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• It’s Hepatitis Awareness Month: Five Reasons We Don’t Get Tested, and How to Overcome Them

  Members of Drexel University's Asian Pacific American Medical Student Association participate in a hepatitis B screening program at a Chinese Christian church in Philadelphia. May is Hepatitis Awareness month. Why do we need an annual reminder about hepatitis B? Because 65 percent of the estimated 2.2 million people in the U.S. living with hepatitis B don’t know they’re infected. Studies show when people know their hepatitis B status, they’re more likely to get monitored regularly, get treatment, and take steps to avoid passing on the disease to partners and their children. So why are so many Americans unaware of their hepatitis B infection? Here are five roadblocks that stop us from getting tested for hepatitis B, and what how we can do to overcome them. We feel fine, so we assume we’re not infected. Hepatitis B rarely causes symptoms. There are very few sensory nerves around the liver, so when a viral hepatitis infection strikes, we rarely feel its effects. As a result, most of us – especially if we were infected as children or newborns – never experience any symptoms for decades. So remember, “feeling OK” is no excuse to avoid testing. We’re afraid and would rather not know if we have hepatitis B. In this case, ignorance can lead to liver damage, cancer, and the spread of this potentially-fatal infection. When a hepatitis B infection is identified and monitored, our chances of leading a long and healthy life increase markedly. Getting tested is scary, but getting liver cancer is deadly. We think we’re not at risk: We humans have an amazing capacity to “forget” or ignore things we’ve done that were stupid, embarrassing and put us at risk, or that might lead to painful discoveries and disclosures. If we ever had unprotected sex with someone whose hepatitis B status is unknown to us, we are at risk. If we or our parents come from a region, such as Asia and Africa, that has high rates of hepatitis B (see the map) we’re at risk. If

  http://www.hepb.org/blog/its-hepatitis-awareness-month-five-reasons-we-dont-get-tested-and-how-to-overcome-them/
• How Was I Infected with Hepatitis B? Making the Journey from Anger to Acceptance

  Image courtesy of stockimages at FreeDigitalPhotos.net By Christine Kukka “How did I get infected? Who could have infected me?” These questions are common when we are first diagnosed with hepatitis B. Dumbfounded by the news, we struggle to understand when this infection could have occurred and who could have infected us with a virus that now threatens our health and well-being. This diagnosis not only affects our health, it can weaken the trust we’ve placed in family members, friends and lovers. It threatens to dismantle basic beliefs we’ve held about fairness and honesty, and the assumption that if we treated people well that we would be treated fairly in return. Infections know no moral codes and ignore all the unspoken deals we have made with the universe. Many of us will never know how we were infected or who infected us. First, hepatitis B rarely causes any symptoms so it’s impossible to tell when we became infected. Second, about 65 percent of people infected with hepatitis B in the U.S. don’t know they’re infected. It’s difficult to blame someone who doesn’t know they carry this virus. While universal hepatitis B immunization has dramatically reduced infection rates since the 1980s, there are still many who did not have access to this immunization.  And, a hepatitis B vaccine administered during childhood would have done nothing for people who were infected at birth. Hepatitis B can be transmitted easily during sex or intimate contact, so even if we practice safe sex scrupulously, if we were not vaccinated we remain at risk. And, often it’s easier to blame someone else rather than own up to our own behavior. But blame holds us back. What we need is forgiveness, instead of acrimony and anger. But acceptance takes time and work. Nearly 30 years ago, writer Randy Schilts tried to find the first person (Patient Zero), who introduced AIDS to North America in his book And the Band Played On. In the book, Schilts suggested that a

  http://www.hepb.org/blog/how-did-i-get-infected-making-the-journey-from-anger-and-blame-to-acceptance/
• Know Your Rights: If You Suffer Severe Liver Damage from Hepatitis B, You May Qualify for SSDI or SSI

