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Hepatitis B Prevention, Living with Hepatitis B

RANN Foundation – Raising Hepatitis B Awareness in India

This post is written by guest blogger Surender, who founded the RANN Foundation – a non-profit organization in India dedicated to educating women and children in a variety of topics – including hepatitis! 

India has one-fifth of the world’s population and carries a large proportion of the global burden of hepatitis B. India harbors 10 to 15 percent of the entire pool of hepatitis B carriers in the world, estimated to be 40 million HBV carriers. About 15 to 25 percent of HBsAg [the hepatitis B surface antigen] carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely. Infections that occur during infancy and childhood have the greatest risk of becoming chronic. Of the 26 million infants born every year in India, approximately one million run the lifetime risk of developing chronic hepatitis B.

RANN Foundation focuses on developing the potential of women and girls to drive long-lasting equitable changes deeply focusing on SDGs mainly 3.3 aims to combat Viral Hepatitis by 2030.

We believe that the best way to unlock human potential is through the power of creative collaboration. That’s why we build partnerships between businesses, NGOs, governments, and individuals everywhere to work faster, leaner, and better; to find solutions that last; and to transform lives and communities from what they are today to what they can be, tomorrow.

My Story:

I was a Human Resource Executive in leading thermal power generation company in India. It was 2010 when during a blood donation camp, I got to know that I have Hepatitis B infection. I had never heard about hepatitis b before this incident. It was a shocking moment for me because I had never gone through any blood transfusion. I discussed with family and prepared all of them for screening of hepatitis B. The results were shocking to all of us as three members had infection of Hepatitis B in my family. It was mother to child transmission. I decided to leave my job, which was the only source of earning for me/family, & started education about the diseases in most vulnerable slums & villages in India. Being a survivor, it was my duty to protect future generations. I started my organization RANN Foundation which aims for awareness and prevention of viral hepatitis in India.

The social stigma surrounding Hepatitis B

I never hide my hepatitis B positive status. In fact, on every occasion, I share my story, but anyone who is living with hepatitis B cannot reveal his/her status due to discrimination in family & society. Discrimination and marginalization of people living with the chronic infection is a major concern that majorly impacts the lives of patients in India. Misconceptions and stigma attached to the disease often leads to marginalization and discrimination against patients. My fight against the disease focuses on multiple fronts – prevention of hepatitis B through vaccination camps of dropout children, conducting education programs on viral hepatitis in schools & urban slums, and providing psychosocial support to patients. Around 1.5 lakh deaths annually and almost 60 million Indians affected, Viral Hepatitis continues to be a serious public health concern. Most of the mortality due to viral hepatitis is attributed to hepatitis B and C, which are also known as silent killers as more than 80% of the infected aren’t aware of their infection.

Project NOhepDelhi: A School Awareness Program

Under Project NOhep Delhi a school awareness program is initiated by RANN Foundation in collaboration with Delhi Commission for Protection of Child Rights (Govt of Delhi) to educate students and teachers about viral hepatitis. The role of students in creating awareness and causing behavioral changes among the general population could go a long way in preventing the spread of viral Hepatitis.

The effort aimed at increasing students’ awareness and knowledge of hepatitis transmission and prevention should, therefore, be of special interest, especially among adolescents and young adults.

At this stage, most detrimental lifelong lifestyles and behaviors are adopted like substance use, alcoholism, etc. which are also a predisposing factor for the contraction of hepatitis infection and other infections. The school is a place where viral hepatitis information can get to adolescents and the teachers are potent instruments for giving out this information. Hence, the need to assess the knowledge of teachers & students about viral hepatitis.

Training of the Students: Senior girls are in the process of taking sessions on viral hepatitis to educate their juniors and other people living nearby their home. Girls were excited while giving their names for the training and showed dedication throughout the program.

Achievements

Project HASI:- RANN in collaboration with Cognizance (IIT- Roorkee) has taken the initiative to educate and empower the rural and urban-rural women of Uttarakhand. We launched the project in October 2018. So far, we have impacted and supported over 4,000 beneficiaries directly and over 1500 indirectly through our community trainers in Haryana & Uttarakhand.

NOhep With Max India Foundation :- We have successfully conducted immunization camps with Max India Foundation catering to 800 children and have provided with hepatitis B vaccinations.

