Hep B Blog

Category Archives: About Hepatitis B

About Hepatitis B, Hepatitis Awareness Month, Hepatitis B Awareness

May is Hepatitis Awareness Month!

May is Hepatitis Awareness Month! This month, we bring awareness to the public health impact of viral hepatitis in the U.S., and the health consequences of hepatitis B and C infections if left untreated.

Globally, hepatitis B virus (HBV) affects 2 billion people and in the U.S. an estimated 2.4 million people are living with a chronic hepatitis B infection. Hepatitis B is often called the “silent killer”, as people often do not realize they are infected with hepatitis B until their liver is severely damaged, which makes it vital that the month of May is dedicated to raising awareness of hepatitis B. Because chronic hepatitis B infection is the most common risk factor for liver cancer, it is critical that we improve awareness on how to prevent, diagnose and treat hepatitis B. Individuals chronically infected with hepatitis B have a 25% to 40% lifetime risk of developing liver cancer. However, it is important to note that with proper testing and treatment, people living with hepatitis B can reduce that risk and live a long and happy life.

This month we look forward to encouraging all adults in the U.S. to get tested for hepatitis B with a simple blood test, and get vaccinated with a safe and effective vaccine if they are not yet protected or infected.  Thank you for helping us bring awareness to hepatitis B this May!

Resources For Patients

The Hepatitis B Foundation has multiple resources for patients you might not be aware of. Below is a small list you should check out!

  • Hep B Community
    • A new global online support group.
  • Physician Directory
    • Find knowledgeable doctors! The Hepatitis B Foundation has created a directory of liver specialists to help those seeking qualified medical care. The specialists have agreed to be included in this directory and treat chronic hepatitis B and/or liver cancer and are willing to be contacted for further information.
  • B Heppy
    • A podcast discussing all things hepatitis B-related. Our first episode discusses the COVID-19 vaccine and people living with hepatitis B.
  • Liver Q’s Video Series on Hepatitis B
    • These short video clips answer some frequently asked questions about hepatitis B.
  • Clinical Trial Locator
    • Volunteering for a clinical trial program can be very valuable. Expensive blood work, treatment medications, and doctor’s visits are usually provided free of charge for those accepted into a study. Clinical trials also provide the opportunity to potentially benefit from the latest advances in medical science.

Check out our website for more!

Resources For Providers

  • CDC’s Hepatitis Awareness Month Social Media Toolkit
  • Hep B United’s and CDC’s Know Hepatitis B Social Media Templates
    • The Know Hepatitis B campaign provides translations in multiple languages like Arabic, Amharic, French, and Swahili, Chinese, and Vietnamese.
  • Hep B United Philadelphia’s Provider ECHO
    • The goal of the Hepatitis B ECHO is to expand provider capacity at the primary care level to diagnose, treat and manage hepatitis B. Each ECHO session will include one case discussion and a 15-minute didactic aimed to empower providers to manage hepatitis B.
  • Webinar: Educational Resources for African Communities
    • Panelists from the Centers for Disease Control and Prevention (CDC) and the African Services Committee will discuss Know Hepatitis B campaign resources for community health workers working within African communities and community-based hepatitis B prevention initiatives. Additionally, hepatitis B activist and storyteller Bright Ansah will share his personal experiences with hepatitis B and highlight the need for greater awareness, education, and resources about hepatitis B in African communities.

About Hepatitis B, HBV, Hepatitis B Awareness, Hepatitis B Prevention

April 30 is National Adult Hepatitis B Vaccination Awareness Day

The Need for an Adult Hepatitis B Vaccination Awareness Day

 In 2019, the hepatitis B community successfully advocated for the introduction of U.S. House and Senate resolutions to designate April 30th as National Adult Hepatitis B Vaccination Awareness Day for the first time! Two years later, the Hepatitis B Foundation is proud to support this day and continue adult vaccination efforts as we gear up for May, Hepatitis Awareness Month.

On April 30th we bring awareness to adult hepatitis B vaccination efforts. Despite a safe and effective hepatitis B vaccine, only 25% of the U.S. adult population has been vaccinated, primarily due to people being born before the vaccine was universally recommended.1 New hepatitis B infections are highest among people aged 30-49 years because many people at risk in this group have not been vaccinated in spite of federal recommendations.

