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Hepatitis B Details

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(heart monitor beeping) - [Instructor] What is Hepatitis B? Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus, known as HBV. It can cause both acute and chronic infection, it's very contagious, and can be spread from one person to another. What is the Hepatitis B classification? Well, Acute Hepatitis B virus infection is a short-term illness that occurs within the first six months after someone is exposed to the Hepatitis B virus. Chronic Hepatitis B virus infection is a longer term illness that occurs when the Hepatitis B virus remains in a persons body. You might be asking yourself, "Well, who's at risk for Hepatitis B?" People who have sex with an infected person, have multiple sex partners, have a sexually transmittable disease, are men who have sexual contact with other men, inject drugs or share needles, syringes, or other drug equipment, live with a person who has Chronic Hepatitis B, are infants born to infected mothers, are exposed to blood on the job, are hemodialysis patients, or travel to countries with moderate to high rates of Hepatitis B. So, how common is Hepatitis B in the United States? First, let's look at Acute Hepatitis B. Since routine Hepatitis B vaccination has been available, Acute Hepatitis B rates have declined by approximately 82% since 1991 and the disease in the United States has dramatically declined, particularly among children. In 2014, there were an estimated 19,200 new Hepatitis B virus infections in the United States. The official number of reported Hepatitis B cases is much lower because many people don't know they are infected, or may not have symptoms and, therefore, never even seek the attention of medical or public health officials. Chronic Hepatitis B in the United States is an estimated 850,000 to 2.2 million persons here in the us. Globally, Chronic Hepatitis B affects approximately 240 million people and contributes to an estimated 786,000 deaths worldwide every year. Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities like birth, where it spread from the infected mother to her baby during the birth process, sex with an infected partner, sharing needles, syringes, or other drug injection equipment, sharing items such as razors or toothbrushes with an infected person, direct contact with the blood or open sores of an infected person, and exposure to blood from needle sticks or other sharp instruments. Now, let's discuss the Hepatitis B incubation period. The incubation period for Hepatitis B ranges between 45 to 160 days, but, on average, is at about 120 days. Now, let's discuss the signs and symptoms of Acute Hepatitis B. They could include, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark colored urine, clay colored stool or bowel movements, joint pain, and Jaundice, which is a yellow color in the skin or the eyes. Symptoms usually last a few weeks, but some people can be ill for as long as six months. Now, let's talk about Chronic Hepatitis B. Some people have ongoing symptoms similar to Acute Hepatitis B, but most individuals with Chronic Hepatitis B remain symptom free for as long as 20 or 30 years. About 15 to 25% of people with Chronic Hepatitis B develop serious liver conditions such as Cirrhosis, or scarring of the liver, or even liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities. The number one way to test for Hepatitis B is through a blood test. When taking blood tests, we're looking for Hepatitis B Surface Antigen, known as HBsAg. HBsAg is a protein on the surface of the Hepatitis B virus, it can be detected in blood during Acute or Chronic Hepatitis B virus infection. The body normally produces antibodies to HBsAg as part of the normal immune response to this infection. A positive test means a person has an Acute or Chronic Hepatitis B virus infection and can pass the virus to others. A negative test means a person does not have the Hepatitis B virus in his or her blood. Hepatitis B Surface Antibody, or anti-HBS, is an antibody that is produced by the body in response to the Hepatitis B surface antigen. A positive test means a person is protected, or immune, from getting the Hepatitis B virus for one of two reasons: either one, he or she was successfully vaccinated against Hepatitis B or two, he or she recovered from an acute infection and can't get Hepatitis B again. Total Hepatitis B Core Antibodies, or anti-HBc, is an antibody that is produced by the body in response to a part of the Hepatitis B virus called the core antigen. The meaning of this test often depends on the results of two other tests: anti-HBs and HBsAg. A positive test means that a person is either currently infected with the Hepatitis B virus, or was infected in the past. IgM Antibody to Hepatitis B Core Antigen, or IgM anti-HBc, is used to detect an acute infection. A positive test means a person was infected with Hepatitis B virus within the last six months. Hepatitis B "e" Antigen, or HBeAg, is a protein found in the blood when the Hepatitis B virus is present during an active Hepatitis B virus infection. A positive test means a person has high levels of virus in his or her blood, and can easily spread the virus to others. This test is also used to monitor the effectiveness of treatment for Chronic Hepatitis B. Hepatitis B "e" Antibody, or HBeAb, or anti-HBe, is an antibody that is produced by the body in response to the Hepatitis B "e" antigen. A positive test means a person has Chronic Hepatitis B virus infection, but is at lower risk of liver problems due to low levels of Hepatitis B virus in his or her blood. Hepatitis B Viral DNA refers to a test to detect the presence of Hepatitis B virus DNA in a persons blood. A positive test means the virus is multiplying in a persons body, and he or she is highly contagious and can pass the virus to others. If a person has a Chronic Hepatitis B virus infection, the presence of viral DNA means that a person is possibly at increased risk for liver damage. This test is also used to monitor the effectiveness of drug therapy for Chronic Hepatitis B virus infection. Now, let's take a closer look at the treatment of Hepatitis B. First, the treatment for Acute Hepatitis B. There is no medication available and it's best addressed through supportive treatment. During this short-term infection, doctors usually recommend rest, adequate nutrition, fluids, and sometimes hospitalization. For Chronic Hepatitis B, regular monitoring for signs of liver disease progression, oral medications including oral antiviral agents; like Tenofovir or Entecavir, the most potent drugs to suppress Hepatitis B virus and rarely leads to drug resistance are used. How do we prevent Hepatitis B? Well, first is through Hepatitis B vaccination and this is a sequence of shots that stimulate a person's natural immune system to protect against HBV. After the vaccine is given, the body makes antibodies that protect a person against the virus. Hepatitis B vaccination is recommended for all infants, starting with the first dose of Hepatitis B vaccine at birth. All children and adolescents younger than 19 years of age who have not been vaccinated. Peoples whose sex partners have Hepatitis B. Sexually active persons who are not in a long term, mutually monogamous relationship. Persons seeking evaluation or treatment for a sexually transmitted disease. Men who have sexual contact with other men. People who share needles, syringes, or other drug injection equipment. People who have close household contact with someone infected with the Hepatitis B virus. Healthcare and public safety workers at risk for exposure to blood or blood contaminated body fluids on the job. People with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients. Residents and staff of facilities for developmentally disabled persons. Travelers to regions with moderate or high rates of Hepatitis B. People with chronic liver disease, people with HIV infection, and anyone who wishes to be protected from Hepatitis B virus infection. In order to reach individuals at risk for Hepatitis B, vaccination is also recommended for anyone in or seeking treatment from the following: sexually transmitted disease treatment facilities, HIV testing and treatment facilities, facilities providing dug abuse treatment and prevention services, health care settings targeting services to injection drug users, health care settings targeting services to men who have sex with men, chronic hemodialysis facilities and end-stage renal disease programs, correctional facilities, and institutions and non-residential day care facilities for developmentally disabled persons.