Project NOhep Delhi :- RANN in collaboration with Delhi Commission for Protection of Child Rights (Govt. of Delhi) has taken the initiative to educate and empower the urban slums women & students of govt schools of New Delhi. We have started project Nohep Delhi in 17 govt schools – appox 35 thousand children) & 3 major slums to conduct awareness program on viral hepatitis. An intensive campaign for awareness generation will be held using different methodS such as health awareness camp, meeting, events, street plays, one to one communication, big events and sensitization with various groups of the society

About Hepatitis B, Hepatitis B Prevention

Hepatitis B is NOT A Genetic Disease – And Here’s Why

There are many misconceptions about the hepatitis B virus. One recurring one is the myth that hepatitis B is a genetic or hereditary disease. The belief is that because multiple family members can be infected by hepatitis B, it must be a virus that runs in families. This is not true. Hepatitis B is NOT genetic. Hepatitis B is spread through direct contact with infected blood. Although transmission can occur a number of different ways, it does not happen at conception or while the child is developing in the uterus. 

Let’s start by breaking down what it means for something to be genetic or hereditary: 

A genetic disease is caused by an error in a person’s genes and is   carried by an individual in their genes. This type of disease may be passed on to a person’s child (which means it is hereditary) or it can occur spontaneously as a result of a gene mutation while a child is growing in the womb. Genes – which make up each of our unique DNA strands – are passed on to a child from both the mother and the father. Therefore, if a mother or father carries a certain hereditary disease or genetic trait, such as brown hair or green eyes, the child has the ability to have that as well. 

Hepatitis B is not a genetic disease because it does not exist in a person’s genes. It is not carried in the egg of a woman or the sperm of a man. The hepatitis B virus exists in the liver cells and circulates in the bloodstream. Unlike a genetic disease, a person is not born with the hepatitis B virus already in their bodies. Instead, the virus is passed from mother to baby during childbirth through infected blood passing from the mother to the child during the physical delivery process. If a pregnant woman tests positive for hepatitis B, she can pass the virus to her newborn through infected blood and tiny tears in the skin that occur during childbirth. Oftentimes, these tears are unable to be seen by the human eye but can still allow for the virus to pass through and make direct contact with mucous membranes (“wet skin”) of the eyes, ears, nose, and mouth of the infant

A number of different factors play a role in determining if a newborn will contract hepatitis B from their mother: the mother’s viral load levels, the mother’s knowledge of her infection, and if the newborn receives post-exposure prophylaxis. Post-exposure prophylaxis is the key to preventing mother-to-child transmission and consists of two parts: the first dose of the hepatitis B vaccine and hepatitis B immunoglobulin (HBIG). Both shots need to be administered 1) in two different limbs and 2) within 12 hours of birth in order to be as effective as possible. Once the shots have been given, the infant should complete the standard hepatitis B vaccine schedule in order to ensure that they are protected for life! *Please note that HBIG is not recommended by WHO, so it may not be recommended or available in all countries.

Commonly Asked Questions: 

It can be difficult to understand facts when they do not align with what you have been told for many years, so we’ve answered some of the most common responses to our information below: 

  1.  If it is not genetic, how is it sexually transmitted? 

 This question goes back to the topic of genes. A genetic disease differs from a sexually transmitted disease because of where the virus is hosted during transmission from one individual to another. A genetic disease is given to a person via cellular DNA while a baby is developing in the mother’s womb. Sexual transmission occurs because the virus is present in blood and sexual fluids and can be transmitted through very tiny, microscopic tears as a result of sexual intercourse.

2.  If it’s not genetic, why do multiple members of my family have it? 

Families tend to share objects – and that’s okay! However, sharp objects like earrings and body jewelry or personal care items like razors, nail clippers, or toothbrushes, can make tiny, microscopic cuts and abrasions in our skin that bleed. Sometimes, we don’t even notice! When a family member uses an object with trace amounts of infected blood and they also have a wound, such as a mouth sore,  cut, or freshly shaved skin, the virus can spread to the uninfected individual. Because hepatitis B is so infectious (at least 50 times more infectious than HIV!), even small amounts of infected blood can cause a person to become infected. Therefore, it is recommended that personal items and sharp objects are not shared – even between family members, or ensure all family members are properly vaccinated for hepatitis B and confirm they are protected

Accidents also occur frequently in households, and sometimes blood is spilled. The virus can live on surfaces outside of the body, so it is essential to properly clean up any blood spills. The key to safely cleaning up blood and killing the virus is to wear gloves and use a fresh diluted bleach solution of 1 part bleach mixed with 9 parts water. 

