AUSTRALIAN GASTROENTEROLOGY INSTITUTE
(educational
arm of the Gastroenterological Society of Australia)
Website: www.gesa.org.au
... Copies reviewed January 2006
HEPATITIS B
An information leaflet for patients and interested
members of the general public
Prepared by the Digestive Health Foundation
Second Edition 2000
What is Hepatitis B?
Hepatitis is inflammation of the liver. It has
a number of different causes, but the most common is damage by a virus.
Hepatitis B is one of the viruses which can damage the liver. Others include the
hepatitis A, C, D and E viruses, and sometimes the Epstein-Barr (glandular
fever) virus and cytomegalovirus (CMV).
How does Hepatitis B virus damage the liver?
The hepatitis B virus (or HBV) multiplies in the liver cells. The body
then tries to get rid of the hepatitis B by killing the infected cells.
Ironically, it is the self-defence, or immune response which does the most
damage to the liver.
How is Hepatitis B spread?
Hepatitis B is spread by contact with blood and other bodily fluids,
usually through a breach in the skin or contact with internal lining surfaces of
the body. The various ways people can acquire hepatitis B include:
| |
1 |
From a carrier mother to her baby at around the
time of birth. This is the most common way for the virus to spread in
some parts of the world. |
| |
2 |
By use of injecting drugs (at any time in the past
or present). |
| |
3 |
By sexual contact. |
| |
4 |
By blood transfusion. This is fortunately
extremely rare these days, as blood in Australia is tested for hepatitis
B before it is transfused. |
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5 |
By tattooing with unsterilised needles. |
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6 |
By close family contact. |
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7 |
By accidental inoculation (ie. needlestick) or
splashing with infected blood or secretions (eg. some groups or health
care workers). |
What damage can Hepatitis B do?
The outcome of hepatitis B infection depends largely on the age at which
it is contracted. Babies, who are infected with the hepatitis B virus at birth,
almost always go on to become longterm ("chronic") carriers of the
virus. However the infection at birth is silent, and the babies appear healthy
and do not become jaundiced (turn yellow). Such people generally appear
perfectly healthy for many years, but after 20, 30, 40 or 50 years they can
become unwell. Chronic carriers who acquire their infection early in life have
an overall chance of approximately 25% of developing cirrhosis (scarring of the
liver) or even liver cancer during their lifetime.
If a teenager or adult becomes infected with the hepatitis B virus there is
about a 50% chance that they will become ill and develop jaundice (or turn
yellow). This illness is called acute hepatitis. However, in the other 50% of
cases, there is no jaundice and the infection is silent (or
"subclinical"). Adults have a good chance (between 90% and 95%) of
being able to get rid of the virus, or "clear" the virus from the
body. Individuals who have been infected and clear the virus are immune to the
disease and do not develop long-term liver damage.
The approximately 5-10% of adults who are unable to clear the virus become
long-term, "chronic" carriers. Generally such people remain in good
health for many years. However, there is an increased chance, that chronic
carriers of the hepatitis B virus (HBV) will develop cirrhosis (scarring of the
liver) or liver cancer over many years or decades.
How can the doctor tell if you are infected with HBV and whether you have
any liver damage?
There are many tests, which assist doctors in assessing liver damage, or
likelihood of future liver damage from hepatitis B. The interpretation of these
tests is not always straightforward, and sometimes specialist advice is needed.
Some of the more important tests are:
| |
1 |
Hepatitis B surface antigen: This is the test to
see whether or not you are infected with the hepatitis B virus. |
| |
2 |
Hepatitis B e antigen: This blood tests tell the
doctor whether or not the virus is continuing to multiply in the liver.
