Hepatitis B Foundation

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乙型肝炎传染简介

我在感染乙型肝炎的初期是否会发病?

乙型肝炎被视为一种“无声的传染”,因为大多数人在被感染的初期并无症状。人们可能会在不知情的情况下感染乙型肝炎。有些受到感染者会发生类似流感的症状,此类症状经常受到忽略—他们认为自己只是感冒,情况很快就会好转。其它人可能会向医生求诊,因为他们觉得比平常更累,胃部不适,或主诉关节疼痛。急性乙型肝炎感染的症状可包括胃部肿胀,皮肤发黄(这被称为“黄疸”)。如果您有任何不同寻常的症状或即使您仅仅是有疑问,请向您的医生求诊。

我应当要求医生进行何种验血?

务必要求您的医生进行乙型肝炎验血。这是一种能够在医生诊所进行的简单化验。如果您认为您在最近感染了乙型肝炎,一般需要4-6 周时间验血才能够出现阳性结果。请索要您的验血报告。务必请您的医生向您明确解释您的验血结果,以便您了解自己是否已患上乙型肝炎。您需要了解自己是否已康复,或者自己是否已受到慢性感染。您的医生可能会对您的血液进行数次复检,以确认对您的诊断。

我可以前往何处接受化验?

您可要求您的医生、当地的卫生部门或肝病专家进行一次简单的乙型肝炎验血。 这一验血可在任何医生诊所进行。如果您在纽约市地区居住,您可致电给免费电话 1-888-888-0981了解详情和医生的转诊。您可以获得英语、国语和粤语信息。

如我感染上乙型肝炎会发生什么?

任何人在感染上乙型肝炎后,通常可能发生三种情况﹕

1.康复—在受到感染的健康成人中,有 90%将“康复”并在六个月以内完全清排除病毒。如验血显示乙型肝炎病毒已消失,且“抗体”已产生,则此人被视为已康复,而不再对他人具有传染性。“抗体”保护他们不会在今后再受乙型肝炎感染。此类人士无需接受疫苗注射,因为他们已受到保护。

2.慢性感染—在受到感染的成人中,有10%在六个月以后无法清除病毒。他们被诊断为乙型肝炎“慢性携带者”。这意味着病毒停留在其血液和肝脏中。乙型肝炎“慢性携带者”能够通过其血液将病毒传染给他人。他们亦可能在今后患上严重的肝病。
3.急性肝功能衰竭—在受到感染的成人中,不到1%可能会发生严重反应,并在与乙型肝炎病毒接触后数周之内死于肝功能衰竭。肝功能衰竭是一种致死性疾病,患者必须立即获得治疗。这是一种非常少见的反应。

所有这些数字有何实际意义?

请想象您坐在一个房间中。房间中包括您在内有100个人。门开了,乙型肝炎走了进来,每个人都受到感染。所有人都回家。有些人在一两周之后发病,而大多数人则不会发病。六个月之后,每个人都应要求返回房间,接受一次简单的乙型肝炎验血。好消息是有90人已清除病毒并“康复”,他们可以回家。但是有10个人(可能也包括您在内?)未能够清除病毒。这10个人经诊断为“慢性携带者”,他们被要求小心行事,避免传染他人,要求其亲人接受化验和疫苗注射,并向能够提供良好医疗护理的医生求诊。即使很少见,另外有一个人可能会立即对乙型肝炎病毒产生严重反应,并在数周后死于肝功能衰竭。

婴儿和儿童如感染乙型肝炎会发生什么?

遗憾的是,婴儿和儿童在受到感染后,在清除病毒方面的困难要大得多。他们的免疫系统还不完善,因此无法清除病毒。因此,他们成为乙型肝炎“慢性携带者”的风险要大得多。病毒将停留在其血液和肝脏中,从而增加了他们在今后患上严重肝病的风险。

1.康复—一岁以下的婴儿有5-10%的机率清除病毒并“康复”。儿童有40%的机率清除病毒(而成人则有90%的康复机率)。

2.慢性感染—有90%的受感染儿童永远无法清除病毒,并将成为乙型肝炎“慢性携带者”—即病毒将在其体内停留很长时间。儿童有60%的机率成为 “慢性携带者”(而成人则有10%的机率)。

我如何知道自己已从乙型肝炎感染“康复”?

如验血显示病人已清除病毒,则其被视为已“康复”。此外,验血必须显示其免疫系统已针对病毒制造一种“表面抗体”。“表面抗体”能够在今后保护您不再患乙型肝炎。您的康复最多需要六个月时间,在此之前您仍有可能传播病毒。一旦您已经康复,您就不会再传染他人。请要求您的医生进行这一简单的验血。

我在“康复”后仍须注射乙型肝炎疫苗吗?

如果您的验血显示您已经康复,您就不需要注射乙型肝炎疫苗。您的免疫系统制造的“表面抗体”将在今后保护您不被传染上乙型肝炎。其功能正如水痘﹕您如果患上水痘并康复,您的身体已成功制造抗体,保护您不再患上水痘。

如医生说我是“慢性携带者”则意味着什么?

