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Hepatitis Delta: Flying Under the Radar in the U.S.

As of 2019, the Centers for Disease Control and Prevention (CDC) requires over 100 diseases, infections and conditions – including hepatitis A, B and C – to be reported by state and local health departments. Physicians who diagnose these conditions, and diagnostic laboratories, are required to report confirmed and/or suspected cases to health departments, who then notify the CDC. This requirement allows the government to monitor disease patterns and track outbreaks to contain the spread of disease and protect the public. While all other forms of viral hepatitis are federally ‘reportable’, hepatitis delta cases are not required to be reported. Hepatitis delta is the most severe form of viral hepatitis, and spreads similarly to hepatitis B; through blood and sexual fluids, making it a public health threat, particularly for the 2.2 million people who already have hepatitis B in the U.S.

Hepatitis delta can only be contracted along with hepatitis B or after someone is already infected with hepatitis B. Acute cases can cause liver damage and even liver failure, and in chronic cases, can accelerate the rate of liver disease progression, as there are no effective treatments available. Although estimated to affect 5-10% of hepatitis B patients, hepatitis delta is severely underdiagnosed, leaving the true disease burden largely unknown in the U.S. and worldwide.

In conjunction with awareness efforts, adding hepatitis delta as a reportable disease could reveal a more accurate prevalence landscape of hepatitis B and delta coinfection and allow for more effective prevention efforts. The CDC asserts that “reporting of cases of infectious diseases and related conditions has been and remains a vital step in controlling and preventing the spread of communicable diseases,1” yet hepatitis delta has still been left out of the list of nationally reportable diseases. While notifying CDC is only voluntary2, 23 states have designated hepatitis delta infections as reportable to local and state health departments, allowing for surveillance of outbreaks, particularly relevant to the current nationwide opioid crisis.

Worchester, Massachusetts, which is currently experiencing a hepatitis A outbreak, also saw one of the worst hepatitis delta outbreaks in the country in the mid 1980’s. The infection was seen among drug users and their sexual partners, sickened 135 people, and killed 15. In those infected with hepatitis B, delta coinfection was present in 54% of drug users and 33% of their sexual partners3
. Interestingly, in Massachusetts, only labs (and not clinicians) are required to report hepatitis delta cases. The reporting requirement allowed the state to be alerted of a spike in cases and respond accordingly – a luxury many other states may not have if neither labs nor clinicians are required to report in their state.

Some states are even scaling back their surveillance; in 2016, New York State removed hepatitis delta from their list of reportable diseases, citing just 21 cases in a two-year period and a health code that asserts a “providers obligation” to “report unusual manifestations of novel strains of hepatitis.”4. Although hepatitis delta is more common outside the U.S., there is evidence to suggest persistent and even growing prevalence. A 2016 prevalence map presented by Eiger BioPharmaceuticals revealed New York City as a “hot-spot” for hepatitis delta cases5. Although more recent prevalence studies are sparse, and often include only small sample sizes, several have noted increases in hepatitis delta coinfection among certain groups. One study in Baltimore, published in 2010, compared blood samples from drug users in the 1980’s to samples obtained from 2005-2006 – and found a 21% increase in hepatitis delta coinfection among people already chronically infected with hepatitis B6. A 2015 study analyzed the blood records of 2,100 hepatitis B positive veterans – nearly 4% were coinfected7. A larger study, analyzing chart records of 500 chronic hepatitis B patients in California found that 8% of patients had a delta coinfection8. Another 2018 publication utilized data from 2011-2016 from the National Health and Nutrition Examination Survey (NHANES) and estimated there to be over 350,000 Americans with past or current hepatitis delta9.