It’s extremely important to note that infected blood must come into contact with uninfected blood or a mucous membrane for transmission to occur. A person cannot become infected from skin-to-skin contact such as shaking hands or hugging, sharing utensils or food prepared by an infected individual, or even kissing.

Prevention: 

The best thing to remember is that hepatitis B is preventable, even if a child is born to a mother living with chronic hepatitis B! Always remember to wash your hands thoroughly with soap and hot water after any possible exposure to blood. In addition, any family members and loved ones who test negative for the hepatitis B surface antigen (HBsAg) and did not recover from a past infection (HBcAb total negative) should get vaccinated to prevent any possible transmission. The vaccine is one of the most effective vaccines in the world! 

Hepatitis B Prevention

Hepatitis B Vaccine Schedule: Standard, Accelerated, and Combination

Getting poked with a needle is never fun, but it’s an extremely important part of protecting yourself and others from infectious diseases! The hepatitis B vaccine is known to be one of the most effective vaccines in the world – and very safe too! As a blood-borne disease that typically has no symptoms, hepatitis B can easily be spread by accident – simply because people are unaware that they have it! Modes of transmission include mother-to-child during birth, unprotected sex, injection drug use, unsafe medical procedures, and the sharing of personal items that may contain blood remnants, such as body jewelry, razors, and toothbrushes. Although certain precautions can be taken to prevent transmission, the only way to completely protect yourself is to get vaccinated. Once you have been vaccinated, you are protected for life!

There are a few options for receiving the hepatitis B vaccination. In most countries, the vaccine is available through a doctors office or a health clinic. The most common option is the standard three-dose vaccine. This consists of three separate doses of the vaccine given through intramuscular injections. In order for the vaccine to be effective, there must be a minimum amount of time between doses. If the minimum amount of time is not followed, the vaccine will not provide full, long term protection from the infection.

3 Dose Schedule:

  • 1st Shot – At any given time, but newborns should receive this dose in the delivery room within 24 hours of birth
  • 2nd Shot – At least one month (or 28 days) after the 1st shot
  • 3rd Shot – At least 4 months (16 weeks) after the 1st shot (or at least 2 months after the 2nd shot). Infants should be a minimum of 24 weeks old at the time of the 3rd shot.

In the United States, there is an FDA approved 2-dose vaccine called Heplisav-B. However, Heplisav-B is only approved for adults. Both doses must be from the Heplisav-B vaccine only.

2-Dose Schedule (U.S. Only):

  • 1st shot – At any given time
  • 2nd shot – At least 28 days after the first shot.

Accelerated Vaccine Schedule

At the moment, Heplisav-B is the only vaccine that is approved on a shortened schedule. Some doctors may offer an accelerated vaccine schedule for special circumstances. However, the accelerated schedule is generally not recommended for individuals who do not need the vaccine within a certain time period. The Centers for Disease Control and Prevention only recommends the accelerated vaccine schedule to those who are traveling on short notice and have a high risk of facing exposure, or to emergency responders in disaster areas. Multiple studies have shown that the minimum time between doses is necessary in order to receive full protection against the infection. If doses are given too close together, the body does not have enough time to create an immune response to the vaccine’ leaving you vulnerable to transmission. If you must complete an accelerated schedule, four doses of the vaccine are required in order to achieve full, long-term immunity.

4 Dose Schedule:

    • 1st Shot – At any given time
    • 2nd Shot – 7 days after the first shot
    • 3rd Shot – Between 21 and 30 days after the 1st shot

 

  • 4th Shot –  1 year after the first shot

 

 

Combined Vaccines

In some cases, the hepatitis B vaccine is administered along with other vaccines or as part of a combination vaccine. Examples of combination vaccines that offer protection against HBV include: 1) The pentavalent vaccine which is used for children and protects against a total of five infectious diseases and 2) the combination hepatitis A and B vaccine. While the pentavalent vaccine is offered as the first dose for children in many countries, it is not ideal unless the child is able to get the birth dose of the HBV vaccine. It can only be given once the child is six weeks old, leaving the infant unprotected during the gap. Therefore, it is strongly recommended that children receive a monovalent hepatitis B dose of the vaccine at birth. For women that are HBsAg positive, the birth dose is the best chance to prevent hepatitis B transmission to the next generation and must be given within 24 hours of birth.