  Image courtesy of Stuart Miles at FreeDigitalPhotos.net The majority of people infected with hepatitis B lead healthy and normal lives. However, a small number of people may develop liver disease that will dramatically affect their quality of life and their ability to work on a short-term or long-term basis. They may not be able to work for several weeks because of side effects from pegylated interferon treatment, or progressive liver damage could make it impossible to work and support themselves and their families even after treatment. Below is information that can help you, your family members, or someone you advocate for apply for disability benefits to help them during when they can't work due to hepatitis B-related health problems. The first step is to find out if you can meet the Social Security Administration’s (SSA’s) medical eligibility requirements to receive disability support. With hepatitis B, you may qualify for one of SSA’s two disability programs: Social Security Disability Insurance (SSDI) is available to qualified, disabled workers who paid into the Social Security system through taxes over the course of their employment history. Supplemental Security Income (SSI) is a program with financial or “need-based” eligibility requirements. If you have limited income and other financial resources, you may meet SSI requirements. To qualify f0r either of these programs, your hepatitis B must meet medical eligibility rules and program-specific requirements. Additionally, your hepatitis and complications must have stopped you from working for 12 months or be expected to prevent employment for at least a year, despite treatment. Qualifying under Blue Book's hepatitis listing The SSA’s Blue Book outlines medical conditions that meet disability requirements. There is a listing for hepatitis in this manual. It appears in section 5.05, which covers chronic liver disease. To meet the listing, your hepatitis B must be unresponsive to treatment,

  http://www.hepb.org/blog/know-your-rights-if-you-suffer-severe-liver-damage-from-hepatitis-b-you-may-qualify-for-ssdi-or-ssi/
• Forget Surface Antibodies, If You Have Both Undetectable Viral Load and HBsAg, You Might Be Functionally “Cured”

  Dr. Robert Gish By Christine Kukka For decades, people living with chronic hepatitis B were told they would be “cured” only when they lost the hepatitis B surface antigen (HBsAg) and developed surface antibodies. It represented the holy grail of recovery that everyone hoped for, but very few achieved. Today, experts are redefining what constitutes a “functional cure” from chronic hepatitis B and taking the surface antibody out of the equation. Researchers, including expert Dr. Robert Gish, suggest if people have an undetectable viral load (HBV DNA), undetectable HBsAg, and no signs of liver damage, they may be "functionally cured," even if they haven't developed surface antibodies. The cure is called “functional” because the only cure for hepatitis B is when the immune system controls or suppresses the virus. People with chronic hepatitis usually experience several infection stages, starting with a high viral load (called immune-tolerant or immune-trained) during childhood and early adulthood, followed by years and even decades of “active” hepatitis B where the immune system tries to clear the infection, indicated by elevated liver enzyme tests. In some lucky people, the “active” phase successfully eradicates HBsAg and infected liver cells. They test negative for HBsAg, their viral load drops to undetectable levels and their liver enzyme tests (for ALT or SGPT) show no signs of liver damage. Despite their "inactive" infection, studies show two-thirds of these people will never develop surface antibodies, said Dr. Gish, medical consultant to the Hepatitis B Foundation and professor consultant of gastroenterology and hepatology at Stanford University. But isn’t developing surface antibodies the gold standard for recovery from hepatitis B? Not any more, explained Dr. Gish. Historically, medical guidelines dictated that chronically-infected patients must generate at least 10 mIU/mL of surface antibodies to be “functionally

  http://www.hepb.org/blog/forget-surface-antibodies-if-you-have-both-undetectable-viral-load-and-hbsag-you-might-be-functionally-cured/
• Diagnosed With Chronic Hepatitis B? What Does Your HBV DNA Test (Viral Load) Tell You?

  Image courtesy of Praisaeng, at FreeDigitalPhotos.net. If you have been diagnosed with chronic hepatitis B, your doctor has probably run several blood tests that show if the infection is harming your liver and identify what stage of infection you are in.  Doctors consider all of these results when deciding if you need treatment and how often you should be monitored. In this blog, we'll examine how one of the tests -- the HBV DNA or viral load test --can give you a snapshot into your hepatitis B infection and your health. The HBV DNA test  is performed on a blood sample using a Polymerase Chain Reaction (PCR) technique that rapidly generates HBV DNA fragments so they can be measured. Today, viral load is usually measured using international units per milliliter (IU/mL). However, in the past it was measured in copies per milliliter (copies/mL), and in some regions and labs, it is still used. If you ever need to convert copies into international units, there are about 5.6 copies in one international unit, so 5,000 copies/mL equals about 893 IU/mL. Remember to keep copies of your lab information on file so you can track your status. An Excel spreadsheet works great. The sensitivity of HBV DNA tests may vary with each lab so it’s a good idea to use the same lab for your test. Labs usually measure down to less than 200 IU/mL. Below the threshold, the viral load is considered “undetectable” – something everyone with chronic hepatitis B wants to hear. How HBV DNA results are presented mathematically on your lab report can be confusing. Because the amount of virus in the blood may be very high – in the millions or billions – the result may be displayed as an exponent or a log, rather than a whole number. You may need to convert these numbers to fully understand them. What does viral load say about what stage of the virus you are in? Your viral load also varies over time depending  on the “stage” of hepatitis B infection. That is why regular monitoring

  https://www.hepb.org/blog/diagnosed-with-chronic-hepatitis-b-what-does-your-hbv-dna-test-tell-you/
• Eloi Verrier, PhD (HDR)

