Kia Saeian, MD, Medical College of Wisconsin Associate Professor of Medicine. Hepatitis B is very common in Southeast Asia and is also more common in the Asian population in the United States.
When people are infected with HBV they often feel tired, nauseated, and feverish. Some people have changes in the color of their urine (it turns dark yellow) or stools (the color is lighter than normal); and some have jaundice, in which the eyes and skin look yellowish. People with mild infection might not have any symptoms.
Usually, the initial hepatitis B infection resolves on its own after a few months. If it does not get better, it is called chronic HBV, which lasts a lifetime. People with chronic infection can infect others and are at increased risk of serious liver disease including cirrhosis and liver cancer.
The younger a person is, the higher their risk of progressing to chronic infection: according to the CDC, up to 90% of infants who get hepatitis B will progress to chronic infection, as will 30% of children aged 1-5 years. "In adults, about 90% get rid of the infection and develop immunity. About 10% go on to develop chronic infection," Dr. Saeian said.
How the Virus Spreads
HBV is typically spread when blood from an infected person enters the body of a person who is not infected. Less frequently it can be transmitted via semen or other body fluids. Hepatitis B can be spread from mother to child at birth, so it is very important for women who are pregnant to receive information on preventing transmission, Dr. Saeian said.
Certain populations are more at risk for acquiring HBV, including people who:
- have sex with someone infected with HBV
- have multiple sex partners
- are men who have sex with men
- share drug needles
- have a tattoo or body piercing done with dirty tools
- live in the same house with someone who has chronic HBV infection
- share a toothbrush or razor with an infected person
- have a job that involves contact with human blood
- get stuck with a needle that has infected blood on it (health care workers can get hepatitis B this way)
- are a client in a home for the developmentally disabled
- have hemophilia
- travel to areas