Pentavalent Vaccine Schedule         

  • 1st Shot –      Monovalent at birth                                                                         
  • 2nd Shot-      Pentavalent at 2 months of age                     
  • 3rd Shot –      Pentavalent at 4 months of age
  • 4th Shot –      Pentavalent at 6 months of age                         

The combined hepatitis A & B vaccine – which is only for adults – can follow the 3 dose vaccine schedule or, if necessary, the 4 dose accelerated schedule. More information on combination vaccines can be found here.

Before you get vaccinated, it is important to get tested for hepatitis B! The vaccine will not work for those who are currently infected or have previously been infected. Those who have recovered from a past infection will produce antibodies to the virus and will not have to worry about becoming reinfected or infecting others – but the virus can become reactivated if they undergo immune suppression, so it is important for you and your doctors to know if you have recovered from a past hepatitis B infection. However, those who are currently infected will still be able to transmit the virus – even if they receive the vaccine. Therefore, it is important to know your current status. Ask your doctor or local healthcare provider for the 3-panel hepatitis B blood test (HBsAg,HBsAb,HBcAB) to find out your status today!

 

Hepatitis B Advocacy, Hepatitis B Prevention, News

Tackling Hepatitis B in Africa: The First Nigerian Hepatitis Summit

This is a guest blog post by Danjuma Adda, MPH, Executive Director of Chargo Care Trust, a non-profit dedicated to helping hepatitis patients in Nigeria. 

In 2016, the World Health Organization (WHO) set targets for the elimination of viral hepatitis as a public health threat by 2030 and provided a global health sector strategy (GHHS) on viral hepatitis for 2016–2021 that has since been adopted and endorsed by 194 countries. Nigeria joined the league of other nations to sign up to the GHSS and was among the few countries in Africa to develop firm goals towards the elimination of viral hepatitis. The goals were mapped out in a comprehensive framework that includes the National Viral Hepatitis Strategic Plan 2016-2020, National Policy for the Control of Viral Hepatitis, and National Guidelines for the Care and Treatment of Viral Hepatitis. An estimated 26 million Nigerians are living with viral hepatitis. A national hepatitis control program was created and a Technical Working Group for the Control of Viral Hepatitis was set up to help address the issues.

Despite these achievements, there has been very little financial assistance or investments by the national government towards the elimination of hepatitis. Gaps like low awareness fueled by myths and misconceptions, lack of available information on hepatitis, poor systems of health, high cost of diagnostic testing and out of pocket expenses for viral hepatitis treatment, low capacity of health care providers, and the proliferation of substandard treatment centres across Nigeria poses a challenge to the elimination goal of hepatitis in the country.

The First Nigerian Hepatitis Summit

To spur action towards hepatitis elimination in Nigeria, hepatitis patient groups and civil society networks organized the first ever Nigeria Hepatitis Summit in December 2018. The groups were led by Danjuma Adda, Executive Director of Chargo Care Trust. The goals of the summit were to:

1. Improve health seeking behavior among Nigerians through disease awareness and, as more people become aware of the disease, help them discover their status and encourage them to seek treatment as appropriate;

2. Increase local and domestic health financing, increase domestic, local responses, and allocate needed funds towards the elimination of the disease as more state governments establish state actions plans;

3. Increase engagement and involvement of the private sector in accelerating the elimination goal of viral hepatitis in Nigeria and;

4. Increase the capacity of health care professionals and improve health care systems to deliver quality viral hepatitis cascade of care in line with WHO and national guidelines.

The summit was held on December 3-4 in Abuja, Federal Capital Territory. Over 200 participants from diverse sectors attended including the:

* WHO’s Nigerian office

* State Directors of Public Health across Ministries of Health

* State HIV/AIDS Program Managers-Hepatitis is domiciled in the State HIV/AIDS programs at both national and state levels.

