working in the field. This year, Dr. Liu’s leadership has led her organization to educating over 1,337 individuals in Chicago’s Chinatown district and screening close to 300 individuals for hepatitis B.

Dan-Tam Phan-Hoang, MSc., is program manager of HBI-Minnesota, a Minneapolis, Minnesota-based non-profit that she helped start in 2015. Dan-Tam is recognized for her leadership in Minneapolis, building strong collaborations with community leaders, healthcare providers, funders, and government agencies to address hepatitis B throughout the state and successfully establishing a hepatitis B outreach and prevention program for high-risk communities in the Twin Cities.

The National Task Force on Hepatitis B for AAPI, is a national organization that brings together scientists, health professionals, non-profit organizations, and concerned citizens in a concerted effort to eliminate the transmission of hepatitis B and to decrease health disparities among those chronically infected. The Task Force is recognized for increasing physicians’ awareness about hepatitis B and launching a new health care provider program, bringing together public health and health care professionals in regional meetings around the country. The Health Education for Liver Providers (H.E.L.P.) Training Program is designed to provide health care providers and their medical team core medical knowledge of hepatitis B and hepatitis C.

Read the summit press release here.

More pictures of the summit can be found on HBU’s Facebook album, Storify, and e-newsletter.

To read about the Hep B United 2016 Summit from last year, click here.