Hep B Blog

Hepatitis B and Hepatitis Delta

 

What is Hepatitis Delta

Hepatitis delta is a liver infection that results from the hepatitis delta virus (also known as HDV) that causes the most severe form of viral hepatitis known to human beings. It is also the smallest virus known to infect humans. Hepatitis delta is unique because it is dependent on the hepatitis B virus (HBV) to infect and reproduce in liver cells, so those already infected with hepatitis B are at a greatly increased risk of developing hepatitis delta.

Since testing for hepatitis delta is not as widespread as it should be (everyone who is diagnosed with hepatitis B should also be tested for hepatitis delta), the exact number of people living with hepatitis delta is unknown. Some reports point to 15-20 million people living with hepatitis delta worldwide, but other studies have estimated that as many as 60-70 million people could be living with hepatitis delta around the world.

Co-Infection with Hepatitis B

Co-infection with hepatitis B and hepatitis delta can cause more serious liver disease than hepatitis B infection alone. This includes faster progression to liver fibrosis (or scarring), higher risk of liver cancer, and earlier onset of cirrhosis or liver failure.

There are two ways in which someone living with hepatitis B can become infected with hepatitis delta. One is through co-infection, which occurs when an individual acquires hepatitis B and hepatitis delta infections at the same time, and the other is through super-infection, which occurs when someone who is already living with hepatitis B acquires hepatitis delta.

A co-infection is less common and will often clear up on its own within six months, but sometimes it can cause very dangerous or fatal liver failure. A superinfection is more common and is the culprit of severe liver disease. As many as 90% of people with a superinfection will develop chronic (life-long) hepatitis B and hepatitis delta infections, 70% of which will progress to cirrhosis. This compares to only 15-20% of chronic hepatitis B infections alone.

Transmission and Prevention

Hepatitis delta can be transmitted in the same ways as hepatitis B, through exposure to infected blood or bodily fluids. This occurs most often through the sharing of hygiene equipment; practices of bodily alterations, such as tattoos, piercings or scarification; unsterile healthcare practices; sharing needles, syringes, or other paraphernalia during injection drug use; or having unprotected sex. Although hepatitis B virus is most commonly transmitted from mothers to their babies during childbirth, it is believed that hepatitis delta transmission through this route is uncommon. Since hepatitis delta cannot be contracted on its own, only people who are already infected with hepatitis B or who are at high risk of contracting both viruses simultaneously can contract hepatitis delta.

A vaccine for hepatitis delta does not exist, but fortunately, the vaccine for hepatitis B protects against hepatitis delta as well! Just as with hepatitis B, family members and sexual partners of people living with hepatitis delta should also receive the hepatitis B vaccine to significantly lower their risk of contracting hepatitis B and hepatitis delta. For those who are already infected with chronic hepatitis B, the best way to protect yourself from hepatitis delta is to practice protected sex (with a condom) and avoid potential blood exposure.

All individuals who have been diagnosed with hepatitis B should also get tested for hepatitis delta. The test is a simple blood test. Hepatitis delta can be managed by a doctor – it is most dangerous when a person does not know they have it, making it that much more important to get tested!

 Who is at Risk

If you are living with chronic hepatitis B, you are at risk for hepatitis Delta. Groups at risk for hepatitis delta include:

  • People chronically infected with hepatitis B are at risk for infection with HDV.
  • People who are not vaccinated for hepatitis B
  • People who inject drugs
  • Indigenous people and people with hepatitis C virus or HIV infection
  • Recipients of hemodialysis
  • Men who have sex with men
  • Commercial sex workers
  • Individuals from countries or regions where hepatitis delta prevalence is high

Several geographical hotspots have a high prevalence of hepatitis delta infection, including Mongolia, the Republic of Moldova, and countries in Western and Middle Africa.

For Patients

If you are living with hepatitis B, it is recommended you get tested for hepatitis delta. Please ask your healthcare providers to be tested for hepatitis delta.

The Hepatitis B Foundation has resources for patients living with hepatitis delta.

Drug Watch – Drugs and Medications in Development for Hepatitis Delta

Clinical Trials – Clinical trials are research studies that test new potential treatments for a disease. Talk to your doctor about possible clinical trials that could be helpful to you.

Find a Doctor – Visit our Physician Directory to locate a doctor near you! It now includes a specific search tool to locate doctors that also manage hepatitis delta patients. For additional assistance locating a doctor, email connect@hepdconnect.org.

Other educational resources include webinar recordings, multilingual fact sheets, and frequently asked questions.

For Providers

Providers in the United States can request hepatitis Delta tests from Quest Diagnostics. It is recommended that you first call your local Quest representative to confirm that the location does this specialty testing.

Below is the coding list for hepatitis delta testing as well as quantitative HBsAg and hepatitis B genotyping.

  • Quest Test Code for HDV Antibody Total—4990 Set up 2 times/week
  • Quest Test Code for HDV Antibody IgM—35664 Set up 2 times/week
  • Quest Test Code for HDV RNA Quantitative PCR—37889 Set up 6 times/week

Quest does not currently offer a national test code for hepatitis delta antibody reflex to HDV RNA quantitative, but you can coordinate with the Quest commercial person that covers your account to possibly set up a custom reflex.