While the true burden of hepatitis delta in the U.S. is debated, one study that analyzed diagnosis codes for over 170 million people showed 10,000 coinfected patients newly diagnosed in 2016 alone4. The American Association for the Study of Liver Diseases (AASLD) recommends delta testing in high-risk groups, but countless journals and leading hepatologists have called for universal testing of hepatitis B patients for hepatitis delta9,10,11  which could reveal thousands of unknown infections. Low awareness, testing, and the lack of inclusion on the notifiable diseases list contribute to the unclear picture of prevalence in the U.S. Inconsistent reporting across states creates holes in data collection and opportunities for missed outbreaks and subsequent treatment and prevention efforts. Adding hepatitis delta to the list of reportable diseases nationally could be the key to understanding who this ‘hidden epidemic’ is affecting, and where, and allow for effective surveillance to prevent future infections.

For more information about Hepatitis Delta Connect or hepatitis delta, visit www.hepdconnect.org or email connect@hepdconnect.org.

References:

1. Centers for Disease Control and Prevention. (1990, June 22). Mandatory Reporting of Infectious Diseases by Clinicians. Morbidity and Mortality Weekly Reports. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00001665.htm.

2. Centers for Disease Control and Prevention. (2018). National notifiable diseases surveillance system (NNDS): Data collection and reporting. Retrieved from https://wwwn.cdc.gov/nndss/data-collection.html

3. Lettau, L. A., McCarthy, J. G., Smith, M. H., Hauler, S. C., Morse, L. J., Ukena, T., et al. (1987). Outbreak of severe hepatitis due to delta and hepatitis B viruses in parenteral drug abusers and their contacts. N Engl J Med, 317(20), 1256-1262.

4. The City of New York. (2016). Hepatitis D and E and other suspected infectious viral hepatitides reporting. Retrieved from http://rules.cityofnewyork.us/tags/reportable-diseases.

5. Martins, E and Glenn, J. Prevalence of Hepatitis Delta Virus (HDV) Infection in the United States: Results from an ICD-10 Review. Poster Sa1486 DDW May 2017.

6. Lauren M. Kucirka, Homayoon Farzadegan, Jordan J. Feld, Shruti H. Mehta, Mark Winters, Jeffrey S. Glenn, Gregory D. Kirk, Dorry L. Segev, Kenrad E. Nelson, Morgan Marks, Theo Heller, Elizabeth T. Golub, Prevalence, Correlates, and Viral Dynamics of Hepatitis Delta among Injection Drug Users, The Journal of Infectious Diseases, Volume 202, Issue 6, 15 September 2010, Pages 845–852.

7. Kushner, T., Serper, M., & Kaplan, D. E. (2015). Delta hepatitis within the veterans affairs medical system in the United States: Prevalence, risk factors, and outcomes.

8. Gish, Robert & Yi, Debbie & Kane, Steve & Clark, Margaret & Mangahas, Michael & Baqai, Sumbella & A Winters, Mark & Proudfoot, James & Glenn, Jeffrey. (2013). Coinfection with Hepatitis B and D: Epidemiology, Prevalence and Disease in Patients in Northern California. Journal of gastroenterology and hepatology. 28. 10.1111/jgh.12217

Valentine’s Day: Dating, Love, and Hepatitis B

Valentine’s Day is a day of celebration, but it can also bring about worries and stress. Some might feel pressure about buying the right gifts for their loved ones. Maybe you’re wondering if it’s too soon in your relationship to celebrate the holiday. We may not be able to help you figure out what type of candy your partner likes the most, but we can help you navigate the holiday if you or a loved one is living with hepatitis B!

Can my partner and I have sex if one of us is infected and the other is not?

One way that hepatitis B is spread is through unprotected sex. This means that certain precautions need to be taken if your partner is uninfected, has not been vaccinated, or has not completed their vaccine series yet. Precautions include using a condom correctly. Using condoms can also prevent other sexually transmitted infections, like hepatitis C and HIV, that can be harmful to everyone, but especially to those who have chronic hepatitis B. Please keep in mind that certain sexual activities carry higher risks of transmission because of tiny, often microscopic tears in the membrane that may occur and increase the chances of direct blood contact! If you believe your partner has been accidentally exposed, they should contact their doctor or a local physician to begin post-exposure prophylaxis (PEP) as soon as possible. PEP can prevent chronic hepatitis B if caught early enough, so it is very important to inform the doctor of a possible exposure soon after it occurs.