In this lesson, we'll be covering everything to do with Hepatitis B including what it is, the various classifications, who is most at risk, how common it is in the U.S., how it's transmitted, the signs and symptoms, how it is diagnosed, and treatment and prevention options.

What is Hepatitis B?

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It can cause both acute and chronic infections, it's very contagious, and it can be easily spread from one person to another.

Hepatitis B Classifications

There are two classifications of Hepatitis B: acute and chronic.

  1. Acute Hepatitis B virus infection is a short-term illness that occurs within the first six months after exposure to the virus.
  2. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in the body.

Who is Most at Risk for Hepatitis B?

People most at risk of getting Hepatitis B include:

  • People who have sex with an infected person
  • People with multiple sex partners
  • People who have a sexually transmitted disease
  • Men who have sex with other men
  • People who share injectable drugs, needles, syringes, and other drug equipment
  • People who live with an infected person
  • Infants born to infected mothers
  • People who are exposed to blood at work
  • Hemodialysis patients
  • People who travel to countries with moderate to high rates of infection

How Common is Hepatitis B in the U.S.?

Acute Hepatitis B

Since routine vaccinations have been available, rates of acute infections have declined by approximately 82 percent since 1991 and have dramatically declined particularly among children.

In 2015, there were an estimated 19,200 new cases of Hepatitis B virus infections, though the actual number is likely much higher since many people don't know they're infected, don't have symptoms, and have never been tested.

Chronic Hepatitis B

It is estimated that between 850,000 and 2.2 million people in the U.S. have a chronic infection. And globally, approximately 240 million people are infected, contributing to around 786,000 deaths each year.

How is Hepatitis B Transmitted?

Hepatitis B is spread when blood, semen, and other body fluids infected with the virus enters the body of a person not infected.

People can become infected during activities like:

  • Birth, as it can be spread from mother to child
  • Sex with an infected partner
  • Sharing needles, syringes, and other drug-injection equipment
  • Sharing items like razors and toothbrushes with infected people
  • Direct contact with blood or open sores of an infected person
  • Exposure to blood from needlesticks and other sharp instruments

The incubation period is between 45 and 160 days with 120 days being average.

Signs and Symptoms of Hepatitis B

Acute Hepatitis B

Signs and symptoms of acute infection include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay colored bowel movements
  • Jaundice (yellow skin or eyes)

Pro Tip #1: Symptoms usually last a few weeks; however, some people can be ill for as long as six months.