* Civil society and NGOs from 26 states in Nigeria

* Academia including the Society of Gastroenterologist and Hepatologist in Nigeria (SOGHIN)

* Private sector representatives

* Professional Medical associations

The Society of Gastroenterologist and Hepatologist (SOGHIN) led the technical faculty. SOGHIN made up 70% of the speakers. Other Speakers included: World Health Organization (WHO); World Hepatitis Alliance (WHA); Clinton Health Access Initiative (CHAI); National Primary Health Care Development Agency; Harm Reduction Association of Nigeria; and Representatives of States Ministries of Health.

Outcomes from the Summit

* Increased advocacy at state ministries of health to ensure state governments prioritize hepatitis cascade of care

* The engagement of private institutions to invest in the hepatitis cascade of care

* Efforts to enhance collaboration towards improving hepatitis cascade of care between civil society organizations and state governments

* Increased domestic financing is needed by state governments towards the elimination of viral hepatitis in Nigeria

* The World Hepatitis Alliance (WHA) UK is partnering with CSOs/Patient groups to build advocacy efforts for hepatitis C financing. To this end, WHA is supporting the development of a hepatitis C financing model for the engagement of state governments and private sector players to invest in elimination projects across Nigeria.

Looking Towards the Future

For the first time, government representatives from the state and national ministry of health, patient representatives, and civil society members came together to talk about the burden of viral hepatitis with the common goal of finding solutions to the pandemic. It was evident during the meeting that the lack of commitment and political will by the national government may cause Nigeria to miss the target goal of eliminating viral hepatitis if strong actions are not taken. Viral hepatitis must be recognized as a disease of public health importance in the country.

At the moment, the viral hepatitis cascade of care remains beyond the reach of the majority of Nigerians, fueling the spread of fake and substandard practices and the proliferation of treatment centres around the nation.

Almost everyone in Nigeria is affected by the scourge of viral hepatitis. Brothers, friends, and relatives have been lost to this disease. The conspiracy of silence across the nation and lack of strong will to address the pandemic remains a puzzle that we all need to solve.

Nigeria has what it takes in terms of financial and human resources to be the regional leader in the drive towards the elimination of viral hepatitis in Africa. What it lacks is the political will and commitment of government at all levels and the interest of private sector players to invest in the elimination of viral hepatitis in Nigeria. At the moment, other African countries are overtaking Nigeria on the path towards elimination by launching ambitious plans for their citizens.

If only we can get the attention and support of the private sector players and business moguls in Nigeria, the country will be on track towards the elimination of this disease and surpass the WHO target. If some of the countries wealthiest individuals contributed just a million dollars each to a National Hepatitis Elimination Project, Nigeria would see profound health benefits for the entire nation.

In order to attract support from partners around the world including pharmaceutical companies, the government of Nigeria must make a bold commitment and investment in addressing the challenge of viral hepatitis for its citizens.

The government of Nigeria must take the first step by making the financial commitment towards provisions for prevention, testing and treatment programs in the country by launching a pragmatic and ambitious Viral Hepatitis Elimination Project with clear targets to reach each year on prevention and treatment, including harm reduction strategies.

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!

Hepatitis B Prevention, Relationships

My partner has been diagnosed with hepatitis B. Can transmission be prevented by vaccination?

Courtesy of Google Images

A hepatitis B diagnosis can be scary and confusing for both you and your loved ones, especially if you are unfamiliar with the virus. Hepatitis B is known to be sexually transmitted, and you may wonder how you can continue your relationship with someone who has been infected. The good news is that hepatitis B is vaccine preventable. This means that after you complete the vaccine series, you cannot contract hepatitis B through any modes of transmission; you are protected for life!

However, it is important to remember that the vaccine will only work if a person has not been previously infected. Therefore, it is necessary to take certain steps after your partner’s diagnosis to protect yourself from becoming infected.

The first step is to visit the doctor and get tested, even if you think that you do not have it. Since hepatitis B often has no symptoms for decades, testing is the only way to know your status. The doctor should perform the Hepatitis B Panel test – a simple blood draw that shows hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb or anti-HBs), and hepatitis B core antibody total (HBcAb or anti-HBc). Looking at these three blood test results together will show if you have a current infection, have recovered from a past infection, or if you need to be protected through vaccination. Once you receive your results, this chart can help you understand what they mean.