Acute hepatitis B cases are rising partially due to the opioid epidemic with the increase in injection drug use. Hepatitis B can be spread through needle sharing or unsterile drug injection equipment. Additionally, hepatitis B can be transmitted from mother-to-child, and about 1,000 newborns become infected   each year in the U.S..2 This statistic is concerning because mother to child transmission can be prevented in most cases with appropriate use of the vaccine. When exposed to the hepatitis B virus at birth, 90% of newborns will develop chronic life-long infection, putting them at much greater risk for cirrhosis and liver cancer.

Immunization rates also remain low among vulnerable populations including those living with other chronic conditions such as hepatitis C, HIV, kidney disease, or diabetes. In fact, just 12% of diabetic adults 60 years old or older are fully vaccinated, and 26% of diabetic adults ages 19-59 have received the complete vaccine series. Healthcare workers are an under-vaccinated vulnerable population as well. According to the Centers for Disease Control and Prevention, just 60% of healthcare personnel have completed their vaccine series. Get yourself vaccinated for yourself and your loved ones!

How to Become Vaccinated for Hepatitis B

In the era of COVID, we are reminded how important vaccines are. Make sure you and your loved ones are vaccinated for hepatitis B. If you are not vaccinated, ask your doctor or healthcare provider for the hepatitis B vaccine. This safe and effective vaccine is given in 2 or 3 doses depending on the vaccine:

The three-dose vaccine (scheduled at 0, 1 and 6 months):

  1. The first dose is administered at any time (newborns should receive their first dose in the delivery room).
  2. The second dose is administered one month after the first dose.
  3. The third dose is administered 6 months after the first dose.

Sometimes committing to a 3-dose shot is hard. Luckily, there is an approved 2-dose hepatitis vaccine, Heplisav-B, for adults in theU.S..

The two-dose vaccine:

  1. The first dose is administered at any time.
  2. The second and final dose is administered one month after the first dose.

More information on the dosing schedule can be found here.

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You can show your support for National Adult Hepatitis B Vaccine Day by using the social media toolkit and hashtag #AdultHepBVaxDay on April 30th and when discussing the hepatitis B vaccine on social media! Graphics are also available to share throughout your networks.

Join the Hepatitis B Foundation and other leading hepatitis organizations for a Congressional Briefing on Thursday, April 29th at 3pm ET where a group of panelists will discuss how we can work towards achieving health equity by increasing adult hepatitis B vaccination rates.

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References

  1. https://www.cdc.gov/hepatitis/populations/idu.htm
  2. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html

Author: Evangeline Wang

Contact Information: info@hepb.org

About Hepatitis B, HBV, Hepatitis B Awareness, Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

Hep B Community – A New Global Online Support Group

The Hepatitis B Foundation is excited to announce our support of a new global online community support group called Hep B Community. Thomas Tu, PhD, a researcher at Westmead Institute for Medical Research founded this online community to reach a global audience who might need support if they are affected by hepatitis B. 

Dr Tu stated that “While hepatitis B remains incurable, it can be managed and treated. But, people with hepatitis B face social stigma and discrimination, discouraging them from seeking medical help that could prevent progression of their illness to serious disease like liver cancer,”. He further explained that this online forum is important for people affected by hepatitis B to feel supported and empowered to take control of their diagnosis. 

Westmead Hospital’s Storr Liver Centre and the Hepatitis B Foundation have provided start-up funding and help coordinate the forum with support from the World Hepatitis Alliance. The site is peer-led, volunteer-run and is free to join. Already, more than 200 members from all over the world have joined.

Chari Cohen, DrPH, MPH, senior vice president, Hepatitis B Foundation, believes, “The new forum is critically important because people can anonymously seek advice about how to live with hepatitis B, and what they can do to protect their liver and long-term health.” If you are considering joining Hep B Community – do not hesitate! In fact, research has shown that people participating in hepatitis support groups can increase their knowledge, coping, and compliance.1 

How Does it Work?

The online forum has multiple sections like learning resources, media about hepatitis B, and general discussion. 

You can post completely anonymously and a hepatitis B expert or a person living with hepatitis B will respond to your questions. You can also choose your own username and the platform will never show your email, ensuring privacy and confidentiality. 

The hepatitis B experts responding to your questions go through a verification process to identify that they are trustworthy sources of information. These providers are clinicians, nurses, scientists or patient experts,  there to provide reliable answers and give information about health guidelines and treatment options. The forum also has researchers and scientists giving explanations and updates about technical information related to hepatitis B virus and treatment. 

The site is completely free! You can access the site even without making an account if you want to browse. However, in order to ask questions or post content, you will need to create an account. Empower yourself and join the other 200 users and immerse yourself in the supportive hepatitis B community!

