17. Are there other counseling recommendations for someone with chronic hepatitis B?

In terms of counseling, we do a lot of things that Dr. Sam So has emphasized as well, although we didn’t really emphasize vaccination. One of my research interests that I’ve published quite a bit is that if you have underlying chronic hepatitis B or chronic hepatitis C or some other liver disease, and you get acute hepatitis A, it will be a more severe liver illness if you already have pre-existing liver disease. Therefore, the CDC now recommends hepatitis A vaccine for all people with any chronic liver disease, alcoholic liver disease, hepatitis B, hepatitis C. Now many of the Asian community that are my age, that were born in China, already have hepatitis A antibodies, about 90%-95% are already immune. So, it’s worth checking an A antibody. Hepatitis A is a very silent infection, occurs often in childhood in Asian countries and most Asians who are adults are already immune and don’t need the vaccine, but younger people are often not immune and need to be vaccinated. Alcohol- now this is just common sense, no one has studied the lower threshold. The best data is from the hepatitis C literature and we know that people who drink daily and heavily have an accelerated progression of their hepatitis C it’s probably the same for hepatitis B. People need to be counseled about infectivity, and there it’s DNA and e-antigen. 50% of sexual partners will be infected with hepatitis B. This is also not widely known- hepatitis B is far more infectious by sexual contact than HIV and more than hepatitis C. Now if you have a low DNA, then there’s a low risk of sexual spread, but you can still spread hepatitis B. All household contacts should be tested and all newborns should be vaccinated.