ACIP review of the hepatitis B birth dose vaccination remains a grave concern - Please read more here.

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  • Who’s at Risk for Hepatitis B? Learning the Hep B Basics

      Are you or someone you know at risk for hepatitis B? You might be more at risk than you think, and since hepatitis B is vaccine preventable, it makes sense to get tested and vaccinated for HBV.  Hepatitis B is the number one cause of liver cancer worldwide. The survival statistics for liver cancer are particularly grim, with a relative 16,6% 5-year survival rate.  The hepatitis B vaccine also protects against hepatitis delta, the most severe form of viral hepatitis. It is important to note that everyone is susceptible to hepatitis B. It does not discriminate.  It infects, babies, children, teens, adults and seniors. It has no racial or religious bias, though it is certainly more prevalent among certain ethnic groups –mainly because it is endemic to the homelands of these communities. For example, if you look at the prevalence map for hepatitis B, you will see that in most of the world, hepatitis B is at an intermediate, (2-7%) or high HBsAg prevalence (>8%) level.  Looking at the numbers, 2 billion people in the world, that’s 1 out of 3 people, have been infected with HBV and 257 million are chronically infected. That represents three-quarters of our world. Even if you aren’t living in these parts of the world, you may be traveling to some of these areas for work or pleasure, or perhaps your parents and other family members were born in HBV endemic areas.  Since there are often no symptoms for HBV, and screening and vaccination may be lacking in some populations, HBV is transmitted from one generation to the next, with many completely unaware of their HBV status – until it’s too late. People at risk for hepatitis B include the following: (not noted in a particular order) Health care providers and emergency responders due to the nature of their work and potential for exposure. Sexually active heterosexuals (more than 1 partner in the past six months) Men who have sex with men (MSM) Individuals diagnosed with a sexually transmitted disease

    http://www.hepb.org/blog/whos-at-risk-for-hepatitis-b-learning-the-hbv-basics/
  • One in Three People Worldwide Has Had Hepatitis B, So Why Do We Feel So Alone?

    Volunteers from the Rann India Foundation teach villagers about hepatitis B testing and prevention in India. By Christine Kukka Hepatitis B is the global pandemic no one talks about, yet one in three people worldwide has been infected. In 2013, hepatitis B and C together was the seventh-leading cause of death worldwide, with hepatitis B causing 780,000 deaths annually. Today, 257 million people have chronic hepatitis B. Despite the availability of an effective vaccine, the number of people living with hepatitis B virus is projected to remain at the current, unacceptably high level for decades and cause 20 million deaths through 2030. How can this happen? Viral hepatitis infection and death rates far outstrip that of ebola and zika. In fact, you have to combine the death toll from HIV and tuberculosis to find human suffering on par with what viral hepatitis causes around the world each year.How has this pandemic remained so hidden and ignored for so long? There are several factors that have kept hepatitis B off public health's global radar. It’s a complicated infection, those who have it have been silenced by shame and ignorance, and more than two-thirds of those infected with hepatitis B have never been tested and don’t know they have it. And then there’s avoidance by the global healthcare community. The development of a hepatitis B vaccine 40 years ago was thought to signal the death knell of this disease. While new infections have plummeted in North America and Europe, in impoverished countries, the vaccine is often not available and infected mothers continue to unknowingly infect their children at birth. There have been successful hepatitis B immunization campaigns around the world, even in poor, remote areas, but there’s a catch. The free hepatitis B pentavalent vaccine provided by the global Vaccine Alliance called GAVI is effective in children starting at age one month. To break the mother-to-child infection cycle, a different and more costly

    http://www.hepb.org/blog/one-in-three-people-worldwide-has-had-hepatitis-b-so-why-do-we-feel-so-alone/
  • Children Living with Hepatitis B

    Hepatitis B does not usually affect a child’s normal growth and development. Most children with chronic hepatitis B infections will enjoy long and healthy lives. Unlike other chronic medical conditions, there are generally no physical disabilities associated with hepatitis B, nor are there usually any physical restrictions for these children. As a parent, you can take comfort from the fact that every child presents unique challenges. Therefore, your child with hepatitis B is just like any other child. The challenges of raising a child with hepatitis B are manageable if you are well informed and use common sense. The Hepatitis B Foundation convened an Expert Pediatric Panel of nationally recognized pediatric liver specialists to create the first national recommendations for the screening, monitoring and treatment of children living with hepatitis B to ensure that they receive the best care possible. HBF's Pediatric HBV Screening and Monitoring Recommendations  (Published in Pediatrics Nov. 2009) HBF's Pediatric HBV Management and Treatment Recommendations  (Published in Hepatology Oct. 2010) PKIDs Hepatitis Report Parents of Kids with Infectious Diseases (PKIDs) is a national non-profit organization that supports families whose children have been affected by hepatitis B and C, HIV/AIDS and other infectious diseases. PKIDs published the first-ever comprehensive Pediatric Hepatitis Report to help parents, health care providers, school personnel, and public health officials understand the unique issues of children living with viral hepatitis, including hepatitis B and hepatitis C.   The 530 page report can be downloaded for free at www.pkids.org.  

    https://www.hepb.org/treatment-and-management/children-with-hepatitis-b/
  • Drug Watch