Reference

  1. Jessop, Amy B. PhD, MPH; Cohen, Chari MPH; Burke, Monika M. RN; Conti, Molli BS; Black, Martin MD Hepatitis Support Groups, Gastroenterology Nursing: July 2004 – Volume 27 – Issue 4 – p 163-169 

Author: Evangeline Wang

Contact Information: info@hepb.org

About Hepatitis B, HBV, Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment, Living with Hepatitis B

How to Find a Hepatitis B Provider

How to Find a Hepatitis B Provider

If you have chronic hepatitis B or are newly diagnosed, it’s important to see a medical provider who has experience managing and treating hepatitis B.

Having a medical provider with hepatitis B expertise on your team not only safeguards your health but also lessens the stress of having a chronic liver disease. “My specialist gave me all the possible scenarios, but most importantly, he gave me my life back,” one hepatitis B patient recalled.

When first diagnosed, it’s often a primary health provider (PCP) or for children a pediatrician who orders diagnostic tests for hepatitis B. Doctors may run additional blood tests and/or immediately refer you to a liver specialist. If your PCP has experience managing and treating hepatitis B, you may decide to continue your hepatitis B care with that provider. Or, they may recommend a specialist who accepts your insurance or practices in the same healthcare system. But,  you may have to do some research to find the best specialist to treat your hepatitis B.

There are two types of specialists who treat liver diseases:

  • A gastroenterologist is an internist who has trained in digestive disorders including the liver, but how much liver expertise a gastroenterologist (GI doctor) has varies based on their training. It’s important to find out if they specialize in liver diseases and if they have experience with hepatitis B.
  • A hepatologist is a physician who specializes in the liver. This doctor has the most expertise and should be up-to-date about new treatments and clinical trials. But not all hepatologists have treated hepatitis B. Many will have treated hepatitis C, but not hepatitis B, so you need to ask.

Tips for finding a specialist:

  • Are they in the Hepatitis B Foundation directory? The Foundation has a Physician Directory of medical providers who treat hepatitis B around the world. These doctors have voluntarily signed up to be included in the database. It is not an exhaustive list, there may be hepatitis B specialists in your area who have not yet joined the directory.
  • Call the practice ahead of time and ask questions. How many hepatitis B patients have they treated? Do they participate in any clinical trials?  Are they aware of current monitoring and treatment guidelines for hepatitis B?
  • What’s the doctor’s reputation? Does anyone in your community see a liver specialist for viral hepatitis? Whom do they recommend?
  • Will you actually see the specialist or an assistant? Do you see a specialist only if there is a need for treatment? If you go to a teaching hospital, do you see the doctor or an intern, fellow or resident?

You are entering into a long-term relationship with someone who may care for you for many years. You need their expertise, but you also need to feel comfortable working with them. Do they listen when you speak and make eye contact? Trust and rapport are very critical.

“It’s really important that they don’t judge me,” one hepatitis B patient explained.  Another patient said that finding a doctor who spoke his language, or had an assistant who was fluent in his language, helped immensely.

Once you identify a specialist, here are some questions to ask:

  • Is the specialist accepting new patients? How long do you have to wait to get an appointment?
  • What hospital or lab do they use, and are they convenient for you? It’s important for you to always use the same lab so you have consistent results that allow apples-to-apples comparisons.
  • Will the doctor call you with the results or will a nurse or other assistants communicate with you?
  • What would you like your care plan to be? Will you go for blood tests and then see the specialist? Typically, hepatitis B patients get blood tests once or twice a year to monitor their liver, unless they are undergoing treatment.

How to design a long-distance care plan if the specialist is far away:  Sometimes, the best hepatitis B specialist is a few hours drive from where you live, but distance doesn’t have to be a deal-breaker. Many people see a specialist for a first visit, and afterwards, simply have their PCPs or local labs email lab results to the specialist. For this remote healthcare relationship to work, your PCP needs to be willing to partner with the specialist. Also, your specialist needs to be open to telephone or video consultations with you as needed.

Technology matters. Sharing medical records and lab tests electronically make a remote relationship work smoothly. If there are firewalls between practices, find out how to ensure your PCP and specialist share your medical records. Be prepared, you may have to be the conduit if the two healthcare systems don’t talk to each other.

Insurance and cost: Ideally, the hepatitis B specialist closest to you accepts your insurance or is in your provider network. That doesn’t always happen so finding out the charges in advance is important.