Preventing Transmission through Vaccines:

If you test negative for HBsAg, HBsAb, and HBcAb, you are not protected from hepatitis B and are considered to have a high risk of contracting the virus from your partner or other means. To prevent transmission, you will need to begin your vaccination series as soon as possible.

The hepatitis B vaccine is a 3-shot series taken over the span of 6 months. The first shot can be given at any time. The second dose should be given at least one month after the first shot, and the third and final dose should be separated from dose 2 by at least two months and dose 1 by at least 4 months.  While there is a minimum amount of time required between doses, there is no maximum amount of time. If you miss your second or third shot, you do not have to start the series over again; you can pick up where you left off! If your partner is pregnant and was diagnosed with hepatitis B, extra precautions need to be taken to prevent transmission to the child. Two shots will need to be given to the child in the delivery room: the first dose of the hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG), if recommended and available in your country.  You can learn more about pregnancy and hepatitis B here.

After completing the series, a quick blood test called the “antibody titer” (anti-HBs titer) test can confirm that you have responded to the vaccine. This test, which should be given at least one month after you receive the third dose, will be greater than 10 mIU/mL if you are protected from hepatitis B. Like the vaccine, your doctor can administer the titer test.

Hepatitis B is spread through direct contact with blood. HBV  is also a sexually transmitted disease, so it is important to practice safe sex by using condoms throughout the duration of the vaccine series until the antibody titer test confirms that you are protected. While you wait for your body to create its defense, there are other steps that you can take to avoid transmission such as not sharing toothbrushes or sharp objects like razors.

The hepatitis B vaccine is the only way to fully protect yourself from the virus. Preventive measures such as using condoms can help prevent hepatitis B transmission, but without vaccination, there can still be some risk.

If you do not have a doctor or are worried about the cost of testing or vaccination, you can still get tested and vaccinated! In the United States, Federally Qualified Health Centers provide the hepatitis B vaccine at low- or no cost to individuals without insurance or with limited plans. You can search for a health center near you here. Internationally, you can search our Physicians Directory and the World Hepatitis Alliance member map to identify member organizations in your country that may have advice on doctors in your area. In addition, keep a lookout out for local health fairs and screenings; they may provide free vaccinations or testing for hepatitis B!

Hepatitis B Prevention

Know the Risk: Transmission Through Tattoos & Piercings

Tattoos and piercings are a popular mode of self-expression. Oftentimes, they hold cultural and societal significance. Rarely are they thought about in relation to public health. In the United States, there are no federal regulations for tattoos or piercings apart from age restrictions. This means that tattoo and piercing parlors may have different sanitation and sterilization standards in accordance with how strictly a state chooses to manage the industry. For example, Nevada does not regulate tattoo or piercing shops, but New Jersey requires each shop to meet certain equipment sterilization and sanitation standards. Many people also decide to forgo a professional setting and receive body art from their friends, which can be especially dangerous. This lack of universal regulations and sanitation laws increases the risk of spreading bloodborne infections like hepatitis B.  

Image Courtesy of Unsplash

How Tattoos and Piercings Work: A tattoo is created by sharp needles repeatedly piercing the skin to embed ink into your body. While this ensures a permanent image, it also exposes your blood directly to the needle and anything that might remain on the needle from its previous usage. As hepatitis B is spread by direct blood contact, getting a tattoo poses a risk of infection if the equipment is not single use has not been properly sanitized, preferably using an autoclave. A fresh tattoo is an open wound, so it is important to properly bandage the area and keep it away from shared items that could potentially have blood on it, such as razors.

When you get a body part pierced, an artist typically uses a piercing gun with a very sharp needle that pokes a hole into the desired area and earrings or body jewelry are placed into the hole to make sure that the body tissue does not close. Earrings or body jewelry pose another possible risk of direct blood contact if they have been previously worn by another individual, so it is always best to use a new pair of earrings when getting pierced. In general, it is best to avoid sharing earrings and body jewelry. It is important to remember that hepatitis B often has no symptoms, so most people who are infected do not know that they have it. Safety precautions should be taken for everyone receiving a tattoo or piercing to prevent accidental transmission of the infection.

