Hepatitis B is a liver disease caused by the hepatitis B virus. Most hepatitis B infections clear up within 1-2 months without treatment. When the infection lasts more than six months, it can develop into chronic hepatitis B, which can lead to:

• Chronic inflammation of the liver

• Cirrhosis (scarring of the liver)

• Liver cancer

• Liver failure

• Death

Causes

Hepatitis B is caused by the hepatitis B virus. This virus is spread through contact with body fluids of an infected person, such as blood, semen, vaginal fluids, and saliva. A woman infected with hepatitis can pass the virus on to her baby during childbirth.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Coming in contact with the blood or other body fluids of someone infected with hepatitis B increases your risk for infection. Unlike hepatitis A virus, hepatitis B virus is not spread through contaminated food or water.

The following situations may increase your risk of getting hepatitis B:

• Having sex with someone infected with hepatitis B or who is a carrier of hepatitis B

• Injecting illicit drugs, especially with shared needles

• Having more than one sexual partner

• Being a man who has sex with men

• Living in the same house with someone who is infected with hepatitis B

• Having a job that involves contact with body fluids, such as:

• • First aid or emergency workers

• • Funeral directors

• • Medical personnel

• • Dentists

• • Dental assistants

• • Firefighters

• • Police personnel

• Having a sexually transmitted disease at the time you come in contact with hepatitis B

• Traveling to areas where hepatitis B is common, such as China, southeast Asia, and sub-Saharan Africa

• Receiving a blood transfusion prior to 1992 (the year a more reliable test to screen blood was developed)

• Receiving multiple transfusions of blood or blood products, as hemophiliacs do (risk is greatly reduced with modern blood screening techniques)

• Working or being a patient in a hospital or long-term care facility

• Working or being incarcerated in a prison

• Being bitten so that the skin is broken by someone whose saliva contains the virus

• Being a hemodialysis patient

Symptoms

Symptoms usually appear within 25 to 180 days following exposure to the virus. The most common symptoms are:

• Yellowing skin and eyes (jaundice)

• Fatigue that lasts for weeks or even months

• Abdominal pain in the area of the liver (upper right side)

• Loss of appetite

• Nausea

• Vomiting

• Joint pain

• Low-grade fever

• Dark urine and light-colored stool

• Widespread itching

• Rash

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Hepatitis B is diagnosed with blood tests, which are also used to monitor its effects on the liver. For chronic cases, a liver biopsy may be needed. A biopsy is the removal of a sample of liver tissue for testing.

Treatment

The symptoms of hepatitis B can be treated with medication. Patients with uncomplicated cases can expect to recover completely. Patients with chronic hepatitis B are sometimes treated with medication to reduce the activity of the virus and prevent liver failure.

Medications include:

• Interferon alfa-2b (Intron A) injection

• Lamivudine (Epivir-HBV) oral medication

Chronic hepatitis B patients should avoid anything that can further injure the liver. These include:

• Alcohol

• Certain medications, dietary supplements, and herbs (Discuss these substances with your doctor before taking them.)

Chronic hepatitis B patients should prevent the spread of their infection by:

• Telling their doctors, dentists, and sexual partner(s) that they have hepatitis B

• Never donating blood, organs, or tissue

• Discussing their hepatitis B status with their doctor during pregnancy or before becoming pregnant to insure the baby receives treatment

Prevention

Hepatitis B can be prevented through vaccination, which consists of three injections over a six-month period. Protection is not complete without all three injections. Anyone at increased risk for hepatitis B should be vaccinated.

In addition, to prevent the transmission of hepatitis B:

• Use condoms or abstain from sex.

• Limit your number of sexual partners.

• Do not inject drugs. If you use IV drugs, get treatment to help you stop. Never share needles or syringes.

• Do not share personal items that might have blood on them, such as:

• • Razors

• • Toothbrushes

• • Manicuring tools

• • Pierced earrings

• If you get a tattoo or body piercing, make sure the artist or piercer properly sterilizes the equipment. You might get infected if the tools have someone else's blood on them.

• If you are a healthcare or public safety worker:

• • Get vaccinated against hepatitis B.

• • Always follow routine barrier precautions and safely handle needles and other sharp instruments.

• Wear gloves when touching or cleaning up body fluids on personal items, such as:

• • Bandages

• • Band-aids

• • Tampons

• • Linens

• Cover open cuts or wounds.

• Use only sterilized needles for drug injections, blood testing, ear piercing, and tattooing.

• If you are pregnant, have a blood test for hepatitis B. Infants born to mothers with hepatitis B should be treated within 12 hours after birth.

RESOURCES:

American Liver Foundation
http://www.liverfoundation.org

Hepatitis B Foundation
http://www.hepb.org

CANADIAN RESOURCES

Canadian Institute for Health Information
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e

Canadian Liver Foundation
http://www.liver.ca/Home.aspx

References:

American Liver Foundation website. Available at: http://www.liverfoundation.org.

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/.

Braunwald E, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Longo DL, eds. Harrison's Principles of Internal Medicine. 15th ed. McGraw-Hill; 2001.