  • Will the specialist bill your insurance or will you need to pay the fee upfront and manage the insurance reimbursement yourself?
  • How much do you have to pay out-of-pocket if the specialist is outside your network, or if you are not insured? Some specialists charge a lower fee to uninsured patients. You may be able to have an annual consultation with a specialist and bring your lab results.

One hepatitis B patient reported he was not entirely happy with the specialist his PCP referred him to. “At the time, I had great insurance so all the tests he ordered weren’t a lot of money out-of-pocket,” he said. “But then I changed jobs and I couldn’t afford all of his tests, and he wanted me to go on treatment though my lab reports didn’t justify it.

“I went looking for a new one and found one in the Hepatitis B Foundation’s website,” he said. “I had to drive farther to see him, but his knowledge and patience were very comforting and he spoke my primary language. He really helped me regain confidence in life.”

Prepare for your visit: Before you see your hepatitis B medical provider, put together a list of questions (see sample questions) and have your lab reports available — either bring hard copies or call ahead of time to make sure the doctor has access to your latest labs and medical records.

After you meet with your specialist, take some time to reflect. Are you happy with the doctor? Did he or she communicate well? Are you clear about what you need to do in the weeks and months ahead to take charge of your health? If the answer is yes, congratulations, you have assembled a good healthcare team.

Contact Information: info@hepb.org

About Hepatitis B, advocacy, HBV, Hepatitis B Awareness

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

About Hepatitis B, HBV, Hepatitis B Advocacy

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.

About Hepatitis B, Hepatitis B Prevention, Relationships

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

About Hepatitis B, HBV, Hepatitis B Prevention, Living with Hepatitis B

Pregnancy and Hepatitis B

 

The hepatitis B virus can cause an acute (lasting less than 6 months) or chronic (lifetime) infection. Chronic infection occurs in 90% of infants infected through mother-to-child transmission at birth; and about 50% of children will develop a chronic infection if exposed to the virus between 1 and 5 years of age. Those infected as adults are much less likely (<5%) to develop a chronic infection. Left untreated, hepatitis B can progress to cirrhosis and other serious liver diseases like liver cancer. This blog will talk about mother-to-child (perinatal) transmission and commonly asked questions about perinatal transmission.

Transmission of Hepatitis B from Mother to Child

Globally, the most common route of transmission is mother-to-child. Some people might think the hepatitis B virus is transmitted genetically, but this is NOT true. Hepatitis B is a virus that can be transmitted from a mother to her child because of the blood exchange that happens during childbirth. The great news is that we can prevent mother-to-child transmission! If a pregnant woman tests positive for hepatitis B infection, then her newborn must be given proper prevention immediately after birth in the delivery room, clinic or bedside:

  • first dose (called “birth dose”) of the hepatitis B vaccine
  • one dose of the Hepatitis B Immune Globulin (HBIG).*

*HBIG is recommended by U.S. CDC. HBIG is not recommended by WHO and may not be available in all countries. What is most important is to make sure the hepatitis B vaccine birth dose is given as soon as possible!

If these two medications are given correctly, a newborn born to a mother with hepatitis B has a 95% chance of being protected from a hepatitis B infection. You must make sure your baby receives the remaining shots of the vaccine series according to schedule to ensure complete protection.

And there is more good news – if a pregnant woman with hepatitis B has a high viral load during pregnancy, it is recommended that she take antiviral therapy during her third trimester, which will further reduce the risk of mother-to-child transmission. If you are pregnant and have hepatitis B, talk to your doctor about testing your HBV DNA level, and starting antiviral treatment if it is elevated. There are WHO guidelines for managing hepatitis B infection among pregnant women, which your doctor can use to guide your care.

Commonly Asked Questions About Perinatal Transmission

I am pregnant, should I be tested for hepatitis B?

ALL pregnant women should be tested for hepatitis B. Testing is especially important for women who fall into high-risk groups such as health care workers, women from ethnic communities or countries where hepatitis B is common, spouses or partners living with an infected person, etc. If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born, ideally as early as possible during the first trimester.

I have hepatitis B and I am pregnant, what should I do?

You already know your hepatitis B status – this is a great first step! The next thing you should do is tell your medical provider who should perform additional laboratory testing, including HBV DNA level (viral load), and should check to see if there is evidence of cirrhosis.

All pregnant women who are diagnosed with hepatitis B should be referred to care with a knowledgeable doctor. Some may require continued treatment with an antiviral, many will not. All women with hepatitis B need regular monitoring throughout their life since hepatitis B infection and the health of the liver can change over time.