    This detailed page of information is made possible by the hard work and research performed by the Hepatitis B Foundation. Please help us continue to offer this kind of essential resource for the treatment of hepatitis B with a donation toward our important programs. Donate here. Compounds in Development for Chronic Hepatitis B Updated May 12, 2023   FAMILY/DRUG NAME     MECHANISM   COMPANY   WEBSITE USA STATUS Interferons: Mimic infection-fighting immune substances naturally produced in the body  Intron A (Interferon alfa 2b) Immunomodulator Merck, USA merck.com Approved 1991 Pegasys (Peginterferon alfa 2a) Immunomodulator Genentech, USA gene.com Approved 2005   Nucleos(t)ide Analogues: Interfere with viral DNA polymerase used for HBV replication Epivir (Lamivudine) *Generics available Inhibits viral DNA polymerase  GlaxoSmithKline (GSK) gsk.com Approved 1998 Hepsera (Adefovir dipivoxil) *Generics available Inhibits viral DNA polymerase  Gilead Sciences, USA gilead.com Approved 2002 Baraclude (Entecavir) *Generics available Inhibits viral DNA polymerase  Bristol-Myers Squibb, USA  bms.com Approved 2005  Tyzeka (Telbivudine) *Generics available Inhibits viral DNA polymerase   Novartis, USA  novartis.com Approved 2006  Viread (Tenofovir) *Generics available Inhibits viral DNA polymerase  Gilead Sciences  gilead.com Approved 2008  Vemlidy (TAF or tenofovir alfenamide) Prodrug of Tenofovir  Gilead Sciences  gilead.com  Approved 2016  Levovir (Cledvudine) Inhibits viral DNA polymerase  Bukwang, S. Korea  bukwang.co.kr  Approved 2006 in S. Korea  Besivo (formerly ANA 380/LB80380) Inhibits viral DNA polymerase  Ildong Pharma, S. Korea  ildong.com  Approved 2017 in S. Korea  Zadaxin Immunomodulator SciClone, USA  sciclone.com  Approved outside USA  ATI-2173 (Clevudine prodrug) Inhibits HBV polymerase  Antios Therapeutics, USA antiostherapeutics.com FDA Hold Direct Acting Antivirals: Targets the virus and interferes in the HBV replication process Silencing RNA’s (siRNAs): Interferes and destroys viral RNA VIR-2218 RNAi gene silencer  Vir Biotech, USA vir.bio Phase II Xalnesiran (RG6346, DCR HBVS) RNAi gene silencer Dicerna with Roche dicerna.com Phase II JNJ-3989  RNAi gene silencer J&J with Arrowhead, USA arrowheadpharma.com Phase II AB-729 RNAi gene silencer Arbutus Biopharma, USA arbutusbio.com Phase II ALG-125755 RNAi gene silencer Aligos Therapeutics, USA  aligos.com Phase I BB-103 RNAi gene silencer Benitec, Australia benitec.com   Preclinical Entry Inhibitors: Interferes with HBV getting into liver cells Bulevirtide (Hepcludex) Entry inhibitor Gilead, USA gilead.com Phase III A2342 Entry inhibitor Albireo, USA albireopharma.com Preclinical Capsid or Core Inhibitors: Interferes with the viral DNA protein shield JNJ 56136379 Capsid inhibitor Janssen, Ireland janssen.com Phase II Canocapavir (ZM-H1505R) Capsid inhibitor Zhimeng Biopharma, PR China core-biopharma.com Phase II EDP-514 Capsid inhibitor Enanta Pharma, USA enanta.com Phase I ALG-000184 Capsid inhibitor Aligos Therapeutics, USA aligos.com Phase I ABI-H4334 Capsid inhibitor Assembly Biosciences, USA assemblybio.com Phase I ATI-1428 Capsid inhibitor Antios Therapeutics, USA antiostherapeutics.com Preclinical HBsAg Inhibitors: Interferes with production of HBV surface antigen (sAg) REP 2139 sAg inhibitor Replicor, Canada replicor.com Phase II Antisense Molecules: Binds to the viral mRNA to prevent it from turning into viral protein Bepirovirsen  HBV Antisense  GSK, USA gsk.com Phase III Gene Editing: Intended to destroy or repress HBV DNA EBT107 CRISPR/Cas 9 Excision Bio, USA excisionbio.com Preclinical PBGENE-HBV ARCUS platform Precision Bio, USA  precisionbiosciences.com Preclinical Immunologicals: Targets the human immune system to attack the HBV virus Therapeutic Vaccine Technology used to stimulate the immune system as a treatment   HeberNasvac        Therapeutic vaccine               CIGB, Cuba Clinical trials in Cuba Phase IV  HepTcell Therapeutic vaccine Altimmune, USA altimmune.com Phase II VBI-2601 (BRII-179) Therapeutic vaccine VBI Vaccines, USA  vbivaccines.com Phase II VVX001 Therapeutic vaccine Viravaxx, Austria viravaxx.com Phase II GSK 3528869A Therapeutic vaccine GSK, USA gsk.com Phase II VTP-300 Therapeutic vaccine Vaccitech, UK vaccitech.co.uk Phase II CVI-HBV-002 Therapeutic vaccine Cha Vaccine Institute, S. Korea en.chavaccine.com Phase I/II JNJ 64300535 Therapeutic vaccine Ichor Medical with Janssen ichorms.com Phase I CARG-201 Therapeutic vaccine CaroGen, USA carogencorp.com Preclinical HB-400 Therapeutic vaccine HOOKIPA Pharma, Austria, with Gilead hookipapharma.com Phase I TherVacB Therapeutic vaccine Helmholtz Zentrum Muenchen, Germany thervacb.eu Preclinical PRGN-2013 Therapeutic vaccine Precigen precigen.com Preclinical ISA104 Therapeutic vaccine ISA Pharma, The Netherlands isa-pharma.com Preclinical VRON-0200 Therapeutic vaccine Viron Therapeutics, USA viriontx.com Preclinical  CLB-3000 Therapeutic vaccine Clear B Therapeutics, USA and Australia clearbtherapeutics.com Preclinical “Decoy 20” Therapeutic vaccine Indaptus Therapeutics, USA indaptusrx.com Preclinical Compounds that activate the innate immune system  Selgantolimod (GS9688) TLR-8 agonist Gilead Sciences, USA gilead.com Phase II Ruzotolimod (RG7854) TLR-7 agonist Roche, Switzerland roche.com Phase II CB06 TLR-8 agonist Zhimeng Biopharma, PR China core-biopharma.com  Phase I YS-HBV-002 Activator of TLR3, RIG1, MDA5 YiSheng Biopharma, China yishengbio.com Preclinical Monoclonal Antibodies: Neutralize or bind the HBV proteins to reduce infection VIR-3434 Monoclonal antibody Vir Biotech, USA vir.bio Phase II Burfiralimab (IgG4) Monoclonal antibody  ImmuneMed, South Korea  immunemed.co.kr/eng  Phase II BJT-778 Monoclonal antibody Blue Jay Therapeutics, USA  bluejaytx.com Phase I Checkpoint Inhibitors: Stimulate exhausted T-cell recognition of HBV-Infected cells    ASC22 (KN035 or Envafolimab) PDL1 inhibitor Ascletis Pharma, PR China ascletis.com Phase II RG6084 PDL1 inhibitor Roche roche.com Phase II AB-101 PDL1 inhibitor Arbutus arbutusbio.com FDA hold 4/25/23 Other Immunologicals   IMC-I109V T-cell Receptor Immunocore immunocore.com Phase I Additional HBV Drugs Under Investigation   GSK 4388067A Targeted immunotherapy GSK, USA gsk.com Phase II ASC42 FXR Agonist Ascletis, Hong Kong ascletis.com Phase II EYP001 FXR agonist Enyo Pharma, France enyopharma.com Phase II APG-1387 Apoptosis inducer Ascentage, PR China ascentagepharma.com Phase II GSK 3965193 PAPD5/PAPD7 inhibitor GSK, USA gsk.com Phase I AB-161 RNA Destabilizer Arbutus Arbutusbio.com Phase I DF-006 Small molecule Drug Farm, Shanghai drug-farm.com  Phase I AB359  CD8 IL-2 immunotherapy Asher Biotherapeutics, USA asherbio.com Preclinical BJT-628 Small molecule  Blue Jay Therapeutics, USA bluejaytx.com Preclinical Hepatitis Delta Virus (HDV)- A virus that co-infects people already infected with HBV Hepcludex (Bulevirtide formerly Myrcludex B) Entry inhibitor Gilead, USA gilead.com EU approved 2023 Phase III USA Lonafarnib Prenylation inhibitor Eiger Biopharma, USA eigerbio.com Orphan drug Phase III Pegylated interferon-lambda Immune modulator      Eiger Biopharma     eigerbio.com Phase III  REP 2139 HBsAg inhibitor Replicor, Canada replicor.com Phase II JNJ-3989 RNAi gene silencer Janssen janssen.com Phase II VIR-2218 + VIR 3434 RNAi gene silencer + Monoclonal antibody  Vir Biotech, USA vir bio Phase II BJT-778 Monoclonal antibody Blue Jay Therapeutics, USA Bluejaytx.com Phase I GI-18000 Immune Response Stimulator GlobeImmune, USA globeimmune.com Preclinical AB-543 Entry inhibitor Assembly Biosciences, USA assemblybio.com Preclinical If you are a person with hepatitis B who is looking for clinical trial or other research opportunities, please visit our patient and provider opportunities page here. 

    https://www.hepb.org/treatment-and-management/drug-watch-2/
  • The Public Health Popularity Contest: Why You've Never Heard of Hepatitis B

    Please welcome guest blogger Charlotte Lee, a pre-med Duke University Senior who has a passion for global health. Charlotte recently learned first hand how viral hepatitis  disproportionately impacts her community and how it tragically touched her own family.   I walked into the first day of my internship ready to take on what I thought were the major public health crises of the world – malaria, AIDS, avian flu. Instead, my supervisor gave me a hefty stack of literature on hepatitis B. Sure, as a premed student I knew that hepatitis had something to do with the liver, but I was shocked to find out that hepatitis B was the most common serious liver infection in the world—one that chronically affects over 350 million people worldwide, including 1 in 12 Asian Americans—and I had never heard of it. As a 21-year old Asian American who is passionate about global health, I felt cheated to only now discover that there is an infectious disease disproportionately affecting my community. Somebody should have told me about this! To then find out that it was completely vaccine-preventable – somebody should have told everyone about this! About halfway through my internship, I found out that my grandfather died from viral hepatitis that he contracted through a blood transfusion. Suddenly the disease had a face, and it was a smiling man with wide rimmed glasses who used to sit me on his lap and feed me popcorn. It now feels like my duty to spread the word. Hepatitis B is transmitted through blood or body fluids and causes deadly liver disease, including liver cancer, in 1 out of every 4 chronically infected people. Meanwhile, the famous West Nile Virus causes serious illness in less than 1% of infected people. So, what makes this disease so easy to ignore? Hepatitis B is unfortunately an invisible disease; it can take up to 20-30 years before symptoms appear, at which time cirrhosis or liver cancer may have already developed. Hepatitis B is a silent

    http://www.hepb.org/blog/why-youve-never-heard-of-hepatitis-b/
  • "التعايش مع التهاب الكبد "ب