People who have HB e antigen are more infectious to others than those
who don't. They are also at greater risk of continued liver damage. |
| |
3 |
Hepatitis B virus DNA: This is another test for
activity or replication rate of the virus. |
| |
4 |
Hepatitis B surface antibody: This blood test is
positive if someone has had hepatitis B, cleared the virus, and is now
immune. People who have had successful hepatitis B vaccination also
usually have a positive hepatitis B surface antibody, indicating that
they are immune. |
| |
5 |
Liver function tests: Blood tests which give an
estimate of liver inflammation or damage. The "ALT" or
(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. |
| |
6 |
Liver ultrasound or scan: These tests use
inaudible sound waves (sonar) to give the doctor pictures of the liver
and can assist in diagnosing cirrhosis or liver cancer. |
| |
7 |
Liver biopsy: This is the removal of a tiny piece
of liver under local anaesthetic, and is used on occasions to assess
damage in the liver. |
| |
8 |
Alpha-fetoprotein: Is a blood test which can
sometimes detect liver cancer. |
Is there any treatment?
Those people who have immunity and normal liver functions tests do not
need any treatment. People who are chronic hepatitis B carriers without liver
damage do not require treatment. However if there is liver damage, the doctor
may consider using an anti-viral medicine. The antivirals are effective in about
30% of people who meet specific criteria. There are two main types of
antivirals: interferon and lamivudine. Interferon is given by injection for
about six months and has significant side effects. Longer duration of therapy or
re-treatment does not add any benefit. Lamivudine is a tablet with few side
effects and is well tolerated over extended therapy. However, the likely
duration of treatment is not easily predictable and most people need to be on
this drug for at least a year. Sometimes long-term treatment with lamivudine can
result in another strain of hepatitis B virus becoming detected. Currently this
other strain does not appear to be of major concern.
What else can be done to improve the liver?
Carriers of HBV should eat a normal healthy diet. Unless your doctor
suggests otherwise, alcohol should be minimised to one standard drink of alcohol
per day. People should avoid behaviour associated with contracting other
blood-borne viruses. (eg. they should practice safer sex and should not share
injecting equipment).
Do people with Hepatitis B need to stay under medical supervision?
People who are carriers of hepatitis B, but are thought to have very
little or no damage to their liver (ie. are HBe antigen and HBV-DNA negative),
have normal physical examination and normal ALT level, should still see their
doctor annually for a check-up. There is a small chance of ongoing liver damage
in these people, more so if the hepatitis B infection occurred at birth.
People who are thought to have liver damage from hepatitis B should see their
doctor regularly. Often the doctor will recommend a physical examination and ALT
level every 6 or 12 months. People who are hepatitis B e antigen positive are at
risk of continued liver damage and should definitely see their doctor at least
annually.
People who already have cirrhosis of the liver will generally be kept under
close supervision by their doctors. Sometimes regular ultrasound examinations
and alpha-fetoprotein levels are recommended. People with very advanced liver
disease may be referred to a liver transplant unit for discussion about liver
transplantation.
How can we stop the spread of Hepatitis B?
The most important step in preventing spread of hepatitis B is to arrange
for all susceptible close contacts (ie. family members, sexual contacts) to be
vaccinated against hepatitis B (see below). People with hepatitis B should also
follow the guidelines shown below.
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1 |
Do not donate blood, organs or any body tissue. |
| |
2 |
Do not allow your blood to contact anyone else's
blood |
| |
3 |
Tell health care workers (including dentists) who
are responsible for your care that you are hepatitis B positive. |
| |
4 |
Make sure anyone living in the same house as you
and who is not already immune, is vaccinated against hepatitis B - this
requires a course of 3 injections over 6 months. |
| |
5 |
Your children should be vaccinated. |
| |
6 |
Babies should be vaccinated FROM BIRTH with a
paediatric dose of hepatitis B vaccine. In addition, babies born to
carrier mothers should also receive a dose of hepatitis B immunoglobulin
as soon as possible after birth. |
| |
7 |
Regular sexual partners should be vaccinated.