  CRCN InsermUniversity of Strasbourg Tenured researcher focusing on virus-host molecular interactions in the context of hepatitis B and D virus infections for the development of new therapeutic strategies. Read the journal picks of the month from our Emerging Scholars Scientific and Medical Advisory Board here.  

  https://www.hepb.org/news-and-events/reports/emerging-scholars-scientific-and-medical-advisors/eloi-verrier-phd-hdr/
• Theobald's Story

  Theobald was not sure how to react when he received a diagnosis of hepatitis B. While trying to learn more about the disease, he found that there were no organizations focused on hepatitis B in his country. He decided to turn his diagnosis into action by creating the Hepatitis Foundation of Ghana to help others.  

  https://www.hepb.org/research-and-programs/patient-story-telling-project/theobalds-story/
• Storytelling: The lived experience of having hepatitis B

  The Hepatitis B Foundation is dedicated to amplifying the voices of those living with hepatitis B and D and their caretakers. We have two storytelling projects: #justB and B the Voice, which allow real people to share their stories through recorded videos. The goal of both campaigns is to raise the profile of hepatitis B as an urgent health priority by putting a human face on this serious illness. We hope to increase advocacy and awareness, decrease stigma and discrimination, and promote testing, vaccination, linkage to care and life-saving treatment.  Please explore our stories here:  Learn more at HepBStories.org.  Want to learn more? Hepatitis B Patient Education Resources Getting Tested for Hepatitis B Understanding Risks of Hepatitis B Understanding Acute vs. Chronic Hepatitis BPreventing Hepatitis B Treatment of Hepatitis B Read more patient stories Additional Stories

  https://www.hepb.org/research-and-programs/patient-story-telling-project/
• Protecting Your Baby Through Vaccination

  Infants born to people with hepatitis B must receive accurate doses of hepatitis B vaccine and hepatitis B immune globulin (if recommended and available) to ensure complete protection. In order to protect these infants, medications should be given immediately after birth in the delivery room or within the first 12-24 hours of life*.   * See Testing and Treatment During Pregnancy section for details. Please note that testing of all pregnant people for hepatitis B is a global recommendation.  Infants Born to Mothers Who Have Hepatitis B: Hepatitis B Vaccine Schedules *Please note that the first dose of the hepatitis B vaccine (birth dose) should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective. Protecting Your Baby Infants born to people who have hepatitis B must receive accurate doses of the hepatitis B vaccine and hepatitis B immune globulin (HBIG) at separate injection sites (opposite limbs) to ensure complete protection. In order to protect these infants, at least the hepatitis B vaccine birth dose should be given immediately after birth in the delivery room or within the first 12-24 hours of life. If recommended and available, HBIG should also be given at that time.   *U.S. CDC recommends both the hepatitis B vaccine and HBIG within 12 hours of birth to babies born to mothers that are HBsAg positive and within 24 hours for all other babies. WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies and does not recommend HBIG for babies born to mothers with hepatitis B. 3-Dose Vaccine Series for Infants (Including the "Birth Dose") The World Health Organization (WHO) recommends that infants born to people who have hepatitis B receive the first dose of the hepatitis B vaccine within 24 hours of birth. Ideally a dose of hepatitis B immunoglobulin (HBIG) is also given if recommended and available. These shots must be followed by the additional hepatitis B vaccine doses given on the recommended schedule. In the U.S., infants should follow a 1 month and 6-month schedule for the additional two doses.  4-Dose Combination Vaccine Series for Infants (Pentavalent or Hexavalent) Combination vaccines, such as the pentavalent and hexavalent vaccines, provide protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. Their hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine on the recommended schedule. Important Information about Vaccine and Hepatitis B Immunoglobulin (HBIG) Shot Administration Where recommended and available, the hepatitis B “birth dose” and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information. *Please Note: Although the U.S. CDC states that the medications can be given within the first 12 hours of life and the WHO states vaccine birth dose to be given within 24 hours, there is no second chance to protect an infant once this window of opportunity is missed. Therefore, the Hepatitis B Foundation strongly recommends that health care professionals administer these medications immediately in the delivery room to avoid any delays or mistakes. General Information About Vaccination Outside the U.S. In developing countries the pentavalent vaccine, a combination five-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 who have hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from mother-to-child (vertical) transmission or from being infected during the first few weeks of life through accidental household exposure from close contacts who may unknowingly be infected (horizontal transmission). Babies born to a mother who has hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth. WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Individual countries may have their own recommendations or no recommendations at all. 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 pregnant people who have hepatitis B.   If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B. It is now recommended globally that all pregnant people get tested for hepatitis B! For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent, hepatitis B vaccine must be given within 24 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 24 hours of birth, and the second and third doses of the hepatitis B vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine. Making sure babies get the birth dose of the hepatitis B vaccine is critical to eliminating hepatitis B virus. The Center for Global Hepatitis Elimination published a review of strategies to improve implementation of hepatitis B vaccine birth dose worldwide, especially in limited-resource settings. This can be a useful resource to help organizations improve hepatitis B vaccine birth dose completion around the world. *WHO does not recommend the birth dose of HBIG, which may not be available in all countries. Talk to your doctor if you have questions. Page updated September 2020.    