    Will I recover from a hepatitis B infection? Most healthy adults who are newly infected will recover without any problems. But babies and young children may not be able to successfully get rid of the virus.  Adults – 90% of healthy adults will get rid of the virus and recover without any problems; 10% will develop chronic hepatitis B.  Young Children – Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection. Infants – 90% will become chronically infected; only 10% will be able to get rid of the virus.  What is the difference between an "acute" and a "chronic" hepatitis B infection? A hepatitis B infection is considered to be “acute” during the first 6 months after being exposed to the virus. This is the average amount of time it takes to recover from a hepatitis B infection.   If you still test positive for the hepatitis B virus (HBsAg+) after 6 months, you are considered to have a "chronic" hepatitis B infection, which can last a lifetime.  Will I become sick if I have acute hepatitis B? Hepatitis B is considered a "silent infection” because it often does not cause any symptoms. Most people feel healthy and do not know they have been infected, which means they can unknowingly pass the virus on to others. Other people may have mild symptoms such as fever, fatigue, joint or muscle pain, or loss of appetite that are mistaken for the flu.   Less common but more serious symptoms include severe nausea and vomiting, yellow eyes and skin (called “jaundice”), and a swollen stomach - these symptoms require immediate medical attention and a person may need to be hospitalized.   How will I know when I have recovered from an "acute" hepatitis B infection? Once your doctor has confirmed through a blood test that you have gotten rid of the virus from your body and developed the protective antibodies (HBsAb+), you will be protected from any future hepatitis B infection and are no longer contagious to others. What should I do if I am diagnosed with chronic hepatitis B? If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection. You should make an appointment with a hepatologist (liver specialist), gastroenterologist, or family doctor who is familiar with hepatitis B. The doctor will order blood tests and possibly a liver ultrasound to evaluate how active the hepatitis B virus is in your body, and to monitor the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment. All chronically infected people should be seen by their doctor at least once a year (or more frequently) for regular medical follow-up care, whether they start treatment or not. Even if the virus is in a less active phase with little or no damage occurring, this can change with time, which is why regular monitoring is so important.   Most people chronically infected with hepatitis B can expect to live long, healthy lives. Once you are diagnosed with chronic hepatitis B, the virus may stay in your blood and liver for a lifetime. It is important to know that you can pass the virus along to others, even if you don’t feel sick. This is why it’s so important that you make sure that all close household contacts and sex partners are vaccinated against hepatitis B.   What tests will be used to monitor my hepatitis B? Common tests used by doctors to monitor your hepatitis B include the hepatitis B blood panel, liver function tests (ALT, AST), hepatitis B e-Antigen (HBeAg), hepatitis B e-Antibody (HBeAb), hepatitis B DNA quantification (viral load), and an imaging study of the liver (ultrasound, FibroScan [Transient Elastography] or CT scan). Is there a cure for chronic hepatitis B? Right now, there is no cure for chronic hepatitis B, but the good news is there are treatments that can help slow the progression of liver disease in chronically infected persons by slowing down the virus. If there is less hepatitis B virus being produced, then there is less damage being done to the liver. Sometimes these drugs can even get rid of the virus, although this is not common.  With all of the new exciting research, there is great hope that a cure will be found for chronic hepatitis B in the near future. Visit our Drug Watch for a list of other promising drugs in development. Are there any approved drugs to treat chronic hepatitis B? Current treatments for hepatitis B fall into two general categories, antivirals and immune modulators:   Antiviral Drugs - These are drugs that slow down or stop the hepatitis B virus, which reduces the inflammation and damage to the liver. These are taken as a pill once a day for at least 1 year, usually longer. There are 6 U.S. FDA approved antivirals, but only three first-line antivirals are recommended treatments: tenofovir disoproxil (Viread/TDF), tenofovir alafenamide (Vemlidy/TAF) and Entecavir (Baraclude). First-line antivirals are recommended because they are safer and most effective. They also have a better resistance profile than older antivirals, which means that when they are taken as prescribed, there is less chance of mutation and resistance. Building resistance makes it harder to treat and control the virus. Immunomodulator Drugs - These are drugs that boost the immune system to help control the hepatitis B virus. They are given as injections over 6 months to 1 year. The most commonly prescribed include interferon alfa-2b (Intron A) and pegylated interferon (Pegasys). This is the only recommended treatment for patients coinfected with hepatitis delta.   Do these drugs provide a “cure” for chronic hepatitis B?
 Although they do not provide a complete cure, current medications will slow down the virus and decrease the risk of more serious liver disease later in life. This results in patients feeling better within a few months because liver damage from the virus is slowed down, or even reversed in some cases, when taken long-term. Antivirals are not meant to be stopped and started, which is why a thorough evaluation by a knowledgeable doctor is so important before beginning treatment for chronic HBV. If I have a chronic hepatitis B infection, should I be on medication? It is important to understand that not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy. Whether you and your doctor decide you should start treatment or not, you should be seen regularly by a liver specialist or a doctor knowledgeable about hepatitis B.  Is it safe to take herbal remedies or supplements for my hepatitis B infection? Many people are interested in using herbal remedies or supplements to boost their immune systems and help their livers. The problem is that there is no regulation of companies manufacturing these produces, which means there is no rigorous testing for safety or purity. So, the quality of the herbal remedy or vitamin supplement may be different from bottle to bottle. Also, some herbal remedies could interfere with your prescription drugs for hepatitis B or other conditions; some can even actually damage your liver. These herbal remedies will not cure a chronic hepatitis B infection.  