If your partner has already completed the 2 dose (where available) or 3 dose vaccine series, there is nothing to worry about! They are not at risk for transmission! The recommended schedule for the three-dose vaccine consists of a dose at 0, 1 and 6 months, and the two-dose adult vaccine is at 0 and 1 month.  Some individuals may be interested in an accelerated vaccine schedule. Please understand that an accelerated schedule entails four shots, not three. The fourth shot would be administered at one year and would provide long term protection. Those that choose a shortened schedule will not have long term protection from hepatitis B if they do not complete the fourth dose. And your partner should have their blood tested 4 weeks after their last vaccine dose to confirm that they are protected.

I’m scared to tell my partner that I have hepatitis B.

It can be intimidating to tell a person something so personal, especially if you are uncertain about how they will react. However, it is extremely important! Even if you are using condoms, it is necessary to let your partner know your status before becoming intimate. Once you tell them, it will be a huge relief!

So, how can you prepare for the conversation?

  1. Research: hepatitis B can be confusing, so it is important that you both are familiar with the infection, including how it is transmitted! Apart from HBF’s website, the Centers for Disease Control and Prevention (CDC) has great information and handouts (in multiple languages!) on the infection. Consider printing one or two fact sheets out for your partner to look over.
  2. Take a deep breath: Don’t rush into the conversation. Take a moment to think about what you want to say. This will help you to stay calm and allow the conversation to progress. Remember to let your partner talk as well!
  3. Speak confidently: Don’t let hepatitis B speak for you! Let your partner know what you’ve learned about your infection and inform them that you are regularly visiting the doctor to monitor the infection. Speaking confidently can help keep them calm as well, and assure them that there is nothing to worry about!

If they react badly to the news at first, don’t worry! Everybody processes things at different rates and many people fear what they don’t understand. Try giving them some space and let them think about the information they’ve been given. You can also show them Heng’s #justB video; it tells the story of a man who fell in love and married a woman who is living with chronic hepatitis B and how he still supports her today! Also, remind your partner that hepatitis B is vaccine preventable! Three simple shots can protect them for life and they will never have to worry about the risk of transmission again!

Some people will never react kindly to the news, and that’s okay too! It may be disappointing, but don’t let it keep you down! You deserve someone who will accept and love you for who you are! Your chronic hepatitis B infection does not define you; it is just a small part of who you are.

For Partners of Chronic Hepatitis B Patients:

Valentine’s Day is a  time of love, and what better way is there to show love than by being supportive? If your partner is living with hepatitis B, you can show them you care in small ways! Perhaps it’s skipping the alcohol once in a while when you two go out with friends so they don’t feel alone. You can also try cooking healthy meals with them or exercising together a few times a week. Small gestures can say big things!

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!

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 up to 7 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!

 

Join us for a Twitter Chat for Liver Cancer Awareness Month!

October is Liver Cancer Awareness Month. Often we neglect to think about the link between hepatitis and liver cancer. Tuesday, Oct. 16, representatives from Hepatitis B Foundation, CDC’s Division of Viral Hepatitis, and NASTAD will co-host a twitter chat at 3 p.m. EST to discuss this important link.

Featured guests include Prevent Cancer Foundation, Hep B United Philadelphia (HBUP) and Iowa Harm Reduction Coalition. Prevent Cancer Foundation is a national nonprofit dedicated to cancer prevention and early detection. HBUP is a Hep B United partner committed to testing and vaccination to fight hepatitis B and liver cancer in Philadelphia. Iowa Harm Reduction Coalition is a non-profit organization providing non-judgmental and compassionate services that empower people to care for themselves and one another.

Below are the questions to be discussed during the chat. How can you contribute?  Join the conversation that day and throughout the month with the hashtag #Liverchat. Share any resources or strategies you have that raise awareness about the link between liver cancer and hepatitis.