Do Your Research: Making a permanent decision can be difficult and the risk of contracting an infection can complicate matters; it is not something that you want to rush into it. Completing background research can narrow down your choices and help you feel more confident in your ultimate decision. Look at reviews of the shops and see what customers have said. If you see a review about a rash or an infection, it could be a sign that the establishment is not meeting basic safety standards. If you are in America, you can also check the state laws for body art and ask to see a parlor’s compliance certificates if they are not displayed. Don’t be afraid to ask questions! Ask to see the autoclave and ensure equipment bags are opened in front of you.

Image Courtesy of Unsplash

Although it may be tempting to have a friend or family member complete your body art in the comfort of a familiar setting, it also poses a higher risk for exposure to infections like hepatitis B. It is likely that such a setting does not have the proper tools, sterilization equipment, or training to clean the needles as they should be cleaned. Completing the hepatitis B vaccine series is strongly recommended for everyone, but especially to those who participate in activities with higher chances of blood exposure, such as getting body art in unregulated areas. After completing the vaccine series, most people are protected from hepatitis B for life, but other infections – like hepatitis C or HIV – still pose a risk.

If you need help identifying safe establishments, the Association for Professional Piercers is an international non-profit organization that allows you to search for shops in your area that meet certain health standards and answers any questions you may have about piercing. The Alliance for Professional Tattooists, Inc. is another international non-profit that can also help you find safe shops. Both have been approved by the Centers for Disease Control and Prevention (CDC). For more information from the CDC about hepatitis B or other bloodborne infections, click here.

What to look for in a Tattoo or Piercing Parlor:

  • Gloves – The artist should be wearing disposable gloves to keep the risk of contamination and blood exposure as low as possible. In addition, they should change their gloves each time they leave their work area or switch to a new client.
  • Disinfectant – Does the artist wipe down their work area when they are done with a client? Make sure that any area that they have set a tool on has been properly cleaned as well. The hepatitis B virus can survive on a surface for up to a week, so it is extremely important that any surface a tool comes into contact with has been sanitized.
  • Clean Equipment – Many tattoos and piercing shops have reusable needles and piercing guns. These objects are sharp and draw the clients’ blood, so they should always be thoroughly cleaned before being used again. If you notice that an artist works on one client and does not disinfect or change their tool before accepting a new client, there is an extremely high risk for blood exchange. Be sure to ask about the autoclave.
  • Certifications – Oftentimes, shops will have their certifications displayed on the wall. This shows that they have either been properly trained or are required to meet certain standards by law. Depending on the certification, this could mean that the shop is well-educated in preventing and knows how to properly sterilize their tools.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened. To a find a place near you where you can get tested in the U.S., visit www.hepbunited.org.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service.

Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.

Hepatitis B Advocacy, Hepatitis B Prevention

Vlog: Lunch & Learn Session with Jefferson APAMSA

Join Michaela Jackson for A Day in the Life of a Public Health Coordinator as she takes you behind the scenes of Hep B United Philadelphia.

In this episode, the Hepatitis B Foundation joins Hep B United Philadelphia in the City for a Lunch & Learn session with Jefferson University APAMSA students.

Hepatitis B Prevention, Hepatitis B Treatment

Be Your Own Advocate in the Medical Room

The hepatitis B virus (HBV) can be transmitted two ways: 1) through direct contact with blood and 2) infected body fluids. Some risks for direct blood contact are obvious, such as touching an open wound to another open wound or cleaning up someone’s blood without any protective gear. However, other methods of blood transmission are harder to catch. Common activities like sharing razors, earrings, or toothbrushes are simple, innocent actions, yet they all have the potential for blood exchange.

Medical and dental procedures are aspects of our lives that we might not think twice about. While beneficial to our health, they also carry the risk of exposure to another person’s blood. Surgeries, shots, and dental activities all use sharp objects that pierce the skin and draw blood.  If the tools are not properly sterilized, or cleaned, before they are used on a new patient, the blood that was on the equipment can be transferred to the next patient.

Image courtesy of Cook Services

How do I know if medical tools are sterile? Ask! It is your right to know if the equipment that will touch your body has been thoroughly cleaned. In a dentist office, the assistant might unwrap a package of tools in front of you; this typically means that the tools are either new or have been properly cleansed. In a medical setting, needles and surgical equipment might come in packaging as well. If you still are not certain, feel free to ask what the standard cleaning procedures are for the tools being used. The staff will be happy that you are taking your health into your hands!