这意味着您无法清除乙型肝炎病毒。您已成为病毒的“慢性携带者”。由于某种原因,您的免疫系统无法清除乙型肝炎病毒。病毒可在您的血液和肝脏中长期停留。因此,您可能会将病毒传染给他人。您今后患上严重肝病的风险也较高。

如果我患上慢性乙型肝炎,是否有何治疗方法?

美国目前有7种以经过批准的治疗慢性乙型肝炎的药物,这几种药也在中国提供。:

  • Intron A (alpha干扰素) 是一种注射药物, 一周注射数次,用六个月到一年,有时或更久,此药可能会引起象感冒﹑忧郁症和头痛一样症状的副作用,于1991年批准,可用于儿童和成人。
  • Pegasys (pegylated interferon) 聚乙二醇化干扰素) 是一种注射药物,每周注射一次,通常要连续注射六个月到半年。这种药可能会有副作用,如流感症状、抑郁症和其它心理健康问题。此药于2005年5月获得批准,并仅供成人使用。
  • Epivir-HBV 或 Zeffix (lamivudine) 是一种口服药片,一天服用一次,几乎没有副作用﹐服用至少一年或一年以上。主要问题是治疗时和治疗后可能会发生乙型肝炎病毒变异。于1998 年批准,可用于儿童和成人。
  • Hepsera (adefovir dipivoxil) 是一种口服药片,一天服用一次,副作用很少,服用至少一年或一年以上。主要问题是服用此药可能会发生肾脏问题。于2002 年9月批准,仅可用于成人。儿科临床试验正在进行中。
  • Baraclude (entecavir) 恩替卡韦) 是一种每日服用的片剂,可连续服用长达一年而几乎没有任何副作用。这种药在目前用来治疗慢性乙型肝炎的口服抗病毒药物中,被普遍认为是药效最强的一种。此药于2005年4月获得批准,并仅供成人使用。今后可能要进行儿科临床试验。
  • Tyzeka (telbivudine) 是一种每日服用的片剂,可连续服用一年而几乎没有任何副作用。研究显示该药能迅速有效地抑制乙肝病毒。于2006年10月批准用于成人。
  • Viread (tenofovir)是一种每日服用的片剂,可连续服用至少一年而只有很少副作用,于2008年8月被批准用于成人。

不是每一个慢性乙型肝炎患者都需要用药﹐了解这一点很重要。一些患者只需要由其医生定期监测 (至少一年一次)。有肝病活动症状的患者最有可能从治疗中获益。请务必和您的医生谈一谈您是否可以从治疗中获益并讨论一下治疗方案。此外﹐在临床实验和研究渠道中都有令人鼓舞的新药。

所有慢性乙型肝炎患者不论是否接受治疗都要定期看医生﹐这是至关重要的﹗

 

Hepatitis B Infections

Will I feel sick when I am first infected with hepatitis B?
Hepatitis B is considered a "silent infection" because most people don't have symptoms when they are first infected. People can get hepatitis B without even knowing it. Some who are infected may have mild flu-like symptoms which are often ignored -- they think they just have a cold and then get better quickly. Others may go to a doctor because they feel more tired than usual, don't feel like eating, have an upset stomach, or complain about joint pain. Although severe symptoms are not common with a new hepatitis B infection, they could include a swollen stomach or eyes and skin turning yellow (this is called "jaundice"). See your doctor for any unusual symptoms or even if you just have questions.

What blood test should I ask my doctor to order?
Make sure that your doctor orders the hepatitis B blood tests. This is a simple test that can be done in a doctor's office. If you think you have been recently infected with hepatitis B, it will take 4 -6 weeks before a blood test will show positive for the virus. Ask for a written copy of your blood tests. Make sure your doctor clearly explains your blood test results so that you know whether you have hepatitis B or not. You need to know whether you have recovered or whether you have become chronically infected. Your doctor may check your blood several times to confirm your diagnosis.

Where can I go to be tested?
You can ask your family doctor, the local health department, or a liver specialist to order the simple hepatitis B blood test. This blood test can be done in any doctor's office.

You can also call the GlaxoSmithKline HBV Info and Assistance line, toll-free at 1-888-888-0981.  Information about HBV and physician referrals across the country are available in English, Mandarin, Cantonese, Korean, and Vietnamese.

What will happen if I get infected with hepatitis B?
After a person is first infected with hepatitis B, there are usually three things that can happen:

  1. Recovery - 90% of healthy adults who are infected will "recover" and be completely rid of the virus within six months. When a blood test shows that the hepatitis B virus has gone and that "antibodies" have been made, a person is then considered to have recovered. They are no longer contagious to others. The "antibodies" protect them from any future hepatitis B infections. These people do not need the vaccine since they are already protected.
  2. Chronic Infections - 10% of infected adults are unable to get rid of the virus after six months. They are diagnosed as being "chronic carriers" of hepatitis B. This means that the virus stays in their blood and liver. People who are "chronic carriers" of hepatitis B are able to pass the virus on to others through their blood. They may also develop serious liver disease later on.
  3. Acute Liver Failure - Less than 1% of infected adults can have a severe reaction and die from liver failure within several weeks after being exposed to the hepatitis B virus. Liver failure is life-threatening and a person must get immediate medical care. This is a very rare reaction.