There are many companies that make false promises on the Internet and through social media about their products. Online claims and patient testimonials on Facebook are fake and are used to trick people into buying expensive herbal remedies and supplements. Remember, if it sounds too good to be true, then it’s probably not true. Below are reliable sources of information about herbs and alternative medicines. This information is based on scientific evidence, not false promises. Check whether the active ingredients in your herbal remedies or supplements are real and safe for your liver. The most important thing is to protect your liver from any additional injury or harm.   What healthy liver tips are there for those living with chronic hepatitis B? People living with chronic hepatitis B infection may or may not need drug treatment. But there are many other things patients can do to protect their liver and improve their health. Below is our list of the top 10 healthy choices that can be started today! Schedule regular visits with your liver specialist or health care provider to stay on top of your health and the health of your liver. Get the Hepatitis A vaccine to protect yourself from another virus that attacks the liver. Avoid drinking alcohol and smoking since both will hurt your liver, which is already being injured by the hepatitis B virus. Talk to your provider before starting any herbal remedies or vitamin supplements because some could interfere with your prescribed hepatitis B drugs or even damage your liver. Check with your pharmacist about any over-the-counter drugs (e.g. acetaminophen, paracetamol) or non-hepatitis B prescription drugs before taking them to make sure they are safe for your liver since many of these drugs are processed through your liver.  Avoid inhaling fumes from paint, paint thinners, glue, household cleaning products, nail polish removers, and other potentially toxic chemicals that could damage your liver.   Eat a healthy diet of fruit, whole grains, fish and lean meats, and lot of vegetables. “Cruciferous vegetables” in particular -- cabbage, broccoli, cauliflower -- have been shown to help protect the liver against environmental chemicals.  Avoid eating raw or undercooked shellfish (e.g. clams, mussels, oysters, scallops) because they could be contaminated with bacteria called Vibrio vulnificus, which is very toxic to the liver and could cause a lot of damage. Check for signs of mold on nuts, maize, corn, groundnut, sorghum, and millet before using these foods. Mold is more likely to be a problem if food is stored in damp conditions and not properly sealed. If there is mold, then the food could be contaminated by “aflatoxins,” which are a known risk factor for liver cancer. Reduce your stress levels by eating healthy foods, exercising regularly, and getting plenty of rest.  Keep in mind everything you eat, drink, breathe, or absorb through the skin is eventually filtered by the liver. So, protect your liver and your health! Can I donate blood if I have hepatitis B?  No. The blood bank will not accept any blood that has been exposed to hepatitis B, even if you have recovered from an acute infection. هل سأتعافى من عدوى التهاب الكبد "ب"؟ يتعافى معظم البالغين المصابين حديثًا ممن يتمتعون بصحة جيدة دون حدوث أي مشكلات. ولكن قد لا يمكن للرضع والأطفال الصغار التعافي من الفيروس بنجاح.  البالغون – 90% من البالغين الذين يتمتعون بصحة جيدة يتعافون من الفيروس دون حدوث أي مشكلات؛ بينما يصاب 10% منهم بفيروس التهاب الكبد "ب" المزمن.  الأطفال الصغار – يصاب ما يصل إلى 50% من الأطفال الصغار الذين تتراوح أعمارهم بين سنة وخمس سنوات بعدوى التهاب الكبد "ب" المزمنة. الرضع – يُصاب 90% من الرضع بالعدوى المزمنة؛ بينما يتعافى 10% منهم فقط من الفيروس.  ما الفرق بين عدوى التهاب الكبد "ب" "الحادة" و"المزمنة"؟ تُعد عدوى التهاب الكبد "ب" "حادة" خلال الأشهر الستة الأولى بعد الإصابة بالفيروس. وهذا هو متوسط الفترة الزمنية المستغرقة للتعافي من عدوى التهاب الكبد "ب". وإذا كانت نتيجة اختبار فيروس التهاب الكبد "ب" لا تزال إيجابية بعد مرور 6 أشهر (+HBsAg)، فأنت مصاب بعدوى "مزمنة" لالتهاب الكبد "ب"، حيث قد تستمر مدى الحياة.  هل سأشعر بالتعب إذا كنت مصابًا بالتهاب الكبد "ب" الحاد؟ يعتبر فيروس التهاب الكبد "ب" "عدوى صامتة" لأنه غالبًا لا يتسبب في ظهور أي أعراض، إذ يشعر معظم الأشخاص أنهم بصحة جيدة ولا يعرفون أنهم مصابون، مما يعني إمكانية نقلهم للفيروس للآخرين دون علمهم. وقد يعاني آخرون من أعراض خفيفة مثل الحمى أو التعب أو آلام المفاصل أو العضلات أو فقدان الشهية، لذلك قد يحدث خلط بين هذه الأعراض وأعراض الإنفلونزا العادية. وتتضمن الأعراض الأقل شيوعًا ولكن الأكثر خطورة حالات شديدة من الغثيان والقيء واصفرار العين والجلد (يسمى "اليرقان") وانتفاخ المعدة - تتطلب هذه الأعراض عناية طبية فورية وقد يحتاج الشخص إلى دخول المستشفى.   كيف أعرف أنني قد تعافيت من عدوى التهاب الكبد "ب" "الحادة"؟ بمجرد أن يؤكد طبيبك من خلال اختبار الدم أنك قد تخلصت من الفيروس وأن جسمك قام بتطوير الأجسام المضادة الواقية (+HBsAb)، فأنت بذلك تكون محميًا من أي عدوى محتملة في المستقبل بالتهاب الكبد "ب" ولن تنقل العدوى للآخرين بعد ذلك. ماذا أفعل إذا تم تشخيصي بالتهاب الكبد "ب" المزمن؟ إذا كانت نتيجة اختبار التهاب الكبد "ب" إيجابية لمدة تزيد عن 6 أشهر، فهذا يدل على أنك مصاب بعدوى مزمنة بالتهاب الكبد "ب". ويتعين عليك تحديد موعد مع طبيب الكبد (أخصائي أمراض كبد)، أو أخصائي أمراض الجهاز الهضمي، أو طبيب العائلة المتخصص في أمراض فيروس التهاب الكبد "ب"، حيث سيطلب منك الطبيب اختبارات الدم وربما فحص بالموجات فوق الصوتية للكبد لتقييم مدى نشاط التهاب الكبد "ب" في جسمك، ولمتابعة الحالة الصحية للكبد. وقد يطلب الطبيب رؤيتك مرة أو مرتين سنويًا على الأقل لمتابعة حالة التهاب الكبد "ب" وتحديد مدى استفادتك من العلاج. ويجب أن يفحص الطبيب جميع الأشخاص المصابين بعدوى مزمنة مرة واحدة سنويًا على الأقل (أو بصورة متكررة) من أجل الحصول على رعاية طبية مناسبة ومتابعة منتظمة، سواء بدؤوا العلاج أم لا. وحتى إذا كان الفيروس في مرحلة أقل نشاطًا مع حدوث أضرار قليلة أو عدم حدوث أي أضرار، فيمكن أن يتغير ذلك بمرور الوقت، وهذا هو السبب وراء أهمية المتابعة المنتظمة.   ويمكن أن يتوقع معظم المصابين بعدوى مزمنة بالتهاب الكبد "ب" عيش حياة طويلة وحالة صحية مستقرة. بمجرد تشخيصك بالتهاب الكبد "ب" المزمن، قد يبقى الفيروس في دمك وكبدك مدى الحياة. ومن المهم معرفة أنه بإمكانك نقل الفيروس للآخرين، حتى ولو لم تشعر أنك مريض. ولهذا السبب فإنه من المهم للغاية التأكد من أن جميع الأشخاص الذين تتعامل معهم من الأسرة عن قرب والزوجة/الزوج قد أخذوا لقاحًا ضد التهاب الكبد "ب".   ما الاختبارات التي سأجريها لمتابعة حالتي بالإصابة بالتهاب الكبد "ب"؟ الاختبارات الشائعة التي يطلب الأطباء إجراءها لمتابعة حالة التهاب الكبد "ب" تتضمن فحوصات الدم الخاصة بالتهاب الكبد "ب"، واختبارات وظائف الكبد (تحليل ALT، وتحليل AST)، وفحص المستضد "e" لالتهاب الكبد "ب" (HBeAg)، والجسم المضاد "e" لالتهاب الكبد "ب" (HBeAb)، وقياس كمية الحمض النووي (DNA) لفيروس التهاب الكبد "ب" (الحِمل الفيروسي)، والأشعة التصويرية للكبد (باستخدام الموجات فوق الصوتية أو الفيبروسكان [التصوير الإلستوجرافي العابر] أو الأشعة المقطعية (CT)). هل يوجد علاج لالتهاب الكبد "ب" المزمن؟ لا يوجد علاج لفيروس التهاب الكبد "ب" المزمن في الوقت الراهن، ولكن الخبر السار هو أن هناك علاجات يمكن أن تساعد في إبطاء انتشار أمراض الكبد عند المصابين بالعدوى المزمنة من خلال إبطاء تكاثر الفيروس. إذا كان هناك انتشار أقل لفيروس التهاب الكبد "ب"، فسيقع ضرر أقل على الكبد. وفي بعض الأحيان، يمكن أن تساعد هذه الأدوية في التعافي من الفيروس، على الرغم من أن هذا الأمر ليس شائعًا.  وبوجود كل تلك الأبحاث الجديدة المثيرة للاهتمام، هناك أمل كبير في العثور على علاج لالتهاب الكبد "ب" المزمن في المستقبل القريب. يُرجى زيارة قسم Drug Watch (قائمة الأدوية الخاضعة للمراقبة) للاطلاع على قائمة بالأدوية الواعدة قيد التطوير. هل توجد أدوية معتمدة لعلاج التهاب الكبد "ب" المزمن؟ تنقسم العلاجات الحالية لالتهاب الكبد "ب" إلى فئتين عامتين، هما الأدوية المضادة للفيروسات ومُنظِّمات المناعة: الأدوية المضادة للفيروسات - هي الأدوية التي تعمل على إبطاء تكاثر فيروس التهاب الكبد "ب" أو إيقافه؛ مما يقلل التهاب الكبد وتضرره. وتؤخذ هذه الأدوية على هيئة حبة مرة واحدة في اليوم لمدة سنة على الأقل، وعادة ما تكون المدة أطول من ذلك. تتوفر 6 مضادات للفيروسات معتمدة من قِبل إدارة الغذاء والدواء الأمريكية (FDA)، ولكن يُنصح باستخدام ثلاثة فقط من الخيارات الأولى من مضادات الفيروسات: تينوفوفير ديسوبروكسيل (فيريد/TDF)، تينوفوفير ألفيناميد (فيمليدي/TAF)، إينتيكافير (باراكلود). يُوصى باستخدام الخيارات الأولى من مضادات الفيروسات لأنها أكثر أمانًا وفاعلية. كما أن لها خاصية مقاومة أفضل من الأدوية الأقدم المضادة للفيروسات؛ مما يعني أنه عند تناولها على النحو الموصوف، تكون هناك فرص أقل لحدوث طفرات ومقاومة. ومن المعروف أن مقاومة الجسم تزيد من صعوبة علاج الفيروس والسيطرة عليه. الأدوية المناعية - هي الأدوية التي تقوي جهاز المناعة حيث تساعد على السيطرة على فيروس التهاب الكبد "ب". ويتم تناولها على هيئة حقن على مدى يتراوح من 6 أشهر إلى سنة. تتضمن الأدوية التي غالبًا ما تُوصف للمرضى "إنترفيرون ألفا-2ب" (إنترون "أ") و"بيغ-إنترفيرون" (بيغاسيس). وهذا هو العلاج الوحيد الموصى به للمرضى المصابين بفيروس التهاب الكبد دلتا (المعروف أيضًا بالتهاب الكبد "د").   هل تعتبر هذه الأدوية بمثابة "علاج" لالتهاب الكبد "ب" المزمن؟ على الرغم من أن الأدوية الحالية لا تعتبر علاجًا كاملاً، إلا أنها تعمل على إبطاء تكاثر الفيروس وتقلل من خطر الإصابة بأمراض الكبد الأكثر خطورة في مرحلة لاحقة من الحياة. ويؤدي ذلك إلى شعور المرضى بالتحسن خلال بضعة أشهر بسبب تباطؤ تلف الكبد الناتج عن الفيروس، أو حتى بسبب عكس تأثيره في بعض الحالات، عند تناول الأدوية على المدى الطويل. ليس من المفترض أن يتم إيقاف مضادات الفيروسات وتناولها مرة أخرى، وهذا هو سبب الأهمية البالغة للخضوع إلى تقييم شامل على يد طبيب واسع الاطلاع قبل البدء في علاج فيروس التهاب الكبد "ب" (HBV) المزمن. إذا كنتُ مصابًا بعدوى التهاب الكبد "ب" المزمن، فهل يجب أن ألتزم بتناول دواء معين؟ من المهم أن تدرك أنه ليس كل مصاب بالتهاب الكبد "ب" المزمن يحتاج إلى تناول أدوية. لذا، يتعين عليك التحدث مع طبيبك عما إذا كانت حالتك تستدعي العلاج بالأدوية أم لا. وسواء قررت أنت وطبيبك أنه يجب عليك بدء العلاج أم لا، فيجب أن تتابع حالتك بانتظام مع طبيب متخصص أو طبيب مُطّلع على حالات الإصابة بفيروس التهاب الكبد "ب".  هل من الآمن تناول العلاجات العشبية أو المكملات الغذائية لعلاج التهاب الكبد "ب"؟ يرغب الكثيرون في استخدام العلاجات العشبية أو المكملات الغذائية في سبيل تقوية أجهزة المناعة الخاصة بهم وحماية الكبد. ولكن المشكلة تكمن في عدم وجود قواعد محددة تعتمد عليها الشركات التي تصنع هذه المنتجات؛ مما يعني عدم وجود اختبارات صارمة للسلامة أو النقاء. ولذلك، قد تختلف جودة العلاجات بالأعشاب أو المكملات الغذائية من شركة إلى أخرى. كما يمكن أن تتعارض بعض العلاجات العشبية مع الأدوية التي تتناولها لعلاج التهاب الكبد "ب" أو أي حالات أخرى؛ إذ يمكن لبعضها أن يؤدي إلى تلف الكبد. ولن تُداوي هذه العلاجات العشبية عدوى التهاب الكبد "ب" المزمنة.  وهناك الكثير من الشركات التي تقدم وعودًا كاذبة على الإنترنت وعبر وسائل التواصل الاجتماعي بشأن منتجاتها. وهناك ادعاءات تُنشر عبر الإنترنت وشهادات للمرضى على منصة فيسبوك مضللة وكاذبة، وتُستخدم لخداع الأشخاص لشراء العلاجات العشبية والمكملات باهظة الثمن. لذا، تذكر أن المنتجات التي يتم الحديث عن جودتها بشكل مبالغ فيه وبدرجة تفوق حد التصديق ليست فعالة كما يُقال. فيما يلي مصادر موثوقة للمعلومات المتعلقة بالأعشاب العلاجية والأدوية البديلة. وهذه المعلومات مبنية على أدلة علمية، وليست مجرد وعود كاذبة. تأكد أن المكونات الفعالة في العلاجات العشبية أو المكملات الغذائية حقيقية وآمنة على الكبد. أهم شيء هو حماية الكبد من أي إصابة أو ضرر إضافي. ما النصائح التي يمكن تقديمها للتمتع بكبد صحي بالنسبة للأشخاص الذين يعانون من فيروس التهاب الكبد "ب" المزمن؟ قد يحتاج الأشخاص المصابون بعدوى التهاب الكبد "ب" المزمن إلى علاج دوائي، وقد لا يحتاجون لذلك. ولكن هناك الكثير من الأمور الأخرى التي يمكن للمرضى فعلها لحماية كبدهم وتحسين مستوى صحتهم. فيما يلي قائمة بأفضل عشرة خيارات صحية يمكن أن تبدأ باتباعها اليوم! حدد مواعيد منتظمة لزيارة أخصائي الكبد أو مقدم الرعاية الصحية للحفاظ على صحتك وصحة الكبد "ب" بأفضل حالة ممكنة. تناول لقاح التهاب الكبد "أ" لحماية نفسك من أي فيروس آخر يمكن أن يهاجم الكبد. تجنب شرب الكحول والتدخين لأن كليهما سيتسببان في إلحاق الضرر بكبدك المصاب بالفعل بفيروس التهاب الكبد "ب". تحدث إلى طبيبك قبل البدء في تناول أي علاجات عشبية أو فيتامينات مكملة لأن بعضها يمكن أن يتعارض مع أدوية علاج فيروس التهاب الكبد "ب" الموصوفة طبيًا أو قد تتسبب حتى في إتلاف الكبد. استشر الصيدلي بشأن أي أدوية لا تستلزم وصفة طبية (مثل "أسيتامينوفين" و"باراسيتامول") أو الأدوية غير الموصوفة طبيًا لعلاج التهاب الكبد "ب" قبل تناولها للتأكد من أنها آمنة على الكبد، إذ إن العديد من هذه الأدوية تمر عبر الكبد.  تجنب استنشاق الأبخرة الناتجة عن الدهانات ومخففات الدهان والغراء ومنتجات التنظيف المنزلية ومزيلات طلاء الأظافر والمواد الكيميائية السامة الأخرى التي يمكن أن تتلف الكبد. اتّبع نظامًا غذائيًا صحيًا يعتمد على تناول الفواكه والحبوب الكاملة والأسماك واللحوم قليلة/منزوعة الدهون والكثير من الخضراوات. لقد ثبت أن "الخضراوات الكرنبية"، وبالتحديد الكرنب والبروكلي والقرنبيط، تساعد في حماية الكبد من المواد الكيميائية البيئية.  تجنب تناول الأطعمة البحرية الصدفية النيئة أو غير المطهوة جيدًا (مثل الجندوفلي وبلح البحر والمحار والإسكالوب) لأنها يمكن أن تكون ملوثة ببكتيريا تسمى فيبريو فولنفيكوس (الضمة الجارحة)، التي تُعد شديدة السمية على الكبد ويمكن أن ينتج عنها ضرر كبير. تحقق من علامات العفن على سطح المكسرات والذرة والحبوب والفول السوداني والذرة الرفيعة والذرة البيضاء قبل تناول أي من هذه الأطعمة. من المرجح أن يتسبب العفن في حدوث مشكلات في حالة تخزين الطعام في أجواء تتسم بالرطوبة وغير مُحكمة الغلق على النحو الصحيح. قد يعني وجود عفن أن الطعام يمكن أن يكون ملوثًا بمركبات "أفلاتوكسين"، التي تعتبر من عوامل الخطر المعروفة التي تسبب سرطان الكبد. خفّف من مستويات التوتر في حياتك من خلال تناول الأطعمة الصحية وممارسة الرياضة بصفة منتظمة والحصول على قسط كافٍ من الراحة.  ضع في اعتبارك أن كل ما تأكله أو تشربه أو تستنشقه أو تمتصه عبر الجلد يتم ترشيحه في النهاية عن طريق الكبد. لذا، يجب عليك حماية كبدك وصحتك! هل يمكنني التبرع بالدم إذا كنتُ مصابًا بالتهاب الكبد "ب"؟  لا، لن يقبل بنك الدم أي دم تعرض لفيروس التهاب الكبد "ب"، حتى إذا كنت قد تعافيت من الإصابة بعدوى حادة

