The Lambda Clinic - Sexual Health Advice - Patient Information Leaflet
http://www.lambdaclinic.co.uk/hepatitis-b.html
Hepatitis B
What is hepatitis and hepatitis B?
Hepatitis is an inflammation / infection of the liver with many causes such as alcohol excess and several types of viruses. One such virus that causes hepatitis is called the hepatitis B virus. In this leaflet we shall only discuss the hepatitis B virus
How does one get hepatitis B?
From person to person (also called ‘horizontal transmission')
Blood and other bodily fluids such as saliva, semen and vaginal secretions contain the virus in infected people. The main ways in which people become infected include:
· Having unprotected sex with an infected person. However, many people with hepatitis B do not realise that they are infected with the hepatitis B virus and thus they can pass on the virus during sex without realising it.
· From infected blood which only requires a small amount to come into contact with a cut or wound to allow the virus to enter the bloodstream and cause infection. For example:
· By sharing needles when injecting drugs.
· Although all blood donated in the UK is checked for the hepatitis B virus (and for certain other infections) there is a very very small risk of getting hepatitis B from a blood transfusion.
· From needlestick injuries where the needle has been used on an infected person.
· There is a small risk of contracting the virus from sharing razors, toothbrushes, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for tattooing, body piercing etc.
· A bite from an infected person, or if their blood spills onto a wound, into eyes or into your mouth.
From mother to baby (also called ‘vertical transmission')
This occurs during childbirth. This is more common in parts of the world where there are many people who are infected with hepatitis B virus. It is a rare form of vertical transmission in the UK.
The virus is not passed on during normal social contact such as holding hands, sharing cups or hugging.
What are the symptoms of hepatitis B and how does hepatitis B progress?
It occurs in two phases i.e. an acute phase when you are first infected and a chronic phase when the virus remains over long-term.
Acute hepatitis B infection
In about 50% of cases, no symptoms or only mild ‘flu-like' symptoms occur in the acute phase. You may not be aware that you have been infected with the hepatitis B virus. In particular, babies show no symptoms at first when they are infected from their mothers during childbirth.
If symptoms do occur they usually develop soon after being infected with the virus (within 1 – 6 months called the ‘incubation period'). Symptoms include:
· Flu-like illness (fever, feeling generally unwell, tiredness)
· Abdominal pain
· Nausea and vomiting
· Itchy skin
· Jaundice (yellow tinge of skin and whites of eyes, dark urine and pale faeces)
Symptoms of acute hepatitis B infection usually disappear after a few weeks as the body's immune system either clears the virus or controls the effects. Rarely, an acute severe (‘fulminant') hepatitis develops which can be life-threatening.
Following the initial ‘acute' phase:
· In more than 9 in 10 cases in adults, the virus is cleared from the body by the body's immune system usually within 3 – 6 months. In this situation you are no longer infectious and you are immune to further infection.
· In up to 1 in 10 cases in adults, the virus remains long-term (‘chronic' hepatitis B infection). This may occur whether or not you have symptoms in the acute phase.
· In more than 9 in 10 babies infected from their mothers, the virus remains long-term.
Overall, there is a good chance of full recovery and clearing the virus for adults who become infected with hepatitis B virus. This is unfortunately the opposite for new-born babies who usually remain infected long-term.
Chronic hepatitis B infection
· A chronic hepatitis B infection is one that persists long-term i.e. more than six months. Of those people who develop chronic hepatitis B infection:
· Up to 75% of these people remain well. The virus remains in the body and causes no damage or problems to the liver or other organs. This is called being a ‘carrier' and is sometimes called ‘chronic inactive hepatitis B'. You may not know that you are carrier, and although you have no symptoms, you can still pass on the virus to others who then may go on and develop problems. In about 1 in 5 carriers the virus is eventually cleared from the body by natural means, but this process may take several years.
· Some people develop persistent liver inflammation (sometimes called ‘chronic active hepatitis B'). Symptoms include: tiredness, muscle aches, lack of appetite, feeling sick, intolerance of alcohol, jaundice, depression, pain in the upper abdomen. Symptoms vary in severity and some people have liver inflammation without having any symptoms.
· Some people develop cirrhosis which is a ‘scarring' of the liver which can cause serious problems. 'Liver failure' is the worst consequence. Cirrhosis usually takes many years of progression after being infected with hepatitis B virus.
· A small number of people with cirrhosis can develop liver cancer after a further period of time.
How is hepatitis B diagnosed?
A simple blood test can detect if you have the hepatitis B virus. This test detects a protein called hepatitis B surface antigen (HbsAg). The result is usually known within 3 days. The Lambda Clinic can arrange a blood test to test for the hepatitis B virus. If you are found to be infected i.e. if you are HbsAg positive, then other tests may be advised to check on the severity of infection.
Can hepatitis B be prevented?
If you have a current hepatitis B infection you should:
· Use condoms when having sex. Also, sexual partners may wish to be tested for hepatitis B, and immunised if appropriate.
· Not donate blood, semen, or carry a donor card.
· Not share any needles or syringes.
· Cover cuts or wounds with a dressing.
· Not share toothbrushes, razors or other items that may be contaminated with blood.
· If any of your blood spills make sure it is cleaned away with bleach.
Immunisation
· Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. These include:
· Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries i.e. doctors, dentists, nurses, medical laboratory workers.
· Drug abusers and their sexual partners and children
· Promiscuous people who change sexual partners frequently
· People who live with someone infected with hepatitis B. This includes all prison inmates, families who adopt or foster a child may be offered immunisation when the hepatitis B status of the child is not known, people who live or work in residential accommodation for those with learning difficulties, travellers to countries where hepatitis B is common and undertake risky behaviour such as promiscuous sexual activity and injecting drugs.
· People who regularly get blood transfusions.
Post exposure prevention
· If you are not immunised and have been exposed to the virus you should seek medical advice immediately e.g. if you are a health worker and you have had a needlestick injury. An injection of antibodies called immunoglobulin and starting a course of immunisation may prevent the hepatitis B infection from developing.
· Preventing infection in newborn babies who are at risk
· All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, the baby will be given immunoglobulin injections and also immunised immediately after birth. The transmission of the virus to the baby is thought to mainly occur during childbirth and not during the pregnancy. With this treatment regime there is a good chance of preventing long-term infection developing in the baby.
What is the treatment of hepatitis B?
Treatment during the acute phase
No specific treatment can clear the hepatitis B virus. Drinking lots of water to avoid dehydration is a good start. In rare cases, severe hepatitis develops which may need specialist hospital care. There is unfortunately no treatment that can prevent acute hepatitis B infection from becoming chronic.
Treatment during the chronic infection
Not everyone with chronic infection needs treatment. It depends on how ‘active' the disease is. The main aim of treatment is to prevent active disease progressing to severe liver inflammation and cirrhosis. A liver specialist will advise on when treatment may help. Antiviral treatment does not work in every case and side-effects can be troublesome.
BMI The Edgbaston Hospital
22 Somerset Road
Edgbaston
B15 2QQ
Telephone: 0121 452 2815