  • Q1:What are things everyone should know about liver cancer, and also the link between hepatitis and liver cancer?
  • Q2: What can people do to prevent hepatitis, or for those living with hepatitis, what can be done to protect the liver and prevent liver cancer?
  • Q3: What are the barriers that keep people from getting screened for hepatitis and liver cancer and how can they be addressed?
  • Q4: Why are some populations more vulnerable to hepatitis and liver cancer, and how do we address the disparities?
  • Q5: What resources are available to educate others about hepatitis B & C and liver cancer? What resources are needed?
  • Q6: Who are your key partners in addressing liver cancer? Who would you like to engage more in your work? (Tag them here!)
  • Q7: What is one lesson learned or piece of advice for others who want to expand their work on the link between viral hepatitis and liver cancer?

Co-hosts and featured partners of the chat include:

  • Hepatitis B Foundation – @hepbfoundation
  • NASTAD – @NASTAD
  • CDC Division of Viral Hepatitis – @cdchep
  • Prevent Cancer Foundation – @preventcancer
  • Hep B United Philadelphia – @hepbunitedphila
  • Iowa Harm Reduction Coalition – @IAHarmReduction
  • CDCNPIN will be moderating the chat – @cdcnpin

Confirmed participants and their handles include:

  • Hep B United  – @hepbunited
  • Coalition Against Hepatitis For People of African Origin – @CHIPO_HBV
  • Liver Cancer Connect – @livercancerconn
  • CDC’s Division of Cancer Prevention and Control – @CDC_Cancer
  • Hep Free Hawaii – @HepFreeHawaii
  • HBI-DC – @HBIDC
  • HepFreeNYC – @hepfreenyc
  • NAIRHHA Day – @NAIRHHADAY
  • Minnesota Department of Health – @mnhealth
  • Philly Hep C Coalition – @hep_CAP

Just getting started with Twitter? Do you wish to join the conversation but you don’t know how?  Type #Liverchat in the search box of the Twitter application to follow the chat, and click on “Latest”.

 

You can prepare your tweets in response to the topics listed above in advance, or you can also tweet on the fly, re-tweet, or Like a tweet during the chat.

The questions are labeled Q1, Q2, etc. so please respond/answer specific question by using A1, A2, etc. in front of your tweets. Remember to include the #Liverchat hashtag, which is not case sensitive, in all of your tweets.

If you plan to participate, please contact us at info@hepb.org and we’ll add you to the list of confirmed participants. Let us know if you have any other questions about joining the chat. We’re here to help!

 

 

 

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

If you have just been diagnosed with hepatitis B virus (HBV) then you need to understand how HBV is transmitted. This is important whether you have an acute or chronic infection.  You must understand you are infectious and can transmit the virus to others.

How is hepatitis B transmitted? Hepatitis B is transmitted through direct contact with infected blood. This can happen through direct blood-to-blood contact, unprotected sex, unsterile needles, unsterile medical or dental equipment, and from a HBV infected mother to her baby at birth.  For kids, pediatric experts report that the fluid that oozes from cuts and open sores is also highly infectious, so keep those open cuts covered. HBV 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 HBV is not contracted during most of life’s daily activities. You don’t need to keep cups and utensils separate. 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, or an unsafe blood transfusion, or medical or dental procedures performed without proper infection control. Some may never know how they were infected. What is important is that you are now aware.

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. Greater than 90% of babies and up to 50% of young children infected with HBV will remain chronically infected, and most will have no symptoms.  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. In Asia, vertical transmission from mother to child is particularly common; whereas in Africa, horizontal transmission at a young age may be more likely.

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. Many are surprised when family is tested, and they learn hepatitis B appears to “run in their family”.  Hepatitis B is not genetic, but it is very easily passed from an HBsAg positive mom to her baby at birth. Hep B is a vaccine preventable disease, but not all moms living with the virus have access to the birth dose for their baby or able to complete the vaccine series, or they have a high viral load resulting in failure of HBV birth prophylaxis. The good news is that today we can prevent the transmission of hepatitis B to the next generation.