What do all these numbers really mean?
Imagine you are sitting in a room. There are 100 people in this room, including yourself. The door opens and the hepatitis B virus walks in and infects everyone. You all go home. Some people may feel sick a couple weeks later, most of you will not. Six months later everyone is asked to return to the room for a simple hepatitis B blood test. The good news is that 90 people will have gotten rid of the virus and "recovered". They can go home. But 10 people (maybe including you?) have been unable to get rid of the virus. These 10 people are then diagnosed as "chronic carriers". They are told to be careful to avoid infecting others, to test and vaccinate their loved ones, and to find a doctor who can provide good medical care. Although this is rare, one person may have an immediate severe reaction to the hepatitis B virus and die several weeks later from liver failure.

What happens to babies and children who are infected with hepatitis B?
Unfortunately, babies and children have a lot more trouble getting rid of the virus after being infected. Their immune systems are too young to fight off the virus. So they are at much greater risk for becoming "chronic carriers" of hepatitis B. The virus will stay in their blood and liver for a long time, which increases their risk for serious liver disease later on.

  1. Recovery - Babies under one year have a 5-10% chance of getting rid of the virus and "recovering". Children have a 40% chance of getting rid of the virus (whereas, adults have a 90% chance of recovering).
  2. Chronic Infections - 90% of infected babies will never get rid of the virus and will become "chronic carriers" of hepatitis B -- the virus will stay in their bodies for a very long time. Children have a 60% chance of becoming "chronic carriers (whereas, adults have only a 10% chance of becoming chronically infected).

How will I know if I have "recovered" from a hepatitis B infection?
A person is considered to have "recovered" when blood tests show they have gotten rid of the virus. In addition, the test must show that their immune system has made a "surface antibody" against the virus. The "surface antibody" is what protects you from hepatitis B in the future. Until you recover, which can take up to six months, there is still a risk that you can spread the virus. Once you have recovered, then you can no longer infect others. Ask your doctor for this simple blood test.

Do I still the need the hepatitis B vaccine after I have "recovered"?
You do not need the vaccine if your blood tests show that you have recovered. The "surface antibody" that your immune system makes will protect you against any future hepatitis B infection. It works just like chicken pox: when you get chicken pox and recover, your body has successfully made antibodies to protect you from getting chicken pox again.

What does it mean if my doctor tells me that I'm a "chronic carrier"?
This means that you have been unable to get rid of the hepatitis B virus. You have become a "chronic carrier" of the virus. For some reason your immune system just can't fight off the hepatitis B virus. It can stay in your blood and liver for a long time. As a result, you can pass the virus on to others. You also live with an increased risk for serious liver disease later in life.

Are there any treatments if I have chronic hepatitis B?
Currently, there are seven approved drugs in the United States for people who have chronic hepatitis B infections. These drugs are also available in China:

  • Interferon Alpha (Intron A) is given by injection several times a week for six months to a year, or sometimes longer. The drug can cause side effects such as flu-like symptoms, depression, and headaches. Approved 1991 and available for both children and adults.
  • Pegylated Interferon (Pegasys) is given by injection once a week usually for six months to a year. The drug can cause side effects such as flu-like symptoms and depression. Approved May 2005 and available only for adults.
  • Lamivudine (Epivir-HBV, Zeffix, or Heptodin) is a pill that is taken once a day, with few side effects, for at least one year or longer. Approved 1998 and available for both children and adults.
  • Adefovir Dipivoxil (Hepsera) is a pill taken once a day, with few side effects, for at least one year or longer. Approved September 2002 for adults. Pediatric clinical trials are in progress.
  • Entecavir (Baraclude) is a pill taken once a day, with few side effects, for at least one year or longer. Approved April 2005 for adults. Pediatric clinical trials are in progress.
  • Telbivudine (Tyzeka, Sebivo) is a pill taken once a day, with few side effects, for at least one year or longer. Approved October 2006 for adults.
  • Tenofovir (Viread) is a pill taken once a day, with few side effects, for at least one year or longer. Approved August 2008 for adults.

It is important to know, not every chronic hepatitis B patient needs to be on medication. Some patients only need to be monitored by their doctor on a regular basis (at least once a year, or more). Other patients with active signs of liver disease may benefit the most from treatment. Be sure to talk to your doctor about whether you could benefit from treatment and discuss the treatment options. In addition, there are promising new drugs in clinical trials and in the research pipeline.

However, it is vital that all people with chronic hepatitis B visit their doctor on a regular basis, whether they receive treatment or not!