Can I transmit hepatitis B to my baby when I am breastfeeding?

The U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) recommend that all women with hepatitis B should be encouraged to breastfeed their newborns.  

*Especially if your baby has received the hepatitis B vaccine birth dose, the benefits of breastfeeding outweigh any potential risk.*

Can I prevent my baby from contracting hepatitis B?

Yes! In all cases, it is very important that your obstetrician (or provider who will be delivering your baby), and your newborn’s pediatrician, are aware of your hepatitis B status to ensure that your newborn receives the proper vaccines at birth to prevent a lifelong hepatitis B infection and that you receive appropriate follow-up care.

Should I continue to see a doctor after I give birth?

Yes! Women who have hepatitis B should be closely monitored for 6 months after delivery whether they have been prescribed antivirals are not. This will ensure there are no dangerous elevations in liver enzymes, which can indicate liver damage (ALT flares). For most women whose follow-up testing shows no signs of active disease or cirrhosis, your physician will recommend regular monitoring with a liver specialist (hepatologist) or doctor with experience managing the care of people with hepatitis B. 

World Health Organization Recommendations

In 2020, The World Health Organization released two new recommendations for the prevention of mother-to-child transmission of hepatitis B.

  1. In addition to the series of hepatitis B vaccinations (including the first dose within 24 hours of birth), WHO now recommends that pregnant women testing positive for HBV infection (HBsAg positive) with an HBV DNA viral load threshold of ≥5.3 log10 IU/mL (≥200,000 IU/mL) receive tenofovir prophylaxis; the preventive therapy should be provided from the 28th week of pregnancy until at least birth.
  2. In settings where HBV DNA testing is not available, WHO now recommends the use of HBeAg testing as an alternative to determine eligibility for tenofovir prophylaxis for the prevention of mother-to-child transmission of HBV  This is because some settings have poor access to tests that quantify an individual’s HBV viral load and determine whether a pregnant woman would be eligible for preventive treatment or prophylaxis. This is especially the case in low-income settings or rural areas where many antenatal care visits take place.

Author: Evangeline Wang

Contact Information: info@hep.org

About Hepatitis B, HBV, Liver, Liver Cancer

Hepatitis B and Liver Cancer

Tomorrow, February 4th, marks World Cancer Day! This day harnesses the international community to “raise awareness, improving education and catalysing personal, collective and government action, we’re working together to reimagine a world where millions of preventable cancer deaths are saved and access to life-saving cancer treatment and care is equal for all – no matter who you are or where you live.”

Hepatitis B and Liver Cancer

Cancer is a disease in which normal cells change and grow uncontrollably, that can form a lump called a tumor or mass. A tumor can be benign (not cancerous) or malignant (cancerous). The name of the cancer depends on the part of the body where the cancer first started. The term “primary liver cancer” refers to hepatocellular carcinoma (HCC), the most common type of liver cancer, which starts in liver cells called “hepatocytes.”

In the United States, primary liver cancer has become the fastest growing cancer in terms of incidence (new cases), in both men and women. From 2012-2016, the incidence of liver cancer increased by 2.5%, the largest increase of any cancer during the time period. In 2018, an estimated 42,220 new cases of liver cancer were diagnosed and an estimated 30,200 people died.

Liver cancer mortality also continues to increase, especially among Caucasian, Alaskan Native, American Indian and Hispanic males. Liver cancer disproportionately impacts certain communities more than others: in the U.S., it is now the 5th most common cause of cancer death for men overall, but the 2nd most common cause of cancer death among Asian American and Pacific Islander men, and the 4th most common cause of cancer death among Alaskan Native, American Indian and Hispanic males. The five-year survival rate is about 18%.

Worldwide, the most common risk factor for liver cancer is chronic infection with the hepatitis B virus. Chronic viral hepatitis infections (hepatitis B and hepatitis C) cause at least 80% of all liver cancers. In the United States, the leading cause is chronic hepatitis C virus infections because of the greater number of Americans infected with this virus. Chronic infections with hepatitis B or C are responsible for making liver cancer the most common cancer in many parts of the world. Take a look at other factors which might put you at a higher risk for developing liver cancer.

Prevention

The hepatitis B vaccine was named the first “anti-cancer” vaccine by the U.S. Food and Drug Administration because it prevents chronic hepatitis B infections, thereby preventing liver cancer caused by the hepatitis B virus. In the United States, the hepatitis B vaccine is recommended for all infants and children, and adults at high risk for infection. In many countries, including the United States, vaccinating newborns with the hepatitis B vaccine at birth has resulted in a dramatic reduction in the number of new cases of liver cancer caused by hepatitis B. For more information about the vaccine, visit here.