If you do, or have participated in high-risk activities at some point in your life, you are also at greater risk. This is not a time to judge or be judged.

Time to move forward. Unless your infection is acute 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 didn’t matter. What is important is seeing a doctor to learn more about your infection, getting treatment if you need it, preventing transmission to others, and moving forward with your life.

Join the Conversation at the Hep B United Summit; Watch Summit Sessions On Facebook Live!

The annual Hep B United Summit, organized by the Hepatitis B Foundation, convenes in Washington D.C. from Wednesday, July 25 through Thursday, July 26. National and local coalition partners, experts, stakeholders, and federal partners will meet to discuss how to increase hepatitis B testing and vaccination and improve access to care and treatment for individuals living with hepatitis B.

You can watch many of these sessions on Facebook Live. You can also follow the conversation at the Summit on Twitter with #Hepbunite!

Facebook Live is live video streaming available to all Pages and profiles on Facebook. Check out the agenda below and go to the HepBUnited Facebook Page to view the live broadcast. Some breakout sessions may be broadcast from the Hepatitis B Foundation Facebook Page. Sessions will also be available following the broadcast for those who are not able to join us live.

Here are the details on the sessions that will be broadcast on Hep B United’s Facebook Live unless noted otherwise:

Day 1 – Wednesday July 25:

8:30 – 9:00 AM:  Welcome and Introductions
Tim Block, PhD, President & Co-founder, Hepatitis B Foundation and Baruch S. Blumberg Institute
Chari Cohen DrPH, MPH, Co-Chair, Vice President for Public Health and Programs, Hepatitis B Foundation
Jeff Caballero, MPH, Co-Chair, Hep B United and Executive Director, Association of Asian Pacific Community Health Organizations (AAPCHO)

9:00 AM:  Applying a Health Equity Lens to Eliminating Hepatitis B
Tamara Henry, Ed.D., Teaching Assistant Professor, Prevention and Community Health, he George Washington University Milken Institute School of Public Health

9:30 AM:  Hep B United Coalition: Year-in-Review
Jacqueline Coleman, MEd, MSM, BA, CPC, Facilitator, Vision Que!, LLC Kate Moraras, MPH, Director, Hep B United and Senior Program Director, Hepatitis B Foundation

11:15 AM:  Know Hepatitis B Campaign and Expansion to African Immigrants
Cynthia Jorgensen, DrPH, Team Lead and Sherry Chen, MPH, CHES, Health Scientist, Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC)
Sierra Pellechio, BS, CHES, Health Outreach Coordinator, Hepatitis B Foundation

1:00 PM:  Federal-Community Partnership to Eliminate Hepatitis B
Moderator: Chari Cohen
Panelists:
Matthew Lin, MD, Deputy Assistant Secretary for Minority Health, HHS Office of Minority Health
Corinna Dan, RN, MPH, Viral Hepatitis Policy Advisor, HHS Office on HIV/AIDS and Infectious Disease Policy
Paul J. Wiedle, PharmD, MPH, CAPT USPHS, Acting Director, Division of Viral Hepatitis, CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Sarah F. Schillie, MD, MPH, Division of Viral Hepatitis, CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Nancy Fenlon, RN, MS, Public Health Advisor, Immunization Services Division, CDC National Center for Immunization and Respiratory Diseases
Judith Steinberg, MD, MPH, Chief Medical Officer, Bureau of Primary Health Care, Health Resources and Services Administration (HRSA)

2:30 PM – 3:45 PM:  BREAKOUT SESSIONS I

Preventing Perinatal Hepatitis B Transmission
Moderator: Amy Tang, MD, Hepatitis B Program Director, Charles B. Wang Community Health Center
Panelists:
Ruth Brogden, Center for Asian Health at Saint Barnabas Medical Center/New Jersey Hep B Coalition
Janice LyuMS, Charles B. Wang Community Health Center
Liz TangLMSW, New York City Department of Health & Mental Hygiene