    https://www.hepb.org/languages/arabic/page-595/

  • Pagbubuntis & Hepatitis B  Dapat ba akong magpasuri para sa hepatitis B kung ako ay buntis?Oo, LAHAT ng buntis na babae ay dapat masuri para sa hepatitis B! Kung ikaw ay buntis, siguruhing magpasuri sa iyong doktor para sa hepatitis B bago ipanganak ang iyong sanggol. Bakit napakahalaga ng mga pagsusuring ito para sa mga buntis na babae?Kung ikaw ay nasuri na positibo sa hepatitis B at nagbubuntis, ang virus ay maaaring maipasa sa iyong bagong panganak na sanggol sa panahon ng iyong pagbubuntis at sa panganganak. Kung alam ng iyong doktor na ikaw ay may hepatitis B, makapaghahanda sya ng angkop na medikasyon sa silid ng panganganak upang maiwasang mahawa ang iyong sanggol. Kung ang mga angkop na pamamaraan ay hindi nasunod, ang iyong sanggol ay may 95% pagkakataon na magkaroon ng talamak na hepatitis B! Maaapektuhan ba ng hepatitis B ang aking pagbubuntis?Ang hepatitis B na impeksyon ay dapat hindi magsanhi ng anumang mga problema para sa iyo o sa iyong hindi pa ipinapanganak na sanggol sa panahon ng iyong pagbubuntis. Mahalagang malaman ng iyong doktor ang iyong hepatitis B na impeksyon upang masubaybayan niya ang iyong kalusugan at maprotektahan ang iyong sanggol mula sa impeksyon matapos siyang maipanganak. Kung buntis ako at may hepatitis B, paano ko mapoprotektahan ang aking sanggol? Kung nasuri kang positibo sa hepatitis B, dapat ka ring ipasuri ng iyong doktor para sa hepatitis B e-antigen (HBeAg), at kung positibo, dapat ka ring sumailalim sa pagsusuri sa dami ng hepatitis B na virus sa dugo (HBV DNA quantification). Sa ilang mga kaso, maaaring magpakita ng napakataas na dami ng virus ang mga resulta ng pagsusuri sa laboratoryo. Sa mga kasong ito, maaaring irekomenda ng iyong doktor na uminom ka ng gamot na panlaban sa virus sa huling tatlong buwan ng pagbubuntis, kung kailan ligtas na uminom upang mabawasan ang panganib ng paghawa sa iyong bagong silang pagkapanganak. Kung nasuri kang positibo sa hepatitis B, ang iyong bagong silang ay dapat bigyan kaagad ng dalawang dosis sa silid ng panganganak: Unang dosis ng bakuna sa hepatitis B  Isang dosis ng hepatitis B immune globulin (HBIG) Kung ang dalawang medikasyon na ito ay ibinigay nang wasto sa loob ng unang 12 oras ng buhay, ang bagong silang ay may higit sa 90% pagkakataon na maging protektado laban sa pang-habang buhay na hepatitis B na impeksyon. Dapat mong siguruhin na matanggap ng iyong sanggol ang natitirang 2-3 dosis ng bakuna sa hepatitis B ayon sa iskedyul. Lahat ng dosis ay dapat kumpleto upang ang iyong sanggol ay ganap na protektado laban sa hepatitis B. Mahalaga rin na ang sanggol na ipinanganak ng inang positibo sa HBV ay tumanggap ng pagsusuri sa dugo pagkatapos ng pagbabakuna sa 9-12 buwan upang kumpirmahin na ang sanggol ay protektado laban sa HBV at hindi nahawa. Kabilang sa mga pagsusuri ang HBsAg at anti-HBs titer na pagsusuri. Walang pangalawang pagkakataon upang protektahan ang iyong bagong silang na sanggol!Pagbabakuna sa labas ng Estados UnidosSa maraming mga bansa, ang bakunang limahan (pentavalent), isang kombinasyon ng 5-sa-isa na bakuna na nagpoprotekta laban sa limang sakit (diphtheria, pertussis, tetanus, Hib at hepatitis B) ay maaaring ibigay sa mga sanggol na higit sa 6 linggong gulang, at maaaring ibigay ng hanggang 1 taong gulang. Ang unang dosis ay ibinibigay sa 6 linggo, at ang pangalawa at ikatlong mga dosis ay ibinibigay sa edad 10 at 14 linggo. Ang limahang bakuna ay maaaring makuha nang walang bayad sa pamamagitan ng suporta ng Gavi, ang Vaccine Alliance. Tingnan ang sentro ng Gavi sa bansa upang makita ang mga mapagkukunan at imunisasyon na maaaring makuha: http://www.gavi.org/country/  Para sa mga sanggol na ipinanganak ng mga inang may hepatitis B, ang paghihintay para sa unang dosis ng limahang bakuna ay huli na at HINDI na poprotekta sa sanggol mula sa pagkahawa sa pagpanganak o sa loob ng unang anim na linggo ng buhay. Ang babaeng positibo sa hepatitis B ay malamang na maipasa ang virus sa kanyang sanggol, na talamak na ang maiipasa. Inirerekomenda ng WHO ang bakuna sa hepatitis B sa loob ng 24 oras pagkapanganak para sa LAHAT ng mga sanggol. Magplano nang maaga at magtanong tungkol sa pagkakaroon at gastos ng isahan (monovalent) na dosis ng bakuna pagkapanganak, dahil hindi ito ibinibigay sa imunisasyon ng Gavi. Partikular na mahalaga ito sa mga babaeng positibo sa hepatitis B. Kung hindi ka sigurado sa katayuan ng iyong hepatitis B, mangyaring siguruhing magpasuri para sa hepatitis B sa iyong doktor! Para sa mga sanggol na HINDI tumanggap ng limahang bakuna, ang unang dosis ng isahan na bakuna ng HBV ay dapat ibigay sa loob ng 12 oras ng pagkapanganak, na sinundan ng natitirang 2-3 dosis ng bakuna sa hepatitis B ayon sa iskedyul. Para sa mga sanggol na tumanggap ng limahang bakuna, ang unang isahang dosis ng hepatitis B na bakuna ay binibigay sa loob ng 12 oras ng pagkapanganak, at ang pangalawa at pangatlong mga dosis ng HBV na bakuna ay kasama sa dosis 1 at dosis 2 ng limahang bakuna. *Tandaan: Inirerekomenda ng CDC ang parehong unang dosis ng HBV na bakuna at HBIG sa loob ng 12 oras ng panganganak. Ang HBIG ay maaaring hindi makukuha sa lahat ng mga bansa. Kailangan ko ba ng paggamot sa panahon ng aking pagbubuntis?Ang hepatitis B na impeksyon ay dapat hindi magsanhi ng anumang mga problema para sa iyo o sa iyong hindi pa ipinapanganak na sanggol sa panahon ng iyong pagbubuntis. Mahalagang malaman ng iyong doktor ang iyong hepatitis B na impeksyon upang masubaybayan niya ang iyong kalusugan at maprotektahan ang iyong sanggol mula sa impeksyon matapos siyang maipanganak. Kung nakatira ka sa labas ng U.S. at hindi sigurado sa katayuan ng iyong hepatitis B, mangyaring magpasuri sa iyong doktor para sa hepatitis B. Ang kabiguan ng dosis ng bakuna sa HBV pagkapanganak at HBIG ay maaaring mangyari sa mga babaeng positibo sa HbeAg at mayroong napakataas na dami ng virus, na nagdulot ng pagpasa ng hepatitis B sa iyong sanggol. Lahat ng mga babaeng nasuri na may hepatitis B sa pagbubuntis ay dapat isangguni para sa kasunod na pangangalaga sa doktor na may kasanayan sa pangangasiwa ng hepatitis B na impeksyon. Dapat isasagawa ng iyong doktor ang karagdagang mga pagsusuri sa laboratoryo, kabilang ang hepatitis B e-antigen, antas ng DNA ng HBV DNA, at mga pagsusuri sa paggana ng atay (ALT). Ang antas ng virus na higit sa 200,000 IU/mL o 1 million cp/ml ay nagpapahiwatig ng antas kung saan ang kombinasyong dosis ng bakuna pagkapanganak at HBIG ay nabigo. Ang terapiya na unang-linya na panlaban sa virus gamit ang tenofovir ay maaaring irekomenda upang mapababa ang dami ng virus bago manganak. Ang Tenofovir ay nakikitang ligtas sa parehong panahon ng pagbubuntis at para sa nagpapasusong mga ina. Sa mga kaso kung saan ang tenofovir ay hindi epektibo, ang mga doktor ay maaaring magreseta ng telbivudine o lamivudine. Ang paggamot na panlaban sa virus ay magsisimula sa 28-32 linggo at magpapatuloy nang 3 buwan pagkapanganak. Kailangan ko ba ng panggamot pagkatapos ng aking pagbubuntis? Kung ikaw ay niresetahan ng mga panlaban sa virus sa panahon ng pagbubuntis, dapat subaybayan ang iyong ALT (SGPT) bawat 3 buwan nang 6 na buwan. Matutulungan nitong tukuyin kung dapat bang ipatuloy ang paggamot na panlaban sa virus. Mangyaring huwag itigil ang iyong medikayson na panlaban sa virus maliban kung sasabihin ng iyong doktor, batay sa mga resulta ng pagsusuri. Para sa karamihan ng mga babaeng ang kasunod na pagsusuri ay nagpapakita ng walang palatandaan ng aktibong sakit, irerekomenda ng doktor ang regular na pagsubaybay sa isang espesyalista sa atay. Sa lahat ng kaso, napakahalaga na alam ng iyong obstetrisyan at pedyatrisyan ng iyong bagong silang ang katayuan ng iyong hepatitis B upang masiguro na matanggap ng iyong bagong silang ang wastong mga bakuna pagkapanganak upang maiwasan ang pang-habang buhay na hepatitis B na impeksyon, at upang matanggap mo ang naaangkop na kasunod na pangangalaga. Maaari ba akong magpasuso sa aking sanggol kung ako ay may hepatitis B?Nalalamangan ng pakinabang ng pagpapasuso ang potensyal na panganib ng impeksyon, na napakaliit. Dagdag pa, dahil inirerekomenda na lahat ng mga sanggol ay bakunahan laban sa hepatitis B pagkapanganak, anumang potensyal na panganib ay lalong pinababa. Mayroong datos na nagpapakita na ang tenofovir, na maaaring ireseta upang pangasiwaan ang hepatitis B, ay ligtas para sa nagpapasusong mga babae. Pregnancy and Hepatitis B  Should I be tested for hepatitis B if I am pregnant?Yes, ALL pregnant women should be tested for hepatitis B! If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born. Why are these tests so important for pregnant women?If you test positive for hepatitis B and are pregnant, the virus can be passed on to your newborn baby during your pregnancy or during delivery. If your doctor is aware that you have hepatitis B, he or she can make arrangements to have the proper medications in the delivery room to prevent your baby from being infected. If the proper procedures are not followed, your baby has a 95% chance of developing chronic hepatitis B! Will a hepatitis B infection affect my pregnancy?A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born. If I am pregnant and have hepatitis B, how can I protect my baby?If you test positive for hepatitis B, your doctor should also test you for the hepatitis B e-antigen (HBeAg), and if positive, you should have a hepatitis B viral load blood test (HBV DNA quantification). In some cases, the laboratory test results may show a very high viral load. In these cases, your physician may recommend that you take an oral antiviral drug in the third trimester, which is safe to take to reduce the risk of infecting your newborn at birth. If you test positive for hepatitis B, then your newborn must be given two shots immediately in the delivery room: First dose of the hepatitis B vaccine One dose of hepatitis B immune globulin (HBIG) If these two medications are given correctly within the first 12 hours of life, a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection. You must make sure your baby receives the remaining 2-3 doses of the hepatitis B vaccine according to schedule. All doses must be completed in order for your infant to be fully protected against hepatitis B. It is also important that a baby born to an HBV-positive mother receive post-vaccination serologic testing at 9-12 months to confirm the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer test. There is no second chance to protect your newborn baby! Vaccination Outside the United StatesIn many countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases (diphtheria, pertussis, tetanus, Hib and hepatitis B) may be given to babies more than 6 weeks of age and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of Gavi, the Vaccine Alliance. Check the Gavi country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/. For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from becoming infected during birth or within the first six weeks of life. A woman who is hepatitis B positive is likely to pass the virus on to her baby, who will then be chronically infected. WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a Gavi provided immunization. This is particularly important to women who are positive for hepatitis B. If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B! For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, HBV vaccine must be given within 12 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule. For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 12 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine. *Note: CDC recommends both the first shot of the HBV vaccine and HBIG within 12 hours of birth. HBIG may not be available in all countries. Do I need treatment during my pregnancy?A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born. If you live outside of the U.S. and are unsure of your hepatitis B status, please ask your doctor to test you for hepatitis B. Failure of the birth dose of the HBV vaccine and HBIG may occur in women who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby.All women who are diagnosed with hepatitis B in pregnancy should be referred for follow up care with a physician skilled at managing hepatitis B infection. Your physician should perform additional laboratory testing, including hepatitis B e-antigen, HBV DNA level, and liver function tests (ALT). A virus level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the vaccine and HBIG may fail. First-line, antiviral therapy with tenofovir may be recommended to reduce the viral load prior to birth. Tenofovir has been shown to be safe both during pregnancy and for breastfeeding mothers. In cases where tenofovir is not effective, doctors may prescribe telbivudine or lamivudine. Antiviral treatment begins at 28-32 weeks and continues 3 months postpartum. Do I need treatment after my pregnancy? If you are prescribed antivirals during pregnancy, you should have your ALT (SGPT) monitored every 3 months for 6 months. This will help determine if you should continue antiviral treatment. Please do not discontinue your antiviral medication unless the doctor advises you to, based upon test results. For most women whose follow up testing shows no signs of active disease, your physician will recommend regular monitoring with a liver specialist. In all cases, it is very important that your obstetrician 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. Can I breastfeed my baby if I have hepatitis B?The benefits of breastfeeding outweigh the potential risk of infection, which is minimal. In addition, since it is recommended that all infants be vaccinated against hepatitis B at birth, any potential risk is further reduced. There is data that shows that tenofovir, which may be prescribed to manage hepatitis B, is safe for breastfeeding women.