  https://www.hepb.org/treatment-and-management/pregnancy-and-hbv/protecting-your-baby-through-vaccination/
• Pregnancy and Hepatitis B

  Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth. It is very important that pregnant people know their hepatitis B status in order to prevent passing the virus on to their newborn baby during delivery. If your doctor is aware that you have hepatitis B, he or she can ensure hep B transmission to your baby is prevented by taking the right steps based on blood tests results and to make arrangements to have the proper medications in the delivery room to prevent your baby from being infected.  ALL pregnant people should be tested for hepatitis B. Testing is especially important for people who fall into high-risk groups such as health care workers, people from ethnic communities or countries where hepatitis B is common, spouses or partners living with an infected person, etc. If you are pregnant, be sure your doctor tests you for hepatitis B before your baby is born, ideally as early as possible during the first trimester. If you test positive for hepatitis B infection, then your newborn must be given proper prevention immediately in the delivery room, clinic or bedside: first dose (called "birth dose") of the hepatitis B vaccine one dose of the Hepatitis B Immune Globulin (HBIG).* * Note: HBIG is recommended by U.S. CDC. HBIG is not recommended by WHO and may not be available in all countries. What is most important is to make sure the hepatitis B vaccine birth dose is given as soon as possible! If these two medications are given correctly, a newborn born to a person with hepatitis B has more than a 90% chance of being protected from a hepatitis B infection. You must make sure your baby receives the remaining shots of the vaccine series according to schedule to ensure complete protection. Although the U.S. CDC states that the medications can be given within the first 12 hours of life and the WHO states vaccine birth dose can be given within 24 hours, there is no second chance to protect an infant once this window of opportunity is missed. Therefore, the Hepatitis B Foundation strongly recommends that health care professionals properly administer the birth dose of the hepatitis B vaccine immediately in the delivery room to avoid any delays or mistakes. If you test positive for hepatitis B infection while pregnant, your doctor also should do a hepatitis B viral load blood test (HBV DNA) during your pregnancy. 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 your third trimester to reduce the risk of infecting your newborn at birth. If the hepatitis B viral load test is not available, WHO recommends that pregnant women are tested for the hepatitis B e-antigen (HBeAg), and if positive, an antiviral is recommended during the last trimester. Regardless of viral load levels or HBeAg status, the hepatitis B vaccine birth dose and completion of the vaccine series is essential to protect your infant from infection with the hepatitis B virus.  Additional Resource Links:  U.S.: Centers for Disease Control and Prevention: Viral Hepatitis, Perinatal Transmission (2022) EU/EEA: Antenatal Screening for HIV, Hepatitis B, Syphilis and Rubella Susceptibility in the EU/EEA (2016) Globally: WHO Prevention of Mother-To-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy (2020) Page updated September 2020.  

  https://www.hepb.org/treatment-and-management/pregnancy-and-hbv/