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What is hepatitis B | STDs Test Center

What Is Hepatitis B ?​

hepatitis  B is a liver infection caused by the hepatitis B virus (HBV). The hepatitis B virus is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth. For some people, hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults. Chronic hepatitis B can lead to serious health issues, like cirrhosis or liver cancer. The best way to prevent hepatitis B is by getting vaccinated.

How many new HBV infections occur annually in the United States?

In 2017, a total of 3,407 cases of acute hepatitis B were reported to CDC The overall incidence rate for 2016 was 1.0 cases per 100,000 population. After adjusting for under-ascertainment and under-reporting, an estimated 22,100 acute hepatitis B cases occurred in 2017

What are the signs and symptoms of HBV infection?

      • fever
      • fatigue
      • loss of appetite
      • nausea
      • vomiting
      • abdominal pain
      • dark urine
      • clay-colored bowel movements
      • joint pain
      • jaundice

How is HBV transmitted?

HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen and saliva), including

      • sex with an infected partner;
      • injection drug use that involves sharing needles, syringes, or drug-preparation equipment;
      • birth to an infected mother;
      • contact with blood from or open sores of an infected person;
      • needle sticks or sharp instrument exposures; and
      • sharing items (e.g., razors and toothbrushes) with an infected person.

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

How long does HBV survive outside the body?

HBV can survive outside the body at least 7 days and still be capable of causing infection

Who is at risk for HBV infection?

The following populations are at increased risk for becoming infected with HBV:

      • infants born to infected mothers,
      • sex partners of infected persons,
      • men who have sex with men,
      • injection-drug users;
      • household contacts or sexual partners of known persons with chronic HBV infection;
      • health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids, and
      • hemodialysis patients.

Who should be screened for HBV?

Screening should include testing for three HBV screening serum markers (HBsAg, antibody to HBsAg [anti-HBs], and antibody to hepatitis B core antigen [anti-HBc]) so that persons can be classified into the appropriate hepatitis B category and properly recommended to receive vaccination, counseling, and linkage to care and treatment

People who should be screened for HBV:-

      • People born in countries with 2% or higher HBV prevalence
      • Men who have sex with men
      • People who inject drugs
      • HIV-positive persons
      • Household and sexual contacts of HBV-infected persons
      • People requiring unimpressive therapy
      • People with end-stage renal disease (including hemodialysis patients)
      • Blood and tissue donors
      • People with elevated alanine aminotransferase levels (>19 IU/L for women and >30 IU/L for men)
      • Pregnant women (HBsAg only is recommended)
      • Infants born to HBV-infected mothers (HBsAg and anti-HBs are only recommended)

What is the incubation period for hepatitis B?

If symptoms occur, they begin an average of 90 days (range: 60–150 days) after exposure to HBV 

How is HBV infection treated?

For chronic infection, several antiviral medications are available. People with chronic hepatitis B infection require linkage to care with regular monitoring to prevent liver damage and/or hepatocellular carcinoma. 

Who should be vaccinated against hepatitis B?

The Advisory Committee on Immunization Practices (ACIP) recommends that the following people receive hepatitis B vaccination:

  • All infants
  • Unvaccinated children aged <19 years
  • People at risk for infection by sexual exposure
      • Sex partners of hepatitis B surface antigen (HBsAg)–positive people
      • Sexually active people who are not in a long-term, mutually monogamous relationship (e.g., people with more than one sex partner during the previous 6 months)
      • People seeking evaluation or treatment for a sexually transmitted infection
      • Men who have sex with men
  • People at risk for infection by per-cutaneous or mucosal exposure to blood

      • Current or recent injection-drug users
      • Household contacts of people who are HBsAg-positive
      • Residents and staff of facilities for developmentally disabled people
      • Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
      • Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
      • People with diabetes aged 19–59 years; people with diabetes aged ≥60 years at the discretion of the treating clinician
  • International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of ≥2%)
  • People with hepatitis C virus infection
  • People with chronic liver disease (including, but not limited to, people with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
  • People with HIV
  • People who are incarcerated
  • All other people seeking protection from HBV infection

Should pregnant women be tested for HBV?

Yes. Women should receive HBsAg testing during each pregnancy, and those who are HBsAg-positive should have HBV DNA testing.

Can hepatitis B vaccine be given during pregnancy or lactation?

Yes. The hepatitis B vaccine contains no live virus, so neither pregnancy nor lactation should be considered a contraindication to vaccination of women. On the basis of limited experience, there is no apparent risk of adverse effects to developing fetuses when hepatitis B vaccine is administered to pregnant women. Meanwhile, new HBV infection in a pregnant woman might result in severe disease for the mother and chronic infection for the newborn. Pregnant women who are identified as being at risk for HBV infection during pregnancy should be vaccinated and counseled concerning other methods to prevent HBV infection. Pregnant women may be at increased risk for hepatitis B if they:-

      • have had more than one sex partner during the previous 6 months,
      • are being evaluated or treated for a sexually transmitted infection,
      • have had recent or current injection-drug use, or
      • Have had an HBsAg-positive sex partner.

References

      1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2017. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019. Available at: https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm.
      2. Gomes, T., et al., The Burden of Opioid-Related Mortality in the United States. JAMA Netw Open, 2018. 1(2): p. e180217. Available from PubMed Central PMC6324425external icon
      3. Patel EU, Thio CL, Boon D, Thomas DL, Tobian AA. Prevalence of hepatitis B and hepatitis D virus infections in the United States, 2011-2016external icon. Clin Infect Dis. 2019 Jan 3.
      4. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology 2012;56(2):422-33.
      5. Bond WW, Favero MS, Petersen NJ, Gravelle CR, Ebert JW, Maynard JE. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981;1(8219):550-1.
      6. Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM, High Value Care Task Force of the American College of P, et al. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167(11):794-804.
      7. LeFevre ML. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine. 2014;161(1):58-66.
      8. Lok AS, McMahon BJ. AASLD practice guideline update. Hepatology. 2009.
      9. Weinbaum CM1 WI, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel SM, Ward JW. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. Morbidity and Mortality Weekly Report 2008;19(57 (RR-8)):1-20.
      10. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48(2):335-52.