Combating Hepatitis B-Related Stigma and Discrimination (Hepatitis B Foundation Facebook Live)
Moderators: Nadine Shiroma, Policy Advisor, Hepatitis B Foundation and Rita Kuwahara, MD, MIH, Hepatitis B Policy Fellow, AAPCHO

4:00 PM – 5:00 PM:  BREAKOUT SESSIONS II

Expanding Hepatitis B Screening to Other High-Risk Communities
Moderator: Arman Altug, Hepatitis Education Project (HEP)
Panelists:
Jack Hildick-Smith, Philadelphia Department of Public Health
Thaddeus Pham, Hep Free Hawaii/Hawaii Department of Health

Discuss strategies in reaching new partners to increase hepatitis B screening, vaccination and linkage to care.

Developing Innovative Practices in Hepatitis B Education and Screening  (Hepatitis B Foundation Facebook Live)
Moderator: Catherine Freeland, MPH, Public Health Program Manager, Hepatitis B Foundation
Panelists:
Brandi Dobbs, FNP-BC, CNS-CH,Asian Services in Action, Inc.
Karen Jiobu, Asian American Community Services
Layal Rabat, MA,Asian Pacific Community in Action
Xuan Phan, Mercy Housing and Human Development

Share results from the Hep B United Mini Grants Program.

 Day 2 – Thursday July 26

9:00 AM:   Improving Access to Hepatitis B Treatment
Wayne Turner, Senior Attorney National Health Law Program (NHeLP)
Sierra Pellechio, BS, CHES, Health Outreach Coordinator, Hepatitis B Foundation
Lauren Su, Hepatitis B Foundation

10:30 AM: Increasing Provider Knowledge about Hepatitis B
Richard Andrews, MD, MPH, Co-Chair, National Task Force on Hepatitis B MPH, and Medical Director, HOPE Clinic
Amy Tang, MD, MPH, Co-Chair, National Task Force on Hepatitis B and Hepatitis B Program Director, Charles B. Wang Community Health Center

1:30 PM:   Achieving Health Equity to Eliminate Hepatitis B
Facilitator: Cynthia Jorgensen

Not able to join the sessions with Facebook Live? Follow the conversation on Twitter using the #Hepbunite hashtag. Follow the events, retweet and engage with event attendees and help us raise hepatitis B awareness in the U.S. and around the globe.

World Hepatitis Day is July 28th, and this Summit is a terrific opportunity to share with the world what we’re doing to help those living with hepatitis B in our communities. Other popular hashtags for World Hepatitis Day, and to raise hepatitis B awareness, include: #NOhep, #KnowHepB, #WorldHepatitisDay, #WorldHepDay, #WHD2018, #FindTheMissingMillions #hepatitis, #hepatitisB, #HBV, #hepB, #justB. Connect with, follow and engage with fellow partners and advocates on twitter to keep the hep B conversation going during the Hep B United Summit, World Hepatitis Day events, and beyond.

Check out: @AAPCHOtweets, @AAHC_HOPEclinic, @AAHI_Info, @AAPInews, @apcaaz, @APIAHF, @ASIAOHIO, @CBWCHC, @cdchep, @cpacs, @HBIDC, @HBIMN15, @HepBFoundation, @HepBpolicy, @HepBProject, @HepBUnited, @HepBUnitedPhila, @HepEduProject, @HepFreeHawaii, @HHS_ViralHep, @MinorityHealth, @njhepb, @NVHR1, @nycHepB, @NYU_CSAAH, @sfhepbfree, @supportichs @wahainitiative @jlccrum

Missing from the list? Contact the Foundation at info@hepb.org to be added.

