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About Hepatitis B, HBV

Happy NAIRHHA Day!

Today is NAIRHHA Day! Every September 9th, the Hepatitis B Foundation brings awareness to National African Immigrant and Refugee HIV/AIDS and Hepatitis Awareness Day. Founded by advocates in Massachusetts, Washington D.C., and New York, NAIRHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. The Multicultural AIDS Coalition (MAC), Hepatitis B Foundation and the Coalition Against Hepatitis for People of African Origin (CHIPO) are working to establish NAIRHHA day as their own federally designated awareness day.

Hepatitis B and HIV in African Immigrant Communities

 People of African origin are disproportionately affected by hepatitis B infection. Worldwide an estimated 292 million people are infected with chronic hepatitis B. Over 60 million people in Africa have hepatitis B which annually accounts for an estimated 68,870 deaths.1

In fact, in some African communities in the United States, between 5%-15% of people have chronic HBV infection. Unfortunately, due to the silent nature of the disease, lack of disease awareness, and limited health care access, most African community members who have hepatitis B DO NOT KNOW that they are infected. This puts them at much greater risk for premature death from cirrhosis or liver cancer.

There is a high burden of HIV/HBV co-infection in African countries because both diseases share similar transmission routes such as mother-to-child, unsafe medical and injection practices, and unscreened blood transfusions.2 Chronic HIV/HBV infection is reported in up to 36% of people who are HIV positive, with the highest prevalence reported in west Africa and southern Africa. The co-infection of HIV and HBV is especially dangerous because it accelerates liver disease such as fibrosis and cirrhosis. In fact, liver-related mortality is twice as high among people with an HIV/ HBV co-infection.2

 With approximately 54,000 people with HBV who immigrate to the United States annually it is important to bring awareness to hepatitis B in African Immigrant communities on this day!

Get Involved

Viral hepatitis and HIV heavily impact African immigrant communities in the U.S. Let’s raise awareness and advocate for resources and funding to support elimination efforts & healthier communities.

Action Items:

  1. There are African community organizations all over the U.S., from Boston to Seattle. Connect with one in your area to learn more about & contribute to the health of these vibrant communities. Start by visiting https://www.hepb.org/research-and-programs/chipo/member-organizations/
  2. Data drives policy change & it can be difficult to find data about African immigrant communities because it is often not separated from data about African American communities. Advocate for this data to be separated by contacting your local Department of Health today!
  3. Education & awareness matter! Many elected officials do not know about these issues, but they should! Contact your state & federal reps today to ask what they’re doing to address viral hepatitis & HIV in African immigrant communities. Visit https://www.usa.gov/elected-officials
  4. Change needs resources! Help grow the capacity of African organizations in your area by contributing your time, money, or other resources to eliminating viral hepatitis & HIV in African immigrant communities. Find an org in your state or city & ask how you can plug into their work!
  5. Funding is critical for progress to occur & advocacy is needed to make sure African immigrant communities receive enough money to combat viral hepatitis & HIV. Contact your federal, state, & local elected officials & local department of health to ask what they’re doing to support this. Start with members of @NASTAD found at https://www.nastad.org/membership-directory
  6. Good health & healthcare can’t happen without communication. Learn more about the need for language access programs to include African dialects at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6.
  7. Federal recognition means greater awareness, education, & resources. Continue to support the establishment of NAIRHHA Day as a federally recognized awareness day by contacting @HHS’s sitehiv.gov to advocate for this!
  8. Spread the word! A big part of NAIRHHA Day is raising awareness & you can help with that! Share this toolkit far and wide on social media & also check out some great resources on hepatitis in African immigrant communities at https://www.hepb.org/research-and-programs/chipo/resources/resources-for-educators/

 

 

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  2. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohouès-Kouacou, M. J., Mbaye, P. S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye, A. B., … Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The lancet. Gastroenterology & hepatology, 2(12), 900–909. https://doi.org/10.1016/S2468-1253(17)30295-9

About Hepatitis B

What’s the difference: Hepatitis B vs. Hepatitis E

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 the final installment in a three-part series. You can click the links to view more about hepatitis A and hepatitis C.