    https://www.hepb.org/languages/tagalog/pregnancy/
  • Raising awareness and Enabling Protective Action in an Affected Community in Australia: A work in progress...

    Welcome Guest Blogger Yvonne Drazic. She is a PhD candidate at James Cook University in Cairns, Far North Queensland, Australia. Her research focus is on reducing the rate of undiagnosed and untreated chronic hepatitis B, in migrant communities from endemic areas, particularly the local Hmong community. Yvonne lives with chronic hepatitis B, and feels privileged to be one of the less than 3% of hepatitis B cases treated in Australia. She gives back in so many ways, and is also a list parent on the HB-List, an online patient forum.  As a research student from tropical Far North Queensland in Australia, I am grateful that today’s technology allows me to be part of the global hepatitis B community. My goal is to help our local Hmong community of about 700 people to prevent future repercussions of undetected and untreated chronic hepatitis B (CHB). Having CHB myself, I was amazed to learn how many people miss out on vital medical care because they are unaware of their infection, or of its potential consequences. At present, the incidence of hepatitis B-related liver cancer is rising in Australia because undiagnosed CHB is doing much more harm than newly acquired infections in adults. The majority of affected people in Australia are migrants from endemic areas and Aboriginal and Torres Straits Islander people who were mostly infected at birth or in early childhood. Yet, less than 3% of cases are currently receiving antiviral therapy (Carville & Cowie, 2012). I chose to focus on the Hmong community because studies in the U.S. show a particularly high CHB prevalence (~15%) in this population (Kowdley, Wang, Welch, Roberts, & Brosgart, 2011). And sure enough, when talking to members of the community, I heard sad stories of family members getting sick or dying from liver disease. Hepatitis B as a threat to public health has long been neglected in Australia, compared to the attention given to HIV and hepatitis C. However, based on a National Hepatitis B Needs

    http://www.hepb.org/blog/raising-awareness-and-enabling-protective-action-in-an-affected-community-in-australia-a-work-in-progress/
  • El embarazo y la hepatitis B

