Hepatitis B Foundation

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乙型肝炎傳染簡介

我在感染乙型肝炎的初期是否會發病?

乙型肝炎被視爲一種“無聲的傳染”,因爲大多數人在被感染的初期幷無症狀。人們可能會在不知情的情况下感染乙型肝炎。有些受到感染者會發生類似流感的症狀,此類症狀經常受到忽略—他們認爲自己只是感冒,情况很快就會好轉。其它人可能會向醫生求診,因爲他們覺得比平常更累,胃部不適,或主訴關節疼痛。急性乙型肝炎感染的症狀可包括胃部腫脹,皮膚發黃(這被稱爲“黃疸”)。如果您有任何不同尋常的症狀或即使您僅僅是有疑問,請向您的醫生求診。

我應當要求醫生進行何種驗血?

務必要求您的醫生進行乙型肝炎驗血。這是一種能够在醫生診所進行的簡單化驗。如果您認爲您在最近感染了乙型肝炎,一般需要4-6 周時間驗血才能够出現陽性結果。請索要您的驗血報告。務必請您的醫生向您明確解釋您的驗血結果,以便您瞭解自己是否已患上乙型肝炎。您需要瞭解自己是否已康復,或者自己是否已受到慢性感染。您的醫生可能會對您的血液進行數次複檢,以確認對您的診斷。

我可以前往何處接受化驗?

您可要求您的醫生、當地的衛生部門或肝病專家進行一次簡單的乙型肝炎驗血。 這一驗血可在任何醫生診所進行。如果您在紐約市地區居住,您可致電給免費電話 1-888-888-0981瞭解詳情和醫生的轉診。您可以獲得英語、國語和粵語信息。

如我感染上乙型肝炎會發生什麽?

任何人在感染上乙型肝炎後,通常可能發生三種情况﹕

1.康復—在受到感染的健康成人中,有 90%將“康復”幷在六個月以內完全清排除病毒。如驗血顯示乙型肝炎病毒已消失,且“抗體”已産生,則此人被視爲已康復,而不再對他人具有傳染性。“抗體”保護他們不會在今後再受乙型肝炎感染。此類人士無需接受疫苗注射,因爲他們已受到保護。

2.慢性感染—在受到感染的成人中,有10%在六個月以後無法清除病毒。他們被診斷爲乙型肝炎“慢性携帶者”。這意味著病毒停留在其血液和肝臟中。乙型肝炎“慢性携帶者”能够通過其血液將病毒傳染給他人。他們亦可能在今後患上嚴重的肝病。  

3.急性肝功能衰竭—在受到感染的成人中,不到1%可能會發生嚴重反應,幷在與乙型肝炎病毒接觸後數周之內死于肝功能衰竭。肝功能衰竭是一種致死性疾病,患者必須立即獲得治療。這是一種非常少見的反應。

所有這些數字有何實際意義?

請想像您坐在一個房間中。房間中包括您在內有100個人。門開了,乙型肝炎走了進來,每個人都受到感染。所有人都回家。有些人在一兩周之後發病,而大多數人則不會發病。六個月之後,每個人都應要求返回房間,接受一次簡單的乙型肝炎驗血。好消息是有90人已清除病毒幷“康復”,他們可以回家。但是有10個人(可能也包括您在內?)未能够清除病毒。這10個人經診斷爲“慢性携帶者”,他們被要求小心行事,避免傳染他人,要求其親人接受化驗和疫苗注射,幷向能够提供良好醫療護理的醫生求診。即使很少見,另外有一個人可能會立即對乙型肝炎病毒産生嚴重反應,幷在數周後死于肝功能衰竭。

嬰兒和兒童如感染乙型肝炎會發生什麽?

遺憾的是,嬰兒和兒童在受到感染後,在清除病毒方面的困難要大得多。他們的免疫系統還不完善,因此無法清除病毒。因此,他們成爲乙型肝炎“慢性携帶者”的風險要大得多。病毒將停留在其血液和肝臟中,從而增加了他們在今後患上嚴重肝病的風險。

1.康復—一歲以下的嬰兒有5-10%的機率清除病毒幷“康復”。兒童有40%的機率清除病毒(而成人則有90%的康復機率)。

2.慢性感染—有90%的受感染兒童永遠無法清除病毒,幷將成爲乙型肝炎“慢性携帶者”—即病毒將在其體內停留很長時間。兒童有60%的機率成爲 “慢性携帶者”(而成人則有10%的機率)。

我如何知道自己已從乙型肝炎感染“康復”?

如驗血顯示病人已清除病毒,則其被視爲已“康復”。此外,驗血必須顯示其免疫系統已針對病毒製造一種“表面抗體”。“表面抗體”能够在今後保護您不再患乙型肝炎。您的康復最多需要六個月時間,在此之前您仍有可能傳播病毒。一旦您已經康復,您就不會再傳染他人。請要求您的醫生進行這一簡單的驗血。

我在“康復”後仍須注射乙型肝炎疫苗嗎?

如果您的驗血顯示您已經康復,您就不需要注射乙型肝炎疫苗。您的免疫系統製造的“表面抗體”將在今後保護您不被傳染上乙型肝炎。其功能正如水痘﹕您如果患上水痘幷康復,您的身體已成功製造抗體,保護您不再患上水痘。

如醫生說我是“慢性携帶者”則意味著什麽?

這意味著您無法清除乙型肝炎病毒。您已成爲病毒的“慢性携帶者”。由于某種原因,您的免疫系統無法清除乙型肝炎病毒。病毒可在您的血液和肝臟中長期停留。因此,您可能會將病毒傳染給他人。您今後患上嚴重肝病的風險也較高。

如果我患上慢性乙型肝炎,是否有何治療方法?

對患有慢性乙型肝炎的病人來說,美國有幾種經過批准的藥物。這幾種藥也在中國提供:

  • 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1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-HBVZeffix (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2008年8月批准用于成人。

不是每一個慢性乙型肝炎患者都需要用藥﹐瞭解這一點很重要。一些患者只需要由其醫生定期監測 (至少一年一次)。有肝病活動症狀的患者最有可能從治療中獲益。請務必和您的醫生談一談您是否可以從治療中獲益幷討論一下治療方案。此外﹐在臨床實驗和研究渠道中都有令人鼓舞的新藥。

所有慢性乙型肝炎患者不論是否接受治療都要定期看醫生﹐這是至關重要的﹗

 

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 in 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, depression and other mental health problems. Approved May 2005 and available only for adults.
  • Lamivudine Epivir-HBV, Zeffix, or Heptodin) is a pill that is taken once a day, with almost no side effects, for at least one year or longer. A primary concern is the possible development of hepatitis B virus mutants during and after treatment. Approved in 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. The primary concern is that kidney problems can occur while taking the drug. Approved September 2002 and available only for adults. Pediatric clinical trials are being planned.
  • Entecavir (Baraclude) is a pill taken once a day, with almost no side effects for up to one year. It is considered to be the most potent oral antiviral drug for chronic hepatitis B to date. Approved April 2005 and available only for adults. Pediatric clinical trials may be planned for the future.
  • Telbivudine (Tyzeka) is a pill taken once a day, with almost no side effects. Approved October 2006 and available only for adults. Pediatric clinical trials may be planned for the future.
  • 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!