Don’t forget to join the World Hepatitis Alliance’s  #FindtheMissingMillions  Thunderclap to encourage people to get tested on World Hepatitis Day. Participate in the Hepatitis B Foundations World Hepatitis Day video and tell the world why you think people should be tested for hepatitis B.

Still have questions? Email us at info@hepb.org and we’ll help you get started!

Visit the Hep B United and Hepatitis B Foundation websites for more information about hepatitis B and related programs.

Recently Diagnosed with Hepatitis B? Getting Through the Next Months Waiting to Confirm if Your Infection is Acute or Chronic

Have you recently been told you have hepatitis B?  Dealing with the diagnosis and waiting out the next six months to determine if your infection will resolve itself or learning that it is a chronic infection can be nerve-wracking.

Fortunately, greater than 90 percent of healthy adults who are newly infected will clear or resolve an acute hepatitis B infection.  On the hand, greater than 90% of babies and up to 50% of children infected with hepatitis B will have lifelong, chronic infection. Sometimes people are surprised to learn they have a chronic infection. It can be confusing since there are typically few or no symptoms for decades. If a person continues to test hepatitis B positive for longer than 6 months, then it is considered a chronic infection. Repeat testing is the only way to know for sure.

Acute hepatitis B patients rarely require hospitalization, or even medication.  If you are symptomatic, (some symptoms include jaundice, dark urine, abdominal pain, fever, general malaise)  you may be anxiously conferring with your doctor, but if you are asymptomatic, you might not feel compelled to take the diagnosis seriously.  Ignoring your diagnosis can be very serious. If you have concerning symptoms like jaundice (yellow eyes and skin), a bloated abdomen or severe nausea and vomiting, please see your doctor immediately. Your doctor will be monitoring your blood work over the next few months to see if you clear the virus, or monitoring your liver if there are concerning symptoms.

Your job is to start loving your liver …today.  STOP drinking alcoholic beverages.  Refrain from smoking cigarettes.  Your liver is a non-complaining organ, but you cannot live without it.  Make your diet liver-friendly and healthy filled with a rainbow of vegetables and fruits, whole grains, fish and lean meats. Minimize processed foods, saturated fats and sugar.  Drink plenty of water.

Talk to your doctor before taking prescription medications, herbal remedies, supplements or over-the-counter drugs.  Some can be dangerous to a liver that is battling hepatitis B.  Get plenty of rest, and exercise if you are able.

Don’t forget that you are infectious during this time, and that loved ones, sexual partners and household contacts should be tested to see if they need to be vaccinated to protect against hepatitis B.  Sometimes family members or close household contacts may find that they have a current infection or have recovered from a past HBV infection.  If anyone fears exposure, ensure them that hepatitis B is not transmitted casually. They should get tested, and vaccinated if needed, and take simple precautions. Remind them that 1/3 of the world’s population will be infected with the hepatitis B virus during their lifetime.

On the flip-side… Do not let this new hepatitis B diagnosis consume you.  As the weeks and months pass, you might find that the infection is not resolving, and you might worry that you have a chronic infection.  The associated stress and anxiety can be challenging, even overwhelming.  It can contribute to physical symptoms you may be experiencing.  Find a family member, friend, or health care professional with whom you can share your concerns.

If you are told you have recovered from an acute HBV infection (you are now HBsAg negative, HBcAb positive and HBsAb positive) be sure to get copies of your lab reports to ensure there are no mistakes. Compare them with our easy to use blood tests chart.   If something looks wrong, or if you’re confused, speak up and ask your doctor. Once confirmed, be sure to include hepatitis B as part of your personal health history. This is important in case you have conditions requiring treatment later in life that might once again warrant monitoring of your hepatitis B. It is possible for a past HBV  infection to reactivate if a person requires longterm immune suppressing drugs .

No one wants to learn they have chronic hepatitis B but it is a manageable disease. You’ll want to see a doctor with experience treating chronic HBV so they can run additional tests. There are very effective treatments available, though not everyone with chronic HBV needs treatment. All people living with chronic HBV benefit from regular monitoring since things can change with time. Please do not panic or ignore a chronic hepatitis B diagnosis. Take a deep breath and get started today learning more about your HBV infection and the health of your liver.  Things are going to be okay!