 

Authors: Beatrice Zovich and Evangeline Wang

Contact Information: info@hepb.org

 

 

B Heppy- A Podcast

We are so excited to announce the launch of our podcast: B Heppy! This podcast is part of our 300 Million Reasons campaign, a movement to improve awareness about hepatitis B and liver cancer worldwide, to promote engagement of key stakeholders, and to empower people impacted by hepatitis B to become vocal advocates. There are almost 300 million people around the world living with chronic hepatitis B infection, and we want to make sure each and every voice is heard.

B Heppy addresses various topics about hepatitis B to help inform providers, persons living with hepatitis B and the general public about hepatitis B. The first episode covers the covid-19 vaccine in the context of individuals living with hepatitis B. The Foundation interviewed Robert Gish M.D., Hepatitis B Foundation Medical Director to answer questions like what is an mRNA vaccine, the side effects of the COVID-19 vaccine, and if it is safe for people living with hepatitis B to receive the COVID-19 vaccine.

Our next episode will discuss the history of the Hepatitis B Foundation as well as giving an overview of hepatitis B. We will be joined with co-founders, Joan Block, RN, BSN and Jan Witte and Senior Vice President Chari Cohen, DrPH, MPH.

We hope this podcast reminds you that you are not alone in your diagnosis! Together, we can foster a collaborative and connected global community united around all things hepatitis B.

B Heppy is available on Spotify Podcasts, Apple Podcasts, and Overcast, you can also access it here.

Author: Evangeline Wang

Contact Information: info@hepb.org

Celebrate International Day of Happiness

 

 

 

Saturday, March 20th, marks International Day of Happiness! The United Nations established this day to recognize “the need for a more inclusive, equitable, and balanced approach to economic growth that promotes sustainable development, poverty eradication, happiness, and the well-being of all peoples.” In 2015, the United Nations launched the Sustainable Development Goals which seek to end poverty, reduce inequalities, and protect our planet which all leads to well-being and happiness.

Action Items to Celebrate International Day of Happiness

Celebrate Health and Happiness –

  1. Share a meal with family and friends today! It might not be the best idea to gather in-person during a global pandemic, but you can do this virtually over Zoom or another video sharing platform like Google hangouts or Facetime. Virtually surround yourself with the people you love by sharing a liver-friendly meal. A liver-friendly meal should include lean proteins, fruits and vegetables, and less processed foods. If you plan to gather in-person, a socially-distant meal is recommended. For example, you can use outdoor spaces like parks or backyards to gather and sit an appropriate distance away from each other.
  2. Mental health is just as important as physical health. Research studies have found people living with hepatitis B experience higher rates of depression and anxiety than the general population. This comes as no surprise as there is no cure (although scientists are tiredessly working hard to find one), people with hepatitis B face stigma and discrimination, and when people disclose we risk facing rejection from our peers, friends, and family. But International Day of Happiness does not focus on that. Instead, we will focus on the things, activities, and people who make you happy! This could be taking a walk in the park, baking or cooking for your family, gardening, or crafting. Being mindful and taking time for yourself to do the thing you enjoy about life is important for your happiness. We know a hepatitis B diagnosis does not define you nor defines your happiness. If you want to share want makes you happy, you can through our new campaign, More Than B! Check it out here.

Reduce Inequalities –

  1. Please join the Hepatitis B Foundation in calling upon all companies developing COVID-19 vaccines to include people living with hepatitis B and liver disease in their clinical trials, and to make the resulting sub-group data publicly available. The inclusion of these groups in clinical trials will help improve access to approved vaccines and will broaden trust and acceptance of the vaccines, especially among those who are unsure if they should receive any COVID-19 vaccine. We must account for groups who may be more susceptible to severe illness from the coronavirus. Data is one of the most powerful tools we have to build vaccine confidence amongst vulnerable populations, and one we must fully utilize in order to earn the trust of concerned communities. We must ensure that the voices of the 300 million people around the world who are living with hepatitis B are not forgotten. Add your voice here!
  2. What better way to celebrate than to learn more about your own and your family’s health and to contribute to better health and well-being for your whole community, both now and in the future? The All of Us Research Program is working to make health and medical research more diverse, inclusive, and representative of the actual population in the United States, so that doctors can move toward precision medicine and away from making diagnosis and treatment decisions based on an “average” patient. Participation is especially important for Asian, Pacific Islander, and other community members, who are the least represented. By enrolling in the study, you can get information about your own health and genetics, help move science forward, and even play a role in guiding the research itself! The program holds itself to the highest standards of confidentiality and you can stop participating at any time. Help make the world a healthier and happier place! Learn more and sign up at www.joinallofus.org.

Join #MoreThanB

The Hepatitis B Foundation is very excited to announce the launch of our new campaign: #MoreThanB.  The goal of the campaign is to celebrate the lives of those living with or impacted by hepatitis B worldwide. Hepatitis B might be a big part of our lives, but we want to highlight the other aspects of our lives – our hobbies and dreams, the way we spend our time, the things that make us who we are, outside of hepatitis B.