Why is it important to have sterile tools?   Hepatitis B earned the nickname “silent infection” because there are often no symptoms. Those who have been infected may not take the necessary precautions simply because they do not know that they should. They may not even know they are infected! In many cases, medical and dental professionals are unaware when a patient has hepatitis B. Therefore, it is important to make sure that all equipment that is being reused has been sterilized. Although there are no global sterilization standards, many countries and medical facilities around the world – like hospitals, dental offices, and doctor offices – have disinfection guidelines and practices for their equipment.

Tips to Protect Yourself:

  1. Be your own advocate: Ask the dental hygienist, nurse, doctor, acupuncturist or person in charge of your procedure if the tools have been sterilized.
  2. Know where you go: Try to visit medical or dental facilities that you trust and that provide clean, safe environments for any procedures involving blood or body fluids.
  3. Get vaccinated: Hepatitis B is a vaccine preventable disease. After receiving all three doses, most people are protected for life! Check your immunization records to make sure that you have been vaccinated or ask your doctor or local clinic about the vaccine.
  4. Share with caution: Sharing or eating food prepared by someone with hepatitis B is safe, but any activities that may involve direct contact with blood carry a risk. A good guideline is to keep all personal hygiene items personal.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service. Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Liver Cancer

Journey to the Cure: What Does Liver Cancer Research Look Like? ft. Aejaz Sayeed, PhD

Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.

In the fourth episode (part 2), Kristine Alarcon, MPH sits down with Aejaz Sayeed, PhD, Assistant Professor at the Baruch S. Blumberg Institute, to talk about his research in liver cancer. For any questions about hepatitis B, please email info@hepb.org.

Disclaimer: The information provided in this audio post is not intended to serve as medical advice of endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.

Edited by:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

Script:

Welcome to “Journey to the Cure!” Every month, we’ll sit down with scientists from the Hepatitis B Foundationand the Baruch S. Blumberg Instituteto talk to you about hepatitis B and efforts to find a cure for hepatitis B. There’s still a long way to go, but we’re here to walk you through our journey.

Kristine Alarcon, MPH:
Can you tell me about your research?

Aejaz Sayeed, PhD:
That’s an interesting question. I’vespent a lot of time pursuing breast cancer and prostate cancer. I just started working on the liver cancer. There are millions of people who are pursuing cancer research, but the challenge is that we have done a lot of progress in some cancers, but some cancers, still, we do not have a handle on. For example, we have done a lot of progress in breast and prostate cancer. We have not done much in pancreatic and liver cancer. And, the five-year survival rates of breast and prostate and other cancers have drastically increased, but we have not done much of a progress in pancreatic or a specific form of brain cancer or pancreatic cancer or liver cancer. The problem, again, is that we’re not able to detect the disease at an early stage, and if we had a good set of biomarkers available, there’s a good opportunity, there’s a good chance that we should be able to control these diseases as well.

Kristine Alarcon, MPH:
What attracted you to studying liver cancer?

Aejaz Sayeed, PhD:
I’ve been working on breast cancer and prostate cancer, so in liver cancer, I want to use the tools and techniques, which I used in breast and prostate cancer. That’s why there’s that desire to use the similar strategies, which I used in breast and prostate cancer to discover and characterize markers. That’s why I’m still setting up collaborations with transplant surgeons because liver cancer is treated generally by either resecting the tumor or transplanting the liver. The liver is such an important organ that you cannot really take the liver away. You need the liver. Transplanting the liver is another strategy of treating these patients, so, yes, it is basically that desire that we have more biomarkers, and I can use the knowledge that I gained in breast and prostate to recapitulate the same kind of events, so that we can make a dent.

Kristine Alarcon, MPH:
Yeah; that’s so cool.

Aejaz Sayeed, PhD:
Thank you.

Kristine Alarcon, MPH:
Well, thank you for joining us on this episode of “Journey to the Cure.” Please join us next time for our next episode. Thank you for joining us!

Aejaz Sayeed, PhD:
Thank you!

Baruch S. Blumberg Institute