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 B vs. Hepatitis E

Globally, hepatitis E is a common liver infection. The World Health Organization estimates that 20 million people are infected each year. The virus has 4 known types: genotype 1, genotype 2, genotype 3, and genotype 4. Genotypes 1 and 2 are primarily spread through  fecal-oral transmission or by consuming food or water that has been contaminated and are only found in the human population. Typically, these genotypes are found in Africa, Asia, and Mexico. Poor sanitation and lack of clean water infrastructure contribute to the spread of genotypes 1 and 2.

Image Courtesy of Canva

Genotypes 3 and 4 are found in animal populations and can be passed on to a human if their meat is undercooked and consumed. Pigs, deer, boar, and chickens have all been found to carry the hepatitis E virus, but studies have shown that consuming undercooked infected pig (pork) and wild boar have commonly been the main source of animal-to-human transmission. Although less common, shellfish has also been found to carry the hepatitis E virus as well. Genotypes 3 and 4 are most generally found in China, Taiwan, Japan, and other developed countries.

It is important to remember that hepatitis B is not spread by contaminated food or water. You cannot get hepatitis B by sharing utensils or eating food prepared by someone who is infected. The hepatitis B virus is a blood-borne pathogen, which means that it is only spread through direct blood contact with an infected person’s blood.

Unlike hepatitis B, hepatitis E usually does not progress to a life-long infection. However, the Centers for Disease Control and Prevention (CDC) reports that the number of genotype 3 cases that lead to chronic liver disease are on the rise. In most cases, the infection typically resolves itself after a few weeks. Globally, young people aged 15-40 are considered to be the most at-risk population. Children under 15 generally have no symptoms or develop a mild illness. Young adults will often experience symptoms such as jaundice, vomiting, reduced appetite, and fatigue. At the moment, there are no specific treatment options for hepatitis E. Recommendations include getting plenty of rest and staying hydrated. In extreme cases, hospitalization may be required. Hepatitis E can also lead to fulminant hepatitis, or acute liver failure. Fulminant hepatitis most often occurs with hepatitis E infections in pregnant women and those with weakened immune systems.

Pregnant Women and Hepatitis B/E

Image Courtesy of Canva

Both hepatitis B and E can be transmitted from mother-to-child. This type of transmission is rare for hepatitis E patients but occurs frequently in mothers living with chronic hepatitis B. This is because hepatitis B is a “silent infection”; it often has no symptoms so many mothers do not know that they are infected. It is much less common for hepatitis E to be spread from mother to child because the infection typically resolves itself in 4-6 weeks. The danger with hepatitis E and pregnancy lies within the complications that it can cause. Research has shown that pregnant women have a higher risk of developing fulminant hepatitis than other patients, although more studies need to be conducted to discover the reason why this occurs. Hepatitis E tends to be most dangerous for women in their second and third trimester.  According to the CDC, maternal death rates from hepatitis E can reach 10% – 30% in the final trimester. Mothers can also experience severe illness, premature delivery, and the loss of their pregnancy.

With hepatitis B infection, approximately 90% of infants born to hepatitis B infected mothers will develop chronic hepatitis B and have an increased risk of developing liver disease and liver cancer later in life. This can be avoided, however, if certain precautions are taken once the child has been born!  By making sure the doctor is aware of the mother’s hepatitis B and having the delivery staff administer 1) the first dose of the hepatitis B vaccine and 2) one dose of the Hepatitis B Immune Globulin (HBIG, if available) in the delivery room, the newborn has more than a 95% chance of being protected for life! After the initial shots are given, it is extremely important to follow through with the vaccination schedule for a lifetime of protection.

Prevention

Hepatitis B can be prevented with a 3-dose vaccine or a 2-dose vaccine for adults where available! While you wait to complete the vaccine series, simple steps to prevent transmission include washing your hands thoroughly with hot water and soap, cleaning surfaces that come  into contact with blood with a diluted bleach solution, and not sharing objects that may have trace amounts of blood on them such as razors, toothbrushes, nail clippers and body jewelry. Although there is no vaccine approved for hepatitis E in the United States, there is one available in China. For hepatitis E, genotypes 1 and 2 can be prevented by thoroughly washing your hands after using the bathroom and by boiling water before drinking it. Transmission of genotypes 3 and 4 can be prevented by thoroughly cooking all meat and avoiding undercooked meats. Pregnant women should exercise caution when consuming pork, deer meat, and wild boar.

About Hepatitis B, Hepatitis B Prevention

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!

About Hepatitis B, Living with Hepatitis B

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 at least seven 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!

 

Baruch S. Blumberg Institute