The Hepatitis B Foundation has been a long-time advocate and supporter of individuals living with hepatitis B who express that they are more than their diagnosis. In 2008, The Foundation supported 18-year old John Ellis throughout his “Believe in the Cure” cycling tour from Pensacola to Philadelphia to raise awareness about hepatitis B. When John was diagnosed with hepatitis B as a teenager, he wanted to be “bigger” than his diagnosis, so he undertook this physical challenge, which raised $50,000 for The Foundation’s mission to find a cure and improve the lives of those affected. John helped us all learn to express how we are bigger than a  hepatitis B diagnosis.

We want you to share who you are beyond hepatitis B. Share a few sentences about your life, hobbies, work, family, friends, and upload a photo. We will turn your submissions into social media posts to share on the Foundation’s social media pages. United States respondents, please submit your profile by April 2nd to be featured during Hepatitis Awareness Month in May and international respondents, please submit by June 30th to be featured in July for World Hepatitis Day.

Take a look at the examples below:

“I am constantly learning and finding new adventures. I love to read, attend the theatre (when safe 😊), spend time with my family and dog, and find new ways to incorporate sustainability into my lifestyle. You’re most likely to find me scrolling on social media, or playing a card game with friends!”

 

“I am a wife, dog mom, marathoner and avid traveler. I am passionate about food, hiking, being in nature, exploring, public health and eliminating hepatitis B.”

 

Submit Your More Than B Profile

 

Author: Evangeline Wang

Contact Information: info@hepb.org

 

Sexual Transmission and Hepatitis B Among Adults in China

As the birth-dose for hepatitis B (HBV) increases, sexual transmission is the most common mode of transmitting hepatitis B among unvaccinated adults. A research study, “Evaluating the independent influence of sexual transmission on HBV infection in China: a modeling study” evaluated the independent impact of sexual transmission on hepatitis B. This blog will give a summary of the results of the study, prevention tips, and future recommendations.

Summary of Research Study

 The researchers of this study developed an age- and sex-specific discrete model at the population level to evaluate the influence of sexual transmission on HBV infection in China. They found that in 2014, due to sexual transmission, the total number of chronic HBV infections in people aged 0–100 years increased by 292,581 people! That year, due to sexual transmission, there were  189,200 new chronic infections among men and 103,381 new chronic infections among women. In 2006, sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) of acute HBV infections in China and in 2014, sexual transmission accounted for 34.59% (male: 42.93%, female: 25.73%) of acute HBV infections in China. These statistics demonstrate that acute HBV infections due to sexual transmission increased by 10% and 8% respectively from 2006-2014.

However, researchers found that if the condom usage rate increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1–59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).

Prevention and Harm Reduction Strategies During Sex

 Practicing safe sex is can be a great way to prevent the transmission of hepatitis B. Condoms are an effective way to prevent the transmission of hepatitis B during intercourse. Sometimes during sex, people like to use personal lubricants. When using condoms it is important to remember to only use silicone or water-based lubricant. Oil-based lubricants increase the chance of ripping or tearing the condom. It is highly recommended if someone is living with hepatitis B to have sex with a condom, however, if you are having sex without a condom, certain sexual activities are far more efficient at spreading hepatitis B than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a very high risk of transmission because tears in the skin can occur during penetration, allow more transmission routes for the virus.

Recommendations

If you have never been vaccinated for hepatitis B, it is recommended that you receive the vaccination. The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for lifetime protection against preventable chronic liver disease. The hepatitis B vaccine is also known as the first “anti-cancer” vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide.

If you think you might be at increased risk for hepatitis B infection, is also recommended you get tested for hepatitis B. Hepatitis B is known as the” silent” infection, meaning you could be infected with the virus and not show symptoms that can cause long-term liver damage. If you have not been tested for hepatitis B and would like to know your status, you should get in contact with your primary care provider. Your physician should order a panel of three blood tests for the hepatitis B panel:

  1. HBsAg (hepatitis B surface antigen)
  2. Anti-HBs or HBsAb (hepatitis B surface antibody)
  3. anti-HBc or HBcAb (hepatitis B core antibody)

The results of all 3 blood test results are needed in order to make a diagnosis. Be sure to request a printed copy of your blood tests so that you fully understand which tests are positive or negative, and what your hepatitis B status is.

If you know you have had unprotected sexual intercourse with someone living with hepatitis B, there is something called post-exposure treatment. If an uninfected, unvaccinated person – or anyone who does not know their hepatitis B status – is exposed to the hepatitis B virus through contact with infected blood, a timely “postexposure prophylaxis” (PEP) can prevent infection and subsequent development of chronic infection or liver disease. This means a person should seek immediate medical attention (within 72 hours of exposure) to start the hepatitis B vaccine series. In some circumstances, a drug called “hepatitis B immune globulin” (HBIG) is recommended in addition to the hepatitis B vaccine for added protection.

 

Author: Evangeline Wang

Contact Information: info@hepb.org