    ¿Debería hacerme pruebas para diagnosticar hepatitis B si estoy embarazada? Sí; ¡TODAS las mujeres embarazadas deberían hacerse pruebas para diagnosticar hepatitis B! Si está embarazada, asegúrese de que su médico le haga las pruebas para diagnosticar hepatitis B antes de que nazca su bebé. ¿Por qué son tan importantes estas pruebas para la mujer embarazada? Si su prueba resulta positiva para hepatitis B y está embarazada, el virus se puede transmitir a su bebé recién nacido durante el embarazo o el parto. Si su médico sabe que usted tiene hepatitis B, puede hacer los arreglos para tener los medicamentos adecuados en la sala de parto para prevenir que su bebé se infecte. Si no se siguen los procedimientos adecuados, ¡su bebé tiene un 95% de probabilidad de desarrollar hepatitis B crónica! ¿Una infección por hepatitis B afectará mi embarazo? Una infección por hepatitis B no debería producirles ningún problema ni a usted ni a su bebé no nacido durante el embarazo. Es importante que su médico sepa de su infección por hepatitis B, de modo que pueda supervisar su salud y proteger a su bebé de una infección después de que nazca. Si estoy embarazada y tengo hepatitis B, ¿cómo puedo proteger a mi bebé? Si su prueba resulta positiva para hepatitis B, su médico también debería hacerle la prueba para el antígeno e de hepatitis B (HBeAg) y si resultara positiva, debería hacerse una prueba de carga viral de hepatitis B en sangre (cuantificación del ADN del VHB). En algunos casos, los resultados de las pruebas de laboratorio pueden expresar una carga viral muy elevada. En esos casos, es posible que su médico le recomiende tomar un medicamento antiviral oral en el tercer trimestre, el cual es seguro de tomar para disminuir el riesgo de infectar a su recién nacido al nacer.  Si su prueba es positiva para hepatitis B, su recién nacido debe recibir dos inyecciones de inmediato en la sala de parto: Primera dosis de la vacuna contra la hepatitis B Una dosis de inmunoglobulina contra la hepatitis B (Hepatitis B Immune Globulin, HBIG) Si esos dos medicamentos se administran correctamente en las primeras 12 horas de vida, un recién nacido tiene más del 90% de probabilidad de estar protegido contra una infección por hepatitis B para toda la vida. Asegúrese de que su bebé reciba las restantes dosis 2 y 3 de la vacuna contra la hepatitis B según el esquema. Todas las dosis se deben completar para que su bebé esté completamente protegido contra la hepatitis B. También es importante que a un bebé nacido de una madre positiva para el VHB se le realicen las pruebas serológicas posteriores a la vacunación, a los 9 o 12 meses, para confirmar que el bebé está protegido contra el VHB y que no está infectado. Las pruebas incluyen los títulos de HBsAg y anti-HBs. ¡No hay segundas oportunidades para proteger a su bebé recién nacido! Vacunación fuera de los Estados Unidos En muchos países, la vacuna pentavalente, una combinación de 5 vacunas en 1, que protege contra cinco enfermedades (difteria, tos ferina, tétanos, Haemophilus influenza tipo B [Hib] y hepatitis B) se puede administrar a los bebés de más de 6 semanas de edad y hasta el año de edad. La primera dosis se administra a las 6 semanas de edad y la segunda y tercera dosis se administran a las 10 y 14 semanas de edad. La vacuna pentavalente puede estar disponible gratuitamente con el apoyo de Gavi, la Alianza para las Vacunas.Revise el centro de países de Gavi para ver los recursos e inmunizaciones disponibles: http://www.gavi.org/country/. En bebés nacidos de madres con hepatitis B, esperar por la primera dosis de la vacuna pentavalente es mucho tiempo y NO lo protegerá de infectarse durante el nacimiento ni en las primeras seis semanas de vida. Una mujer positiva para hepatitis B probablemente le transmita el virus a su bebé, quien entonces tendrá una infección crónica. La OMS recomienda la vacuna contra la hepatitis B en un plazo de 24 horas de nacido para TODOS los bebés. Planifique con antelación y pregunte sobre la disponibilidad y costos de la primera dosis monovalente (única) de la vacuna, ya que no es una vacuna que la proporciona Gavi. Esto es particularmente importante para las mujeres positivas para hepatitis B.  Si no está segura del estado de su hepatitis B, ¡por favor asegúrese de que su médico le haga las pruebas para diagnosticar la hepatitis B! Para los bebés que NO reciben la vacuna pentavalente, la primera dosis de la monovalente, la vacuna contra el VHB se debe administrar en un plazo de 12 horas de nacido, seguida de las restantes 2.ª y 3.ª dosis de la vacuna contra la hepatitis B según el esquema. Para los bebés que reciben la vacuna pentavalente, la primera dosis de vacuna contra la hepatitis B monovalente se administra en un plazo de 12 horas de nacido, y la segunda y tercera dosis de la vacuna contra el VHB se incluirán en las dosis 1.ª y 2.ª de la vacuna pentavalente. *Nota: Los CDC recomiendan tanto la primera inyección de la vacuna contra el VHB y de HBIG en un plazo de 12 horas de nacido. Es posible que la HBIG no esté disponible en todos los países. ¿Necesito tratamiento durante mi embarazo? Una infección por hepatitis B no debería producirles ningún problema ni a usted ni a su bebé no nacido durante el embarazo. Es importante que su médico sepa de su infección por hepatitis B, de modo que pueda supervisar su salud y proteger a su bebé de una infección después de que nazca. Si vive fuera de los EE. UU. y no está segura del estado de su hepatitis B, pídale a su médico que le haga pruebas para diagnosticar la hepatitis B. El fracaso de la dosis de nacimiento de la vacuna contra el VHB y de la HBIG puede presentarse en mujeres que son positivas para HBeAg y tienen una carga viral muy elevada, lo que permite la transmisión de la hepatitis B a su bebé. A todas las mujeres a quienes se les diagnostique hepatitis B durante el embarazo se les debe remitir a atención de seguimiento con un médico calificado en el manejo de la infección por hepatitis B. Su médico le debería realizar pruebas de laboratorio adicionales que incluyen antígeno e para hepatitis B, nivel de ADN del VHB y pruebas de función hepática (ALT). Un nivel de virus mayor a 200,000 UI/ml o 1 millón de copias/ml indica un nivel donde la combinación de la dosis de nacimiento de la vacuna contra el VHB y de la HBIG puede fracasar. Se puede recomendar la terapia antiviral de primera línea con tenofovir para disminuir la carga viral antes del nacimiento. El tenofovir ha demostrado ser seguro tanto durante el embarazo como en la lactancia. En casos en los que el tenofovir no es eficaz, los médicos pueden recetar telbivudine o lamivudine. El tratamiento antiviral se inicia a las 28 o 32 semanas y continúa 3 meses después del parto.  ¿Necesito tratamiento después de mi embarazo? Si se le recetaron antivirales durante el embarazo, se le debe supervisar la ALT (Transaminasa pirúvica-glutámica sérica [Serum glutamic pyruvic transaminase, SGPT]) cada 3 meses durante 6 meses. Esto ayudará a determinar si debería continuar el tratamiento antiviral. Por favor no descontinúe su medicamento antiviral, a menos que el médico lo indique, con base en los resultados de las pruebas. Para la mayoría de las mujeres cuyas pruebas de seguimiento no muestran signos de enfermedad activa, el médico recomendará supervisión regular con un especialista en hígado.  En todos los casos, es muy importante que su obstetra y el pediatra de su recién nacido tengan conocimiento del estado de su hepatitis B para garantizar que su recién nacido reciba las vacunas adecuadas al nacer para prevenir la infección por hepatitis B para toda la vida y que usted reciba la atención de seguimiento adecuada.  ¿Puedo amamantar a mi bebé si tengo hepatitis B? Los beneficios de la lactancia superan el riesgo potencial de infección, el cual es mínimo. Además, como se recomienda que todos los bebés sean vacunados contra la hepatitis B al nacer, cualquier riesgo potencial se reduce aún más. Existen datos que demuestran que el tenofovir, que se puede prescribir para controlar la hepatitis B, es seguro para las mujeres que amamantan. Pregnancy & Hepatitis B  Should I be tested for hepatitis B if I am pregnant? Yes, ALL pregnant women should be tested for hepatitis B! If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born. Why are these tests so important for pregnant women? If you test positive for hepatitis B and are pregnant, the virus can be passed on to your newborn baby during your pregnancy or during delivery. If your doctor is aware that you have hepatitis B, he or she can make arrangements to have the proper medications in the delivery room to prevent your baby from being infected. If the proper procedures are not followed, your baby has a 95% chance of developing chronic hepatitis B! Will a hepatitis B infection affect my pregnancy? A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born. If I am pregnant and have hepatitis B, how can I protect my baby? If you test positive for hepatitis B, your doctor should also test you for the hepatitis B e-antigen (HBeAg), and if positive, you should have a hepatitis B viral load blood test (HBV DNA quantification). In some cases, the laboratory test results may show a very high viral load. In these cases, your physician may recommend that you take an oral antiviral drug in the third trimester, which is safe to take to reduce the risk of infecting your newborn at birth.  If you test positive for hepatitis B, then your newborn must be given two shots immediately in the delivery room: First dose of the hepatitis B vaccine One dose of hepatitis B immune globulin (HBIG) If these two medications are given correctly within the first 12 hours of life, a newborn has more than a 90% chance of being protected against a lifelong hepatitis B infection. You must make sure your baby receives the remaining 2-3 doses of the hepatitis B vaccine according to schedule. All doses must be completed in order for your infant to be fully protected against hepatitis B. It is also important that a baby born to an HBV-positive mother receive post-vaccination serologic testing at 9-12 months to confirm the baby is protected against HBV and is not infected. Tests include the HBsAg and anti-HBs titer test. There is no second chance to protect your newborn baby! Vaccination Outside the United States In many countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases (diphtheria, pertussis, tetanus, Hib and hepatitis B) may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of Gavi, the Vaccine Alliance. Check the Gavi country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/. For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from becoming infected during birth or within the first six weeks of life. A woman who is hepatitis B positive is likely to pass the virus on to her baby, who will then be chronically infected. WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a Gavi provided immunization. This is particularly important to women who are positive for hepatitis B. If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B! For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, HBV vaccine must be given within 12 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule. For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 12 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine. *Note: CDC recommends both the first shot of the HBV vaccine and HBIG within 12 hours of birth. HBIG may not be available in all countries. Do I need treatment during my pregnancy? A hepatitis B infection should not cause any problems for you or your unborn baby during your pregnancy. It is important for your doctor to be aware of your hepatitis B infection so that he or she can monitor your health and so your baby can be protected from an infection after it is born. If you live outside of the U.S. and are unsure of your hepatitis B status, please ask your doctor to test you for hepatitis B. Failure of the birth dose of the HBV vaccine and HBIG may occur in women who are HBeAg positive and have a very high viral load, allowing for the transmission of hepatitis B to your baby. All women who are diagnosed with hepatitis B in pregnancy should be referred for follow up care with a physician skilled at managing hepatitis B infection. Your physician should perform additional laboratory testing, including hepatitis B e-antigen, HBV DNA level, and liver function tests (ALT). A virus level greater than 200,000 IU/mL or 1 million cp/ml indicates a level where the combination of the birth dose of the vaccine and HBIG may fail. First-line, antiviral therapy with tenofovir may be recommended to reduce the viral load prior to birth. Tenofovir has been shown to be safe both during pregnancy and for breastfeeding mothers. In cases where tenofovir is not effective, doctors may prescribe telbivudine or lamivudine. Antiviral treatment begins at 28-32 weeks and continues 3 months postpartum. Do I need treatment after my pregnancy? If you are prescribed antivirals during pregnancy, you should have your ALT (SGPT) monitored every 3 months for 6 months. This will help determine if you should continue antiviral treatment. Please do not discontinue your antiviral medication unless the doctor advises you to, based upon test results. For most women whose follow up testing shows no signs of active disease, your physician will recommend regular monitoring with a liver specialist.  In all cases, it is very important that your obstetrician 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.  Can I breastfeed my baby if I have hepatitis B? The benefits of breastfeeding outweigh the potential risk of infection, which is minimal. In addition, since it is recommended that all infants be vaccinated against hepatitis B at birth, any potential risk is further reduced. There is data that shows that tenofovir, which may be prescribed to manage hepatitis B, is safe for breastfeeding women.

    https://www.hepb.org/languages/spanish/pregnancy/
  • A Brave Hepatitis B Activist in China

    I have been active in the HBV community for over twelve years, and during this time and I have been fortunate to make the acquaintance of some wonderful people, many who I consider good friends.  The story below was relayed to me by a friend, though it’s possible you may have seen it in the Chinese news. This is a story about a very brave, Chinese girl with hepatitis B.  She studied in Japan, got her Masters, and married a PhD from China. Last year, she took all her savings, about 10,000 Yuan, with the blessing of her husband who was finishing his thesis in Japan, and went back to China. For the next twelve months, she traveled to major cities in China, all by herself. At each stop, she held up a placard with a sign inviting passersby to have dinner with her, a person with hepatitis B, and that she would pay for the dinners - You eat, I pay. Of course, she repeated her story to the media to emphasize that it is safe to eat with a person that has HBV. A few nights ago, she appeared on CCTV, with another young hero, and they demonstrated how shaking hands with a person with HBV will not pass on the virus.  There was instant testing of the cloths wiping the hands of the infected women. Of course, they tested their saliva too, since Chinese people use chopsticks, and pick food from common plates. All this was presented in front of a live audience, and millions of viewers at home. It brought tears to my eyes. The original graduate from Japan has stopped touring and is now making a documentary. Her husband left Japan on a boat to return to China, the day before the earthquake struck.  He is now home with his wife. However the baton is taken up by another young Chinese lady, with the support of the other activist, and the tour is on again. The actions taken by these young, Chinese activists are inspiring, and are true acts of bravery - especially in a country like China, where HBV discrimination is rampant.  Perhaps we are not all comfortable going public

    http://www.hepb.org/blog/a-brave-hepatitis-b-activist-in-china/