Chronic Hepatitis B

Some people have ongoing symptoms similar to acute Hepatitis B but most individuals with a chronic infection remain symptom free for as long as 20 or 30 years.

Around 15 to 25 percent of people with a chronic infection develop serious liver conditions like cirrhosis (scarring) or liver cancer.

Pro Tip #2: Even as the liver becomes diseased, some people still won't have symptoms. However, certain blood tests for liver function may show abnormalities.

How is Hepatitis B Diagnosed?

The number one way to diagnose Hepatitis B is with a blood test. And there are a number of those available.

Hepatitis B Surface Antigen (HBsAg) Test

This test looks for Hepatitis B Surface Antigens, a protein on the surface of the Hepatitis B virus. It can be detected in the blood during an acute or chronic infection. The body normally produces antibodies to HBsAg as part of the immune response to the infection.

A positive test means that a person has acute or chronic Hepatitis B and it can be spread to others. A negative test means there is no sign of the virus in the blood.

Hepatitis B Surface Antibody (anti-HBs) Test

This is an antibody that is produced by the body in response to the Hepatitis B Surface Antigen.

A positive test means that the person is protected or immune from getting the virus for one or two reasons:

1. The person was successfully vaccinated.
2. The person had an infection and recovered from it, meaning they can't get it again.

Total Hepatitis B Core Antibody (anti-HBc) Test

This is an antibody that is produced by the body in response to a part of the Hepatitis virus called a core antigen. The meaning of this test often depends on the results of two other tests – anti-HBs and HBsAg.

A positive test means the person is currently infected with the virus or was infected in the past.

IgM Antibody Core Antigen (IgM anti-HBc) Test

This test is used to detect an acute infection.

A positive test means the person was infected with the virus within the last six months.

Hepatitis B “e” Antigen (HBeAg) Test

This is a protein found in the blood when the virus is present during an active infection.

A positive test means the person has high levels of the virus in their blood and can easily spread it to others. The test is also used to monitor the effectiveness of treatment for chronic Hepatitis B.

Hepatitis B e Antibody (HBeAb or anti-HBe) Test

This is an antibody produced by the body in response to the Hepatitis B “e” antigen.

A positive test means the person has a chronic infection but is also at a lower risk of liver problems, as they have low levels of the virus in their blood.

Hepatitis Viral DNA Test

This test is used to detect the presence of the virus DNA in the person's blood.

A positive test means the virus is multiplying in the body, which means the person is highly contagious and can spread the virus to others more easily.

If a person has a chronic infection, the presence of viral DNA means they are possibly at an increased risk for liver damage. The test is also used to monitor the effectiveness of drug therapy for chronic Hepatitis B virus infection.

Hepatitis B Treatment Options

Acute Hepatitis B

Sadly, no medications are available to treat an acute infection. The best treatment options are focused on support. Therefore, during an acute infection, doctors recommend:

  • Rest
  • Adequate nutrition
  • Fluids
  • Possibly hospitalization

Chronic Hepatitis B

Treatment options for a chronic infection include:

  • Regular monitoring for signs of liver disease progression
  • Oral medications (oral antiviral agents) like Tenofovir and Entecavir – the most potent drugs on the market to suppress the virus and rarely leading to drug resistance.

Hepatitis B Prevention

The first line of defense is vaccination. The hepatitis vaccine includes a sequence of shots that stimulate a person's natural immune system to protect against HBV. After it's given, the body makes antibodies that protect against the virus.

The vaccine is recommended for:

  • All infants starting with a first dose at birth
  • All adolescents and children under the age of 19 who have not been vaccinated
  • People who are sex partners with those infected with the virus
  • People who have multiple sex partners
  • People who have a sexually transmitted disease
  • Men who have sex with other men
  • People who share needles, syringes, and other drug-injecting equipment
  • People with close household contact with an infected person
  • Healthcare and public safety workers who are at risk of exposure to blood or contaminated body fluids
  • People with end-stage renal disease including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
  • Residents and staff of facilities for developmentally disabled people
  • Travelers to regions where there is moderate to high rates of infection
  • People with chronic liver disease
  • People with HIV infection
  • Anyone who wants to be protected from the virus

Vaccinations are also recommended for anyone who works at:

  • Sexually transmitted disease treatment facilities
  • HIV testing and treatment facilities
  • Facilities providing drug abuse treatment and prevention services
  • Healthcare settings that target services to injection drug users
  • Healthcare settings targeting services to men who have sex with other men
  • Chronic hemodialysis facilities and end-stage renal disease programs
  • Correctional facilities
  • Institutions and nonresidential day care facilities for developmentally disabled people