How is Hepatitis B spread?
Hepatitis B is spread by contact with blood and other bodily fluids – usually through an opening in the skin or contact with internal lining surfaces of the body.
Compared to Hepatitis C , Hepatitis B is a much more infectious condition and more easily spread. At the same time however there is more chance of immunity developing in certain age groups
The ways in which people can be infected with the virus include:
1. Mother to child where the mother is a carrier of hepatitis B. This usually happens around the time of birth. This is the most common way for the virus to spread in some parts of the world eg. Asia.
2. By the use of injecting drugs (at any time in the past or present).
3. By unprotected sexual contact
4. By blood transfusion. This is extremely rare these days in Australia since rigorous testing was introduced.
5. By tattooing with unsterilised needles
6. By close family contact
7. By accidental needle stick injury or by splashing with infected blood or body fluids – usually within the healthcare setting.
What damage can Hepatitis B cause?
The outcome of hepatitis B infection depends largely on the age at which someone is infected. Babies who are infected at birth almost always go on to become long-term (chronic) carriers of the virus.
However the infection at birth is silent and the babies appear healthy and do not usually become jaundiced (yellow). Although these people often appear perfectly healthy for many years, they can become unwell after 20 years or more. Cirrhosis (severe scarring) and liver cancer can occur in chronic carriers who acquired hepatitis B early in life.
If a teenager or adult becomes infected with the virus there is about a 50% chance that they will become ill and develop jaundice (turn yellow). This illness is called acute hepatitis. However, in the other 50% of cases, there is no jaundice. Adults have a good chance of being able to clear the virus from the body naturally and these individuals are then immune to the disease and do not go on to develop long-term liver damage.
In approximately 5-10% of cases, adults are unable to get rid of the virus, and become long-term (chronic) carriers. Generally such people remain in good health for many years. However there is a chance that such people will develop cirrhosis and liver cancer after many years or decades.
How can the doctor tell if you have Hepatitis B and if there is damage to the liver?
There are many tests that can assist doctors in assessing liver damage or the likelihood of future liver damage from hepatitis B. The interpretation of these tests is not always straightforward and may require specialist advice. Some of these tests include:
• Specific hepatitis B blood tests to determine whether or not you are infected with the virus, whether the virus is continuing to multiply in the liver, whether you are currently infectious for the virus, or whether you have had the virus, cleared it and now have immunity to hepatitis B.
• Liver function tests: blood tests which give an estimate of liver inflammation or damage. The ALT (alanine amino transferase) test is a reasonably good guide. Other parts of the liver function tests can help the doctor assess whether or not there may be cirrhosis present.
• Liver ultrasound scan: these tests use inaudible sound waves to take pictures of the liver to assist in diagnosing cirrhosis, fatty liver or liver cancer.
• Liver biopsy: This is the removal of a tiny piece of liver under local anaesthetic for examination to determine how much scarring there is in the liver. The liver biopsy is the most accurate way of assessing this
Fibroscan is an alternative way of assessing the liver for scarring. It is a non-invasive procedure using sound waves to measure the elasicity of the liver
• Alpha-fetoprotein: a blood test which can sometimes detect liver cancer.
Is there any treatment for Hepatitis B?
Those people who have immunity and normal liver function tests do not need any treatment.
People who are chronic hepatitis B carriers [as judged by their blood tests] need to be assessed by their doctor for the degree of viral activity and liver inflammation. A significant number of these patients will need to be a long-term treatment to supress the activity of the virus.
If there is liver damage the doctor may consider using an anti-viral medicine. In some cases the virus may be cleared but in the majority it will be supressed so that the virus no longer causes any damage - in these latter patients [at present] life-long therapy is needed. Life-long therapy is needed in these latter patients because the virus becomes tightly bound to the DNA of the liver cell. There are currently a number of drugs available fo treatment – the 2 main ones used in Australia are Interferon and Baraclude. Usually the assessment and decision to treat hepatitis B is carried out by a liver specialist.
People who already have cirrhosis of the liver will generally be kept under close supervision by their doctor. Regular ultrasound examinations and alpha-fetoprotein levels are usually recommended. People with very advanced disease may be referred to a liver transplant unit for assessment for a liver transplant.
What else can be done to improve the liver if you have Hepatitis B?
Carriers of hepatitis B should eat a normal healthy diet. Alcohol should be minimised or avoided. Care should be taken to avoid contracting other blood-borne viruses (eg. the practice of safe sex and not sharing injecting equipment).
What about Vaccination?
The hepatitis B vaccine is very safe and relatively inexpensive. It is also very effective and gives good immunity in about 95% of the population. The vaccine is usually given in three injections over six months.
Everyone should have vaccination against Hepatitis B - please check with your doctor in this regard.
Certain groups of people in the community are eligible for free hepatitis B vaccination. For more information on this, check with your doctor.
If you are already a carrier of hepatitis B it is a good idea to be vaccinated against hepatitis A as this virus could cause further liver damage.
Who should be vaccinated?
Vaccination can be requested from a general practitioner or local council. It is recommended that the following broad categories of people be vaccinated.
1. All babies and adolescents who have not had hepatitis B vaccination previously.
2. Babies of infected mothers (all pregnant women should be tested for hepatitis B)
3. People who have had accidental exposure (eg. at work)
4. Health care workers
5. Household, family or sexual contacts of carriers of hepatitis B
6. Sexually active homosexual or bisexual men
7. Sex industry workers
8. Injecting drug users
9. Renal dialysis patients
10. Clients and staff of institutions for the intellectually disabled and those in close contact with the de-institutionalised.
11. Aboriginal and Torres Strait Islanders
12. Haemophiliacs and others who may need multiple blood or blood product transfusions, especially if they are given overseas.
13. Prisoners and prison staff
14. International travellers
15. People playing contact sport
16. Child care workers
17. People with other liver diseases
19. People working in accident and emergency services
The Digestive Health Foundation, which is the educational arm of the Gastroenterological Society of Australia. Members of the foundation are drawn from physicians, surgeons, scientists and other medical specialties with an interest in GI disorders.