For more information about liver cancer please visit our Liver Cancer Connect page.

 References

https://www.worldcancerday.org/about-us

https://www.hepb.org/research-and-programs/liver/

 

 

 

About Hepatitis B, HBV, Hepatitis B Advocacy

Correctional Facilities and Hepatitis B

 

People experiencing incarceration in correctional facilities face a disproportionate burden of hepatitis B. This is due to potential increased exposure to high-risk individuals, including people who inject drugs or exchange sex for money or drugs.1 This blog will discuss the prevalence of hepatitis B in individuals experiencing incarceration in the United States and globally, risk factors for infection, and recommendations for policymakers, public health professionals, and correctional facilities.

Prevalence in The United States

The Centers for Disease Control and Prevention (CDC) estimates 850,000 to 2.2 million individuals are living with hepatitis B in the United States.2 Of those individuals, an estimated 0.9% to 11.4% for HBsAg (active, infectious HBV) and 6.5% to 42.6% for HBcAb (ever infected) of people experiencing incarceration are living with hepatitis B.2

Prevalence Internationally

Researchers have conducted various studies in different countries to determine hepatitis B prevalence. For example, a study in Iran found a prevalence of HBV DNA in incarcerated individuals at 2.1%.1  Another study in Mexico City tested over 15,500 men experiencing incarceration and almost 1,800 women experiencing incarceration and found the rate of HBcAb among men was 2.8% and among women, 3.0%. The rate of HBsAg was 0.1% among men and 0.3% among women.1

Risk Factors

Hepatitis B is transmitted through blood, semen, and other bodily fluids.1  Routes of transmission among incarcerated individuals include sharing needles and cookers or other injection drug paraphernalia, sharing tattoo paraphernalia, sharing razors, and having unprotected sex with someone living with hepatitis B.3  Because of policies in the United States criminalizing injection drug use and sex work, correctional facilities are more likely to have higher concentrations of individuals engaging in these risky behaviors. Additionally, sterile equipment is sometimes inaccessible and sharing drug injection equipment is common in correctional facilities which contributes to an increased risk of individuals contracting hepatitis B while experiencing incarceration.3

Recommendations

U.S. Preventive Services Task Force (USPSTF) recommends hepatitis B screening for all high-risk adult individuals which include people experiencing incarceration. However, The Hepatitis B Foundation urges a recommendation for universal screening because it would allow for individuals experiencing incarceration to lower their risk of contracting hepatitis B in correctional settings.

Opt-out vaccine programming is another strategy that can help to prevent the spread of hepatitis B in correctional facilities. However, it is also important for individuals at correctional facilities to be screened before they are vaccinated, to identify those who are already infected. Additionally, when public health professionals implement opt-out hepatitis B vaccination and/or screening programs in correctional facilities, they must ensure clear communication so that program recipients understand what they are being screened/vaccinated for, and that testing/vaccination is voluntary.4 Being diagnosed with a chronic infectious disease can be daunting, and some would rather not know their status, which is important to recognize and respect. Public health professionals also need to recognize the challenges associated with designing vaccination programs in correctional facilities. It is important to design a sustainable program which emphasizes continuous medical care for individuals who test positive for hepatitis B throughout incarceration, even with challenging situations like transfers, and reintegration back into their communities.1

Correctional facilities should consider providing treatment options for people experiencing addiction as well as utilizing a harm reduction approach to provide sterile injection and tattoo equipment to reduce the risk of hepatitis B transmission.1

References

  1. Smith JM, Uvin AZ, Macmadu A, Rich JD. Epidemiology and Treatment of Hepatitis B in Prisoners. Curr Hepatol Rep. 2017;16(3):178-183. doi:10.1007/s11901-017-0364-8
  2. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm
  3. Gupta S, Altice FL. Hepatitis B virus infection in US correctional facilities: a review of diagnosis, management, and public health implications. J Urban Health. 2009;86(2):263-279. doi:10.1007/s11524-008-9338-z
  4. Rosen DL, Golin CE, Grodensky CA, et al. Opt-out HIV testing in prison: informed and voluntary?. AIDS Care. 2015;27(5):545-554. doi:10.1080/09540121.2014.989486

 

Author: Evangeline Wang, Program Coordinator

Contact Information: info@hepb.org

Baruch S. Blumberg Institute