If you are confused about your diagnosis, please feel free to contact the Hepatitis B Foundation at info@hepb.org.

Join a Twitter Chat: Organizations Share Highlights From Hepatitis Awareness Month

Join Hepatitis B Foundation, NASTAD and CDC’s Division of Viral Hepatitis for a Twitter #HepChat at 2 p.m. (EST) Thursday, June 14. The chat will highlight Hepatitis Awareness Month outreach events and allow hepatitis B and C partner organizations to share their successes, challenges and lessons learned from their efforts. HBF’s Kristine Alarcon and Jason Crum, this month’s featured storyteller will also be LIVE on Facebook, so if you’re not on twitter join us at hepbfoundation.

Continue reading "Join a Twitter Chat: Organizations Share Highlights From Hepatitis Awareness Month"

What to do about hepatitis B when you’re pregnant?

Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. 90% of these HBV infected babies will progress to chronic infection  putting them at increased risk of serious liver disease or liver cancer later in life.

It is important that ALL pregnant women get tested for hepatitis B to prevent the transmission of the virus to newborns at birth.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all newborns born to hepatitis B positive women be given two shots in the delivery room – the first dose of hepatitis B vaccine (5 mcg dose) and one dose of hepatitis B immune globulin (HBIG, 0.5 mL dose). If a woman knows that she is infected, it is important that she tell her doctor to have these two drugs available when she is ready to deliver. These two shots must be given at separate injection sites, i.e. different limbs. When administered correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection. The infant will need to complete the hepatitis B vaccine according to schedule as part of a 3 or 4 dose series. CDC recommends follow up testing to confirm immunity or protection against HBV at 9 months or at the baby’s 1 year checkup.

The World Health Organization (WHO) recommends the birth dose of the hepatitis B vaccine for ALL babies, though it is especially important for a baby born to a woman with hepatitis B to receive the first dose of the vaccine as soon as possible, within 24 hours. HBIG may not be available in all countries or may be cost prohibitive. The hepatitis B vaccine series may be completed with the remaining monovalent  (single) injections of the HBV vaccine, or may be completed as part of a combination vaccine series.

In developing countries combination vaccines such as the pentavalent vaccine are often given to babies. The first dose of the pentavalent vaccine (which includes hepatitis B vaccine) is given at 6 weeks of age, and the 2nd and 3rd doses are given at 10 and 14 weeks of age. Waiting for the first dose at 6 weeks is too late for babies born to mothers living with chronic hepatitis, though the pentavalent vaccine should never be used as the birth dose or before 6 weeks. Women who know they have hepatitis B should talk to their doctor about ensuring that a birth dose of the hepatitis B vaccine is available for their baby at birth.

There is no second chance!  It is vitally important that we protect all newborns from hepatitis B!

Also, all infected pregnant women need to learn more about their hepatitis B infection from a liver specialist or a doctor with experience treating patients with chronic hepatitis B. It is recommended that pregnant women have their hepatitis B monitored throughout their pregnancy, to check the health of their liver and to see if they need treatment. For HBeAg positive women with high hepatitis B viral loads, taking FDA-approved antivirals during the last trimester can reduce the amount of virus in the blood and help prevent the chance of transmission to the newborn. Once an infected woman gives birth, it is important that she routinely see her doctor to keep monitoring her hepatitis B infection. Keeping mothers healthy allows them to better take care of their families!

For more information, or if you live in the U.S. and need help with hepatitis B infection during pregnancy, please visit the Perinatal Hepatitis B Prevention Program to find a coordinator near you. If you are outside of the U.S., you may consider visiting the World Hepatitis Alliance to find if there are organizations in your country that can ensure your baby starts with a birth dose of the hepatitis B vaccine.

Visit our website for additional information!