Hep B Blog

Tag Archives: acute HBV

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

Newly Diagnosed with Hepatitis B? Acute or Chronic? Learning the Hep B Basics

Image courtesy of dream designs at FreeDigitalPhotos.net
Image courtesy of dream designs at FreeDigitalPhotos.net

If you’ve just been diagnosed with hepatitis B after a routine blood test or following a blood donation, you may be feeling overwhelmed with information about this complicated infection and references to acute or chronic hepatitis B.

Here is an explanation of these two terms and what happens when you’re first infected with the hepatitis B virus (HBV). Hepatitis B is transmitted through blood and body fluids. It can be spread during unprotected sex, unsafe medical procedures, exposure to blood that enters your body through a cut,  or by sharing personal items such as body jewelry or toothbrushes. Most commonly it is spread during childbirth when the mother is infected.

What is a chronic infection? When we’re infected as newborns or young children, our immature immune systems don’t notice or fight the virus and it travels to our liver and begins reproducing. With no opposition from our immune systems, a hepatitis B infection can continue for years. When a hepatitis B infection lasts longer than six months, it is considered a chronic or long-term infection. Most people with chronic hepatitis B were infected at birth or during early childhood. Immunization with the hepatitis B vaccine and hepatitis B immune globulin (HBIG), if available, within 12 to 24 hours of birth can break this mother-to-child infection cycle, but the birth vaccine dose and often HBIG is not always available around the world.

What is an acute infection? When we’re infected with HBV as healthy adults, about 90 percent of us are able to get rid of the infection within six months. It can take up to six months for our immune systems to generate antibodies and eradicate the infection in our liver. This short-term infection is called acute hepatitis B.

To determine if you have an acute or chronic infection, you must be tested for hepatitis B over a six-month period. The specific test that indicates if you are infected is the hepatitis B surface antigen (HBsAg) test. This antigen covers the surface of the virus and usually there are lots of HBsAg in your blood when you’re infected. If you test positive for HBsAg for longer than six months, it means you have a chronic hepatitis B infection.

But, if you no longer test positive (or “reactive”) for HBsAg after six months and you develop hepatitis B surface antibodies (HBsAb), then you have cleared hepatitis B after an “acute” infection. There are some additional blood tests that your doctor may order to get a better understanding of your infection, but not everyone has access to these tests. Some tests are rather expensive and they may still need to be repeated over time in order to confirm the diagnosis. Please be patient. The good news is that hepatitis B is not typically an emergency.

Here is more good news. If you are a healthy adult and are newly or acutely infected, know that your chances are good that the hepatitis B infection will go away on its own. It is rare that you require medication to get rid of the virus, your immune system does that for you.  A person with a new hepatitis B infection may not have any symptoms, or they may not be very notable. For example, you might feel more tired. About 70 percent of people newly-infected with hepatitis B never experience symptoms.

But, some people experience severe symptoms like jaundice (yellowing skin or eyes), severe nausea or vomiting, or a bloated stomach (unrelated to your weight), and they need to see a doctor immediately. If you have a new or acute infection, even these drastic symptoms may not necessarily mean that you need any form of treatment, but you will need to be monitored with additional tests to make sure your liver is safe.

If you can’t confirm you were infected as a child, you will need to wait the six months to find out if you cleared your infection. Please be patient and do not panic, but remember you do need to take precautions during this time to make sure you don’t spread the infection to others. Practice safe sex (use a condom), and don’t share personal items that may have trace amounts of blood on them.

Also, you can suggest that your family members get screened for hepatitis B and vaccinated if needed. If you were infected at birth, there is a chance that your siblings may also be infected. Sexual partners and close household members should also be tested. There may be a nine-week period right after infection when they may not test positive for HBsAg even if they have been infected.

Diagnosed with Hepatitis B? Do You Need Treatment?

When people learn they are infected with hepatitis B, the first thing they want to know is “what can I take to get rid of this disease?” It can be complicated, and what can be even more difficult to understand is that during different stages of the disease there may be absolutely no benefit from currently available treatments.

Just diagnosed with HBV? Are you acute or chronic? 

First, if you have just been diagnosed with HBV, it is imperative that you determine if you have an acute or chronic infection. If you have an acute, or new infection, then it is important to know that very few people require any sort of treatment. Just be sure you are being monitored by your doctor, and take good care of your health and be sure to prevent transmission to others during this time.

Chronically infected, now what?

If your doctor determines you are chronically infected, then you will need additional information to determine what your next steps should be.

Remember that unless you display urgent symptoms, such as jaundice, or a bloated abdomen, or severe illness, you really can wait a few weeks, or even a few months, to see a liver specialist. Many people panic if they are unable to see a liver specialist immediately.  Relax, find a good doctor, learn what you can about hepatitis B, and take care while you wait.

How will you be evaluated?

Your liver specialist will do a complete work-up on you. He will perform a physical examination, get a complete medical history, and he will run additional blood tests to learn more about your hepatitis B status and your liver health. He may also get a baseline ultrasound or perform other diagnostic imaging procedures to gain more data so he can make a decision whether or not you would benefit from treatment at this time.  Some of the blood work may need to be repeated over a period of time before your doctor decides whether or not to move forward with treatment. Do not beg your doctor for treatment. Waiting and watching is sometimes the smartest thing to do.  Treatment is rarely an emergency. Time is on your side, so please be patient.

What can you do while you wait?

This is a good time to look at some of your personal lifestyle choices and consider some basic changes that might benefit you at this time. Avoid alcohol, and stop smoking. Focus on eating a well-balanced diet filled with fresh vegetables, fruit, whole grains and lean meats. Avoid fast and processed foods when possible. They may contain trans fats, partially hydrogenated fats, high fructose corn syrup and other less desirable “ingredients”. Don’t’ forget to get everyone in the household screened and vaccinated against HBV if you have not already done so.

What’s next? Tune in next time to learn about some of your blood work…