Until they have completed the course of injections, and a follow up
blood test shows they are immune, you should practise safe sex. |
| |
8 |
For casual sexual contacts, you should practise
safe sex. This means condoms for all intercourse, and avoidance of
trauma or blood contact. |
| |
9 |
Cover all cuts etc, with adequate dressings. Do
not allow other people to touch your wounds without gloves on. |
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10 |
Dispose of blood-stained articles safely |
| |
11 |
Wipe up blood spills with concentrated household
bleach. |
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12 |
Do not share needles or any other injecting drug
equipment. |
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13 |
If your job involves potential for blood or other
body fluid spread to other people (eg. if you are a health care worker
involved in invasive procedures), you should consider your
responsibilities and discuss other career options with a counsellor or
your doctor. |
Tell me more about vaccination
The hepatitis B vaccine is very safe and relatively inexpensive. It is
also very effective and gives good immunity in 95% or more of the population.
Older people (ie. Over 40 years) are less likely to develop good immunity. The
vaccine is usually given in three injections over six months. People at high
risk of contracting hepatitis B need a blood test one month after the last dose
to see whether or not they are immune.
Should everyone be vaccinated against Hepatitis B?
The Digestive Health Foundation has a policy statement, which recommends
that all Australian babies, children and teenagers, and people at increased risk
of developing hepatitis B, are immunised against hepatitis B, as happens in many
other countries in the world. Until this happens, it is recommended that the
current National Health and Medical Research Council guidelines be followed.
These guidelines, which are currently under review, state that the following
broad categories of people should be vaccinated against hepatitis B (vaccination
should be requested from general practitioner or local council):
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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. |
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6 |
Sexually active homosexual or bisexual men. |
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7 |
Sex industry workers. |
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8 |
Injecting drug users. |
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9 |
Renal dialysis patients. |
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10 |
Clients and staff of institutions for the
intellectually disabled and those in close contact with the
de-institutionalised. |
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11 |
Aborigines and Torres Strait Islanders. |
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12 |
Haemophiliacs and others who can expect to receive
multiple blood or blood product transfusions, especially if these are
given overseas. |
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13 |
Prisoners and prison staff. |
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14 |
International travellers. |
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15 |
People playing contact sport. |
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16 |
Child care workers, staff of school. |
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17 |
Those with other liver diseases. |
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18 |
Embalmers. |
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19 |
People working in accident and emergency services. |
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Note: All pregnant women
should be tested for hepatitis B so that their babies can be vaccinated
against hepatitis B if the mother is a carrier. |
Further Questions ?
This leaflet cannot be completely
comprehensive, and is intended as a guide only. The information is current at
the time of printing, but may change in the future. If you have further
questions you should raise them with your own doctor. There are also Digestive
Health Foundation brochures available on hepatitis A and hepatitis C.
This leaflet is endorsed by the Australian Liver Association Printing and
distribution were sponsored by educational grants from Glaxo Wellcome Australia.
Further copies of these patient information leaflets on hepatitis B are
available from the Digestive Health Foundation, 145 Macquarie Street, Sydney,
NSW. 2000. Telephone (02) 9256 5455, Fax (02) 9241 4586. Website http://www.gesa.org.au
DIGESTIVE HEALTH FOUNDATION
The Digestive Health Foundation (DHF) is an
educational body committed to promoting better health for all Australians by
promoting education and community health programs related to the digestive
system.
The DHF is the educational arm of the Gastroenterological Society of Australia,
the professional body representing the Specialty of gastrointestinal and liver
disease in Australia. Members of the Society are drawn from physicians,
surgeons, scientists and other medical specialties with an interest in GI
disorders.
Since its establishment in 1990 the DHF has been involved in the development of
programs to improve community awareness and the understanding of digestive
diseases.
Research and education into gastrointestinal disease are essential to contain
the effects of these disorders on all Australians.
Guidelines for General Practitioners and patient leaflets are available on a
range of topics related to GI disorders. Copies are available by contacting the
Secretariat at the address below.
Digestive Health Foundation 145 Macquarie Street SYDNEY NSW 2000
Phone: (02) 9256 5454 Facsimile: (02) 9241 4586 E-mail: gesa@racp.edu.au
Website: http://www.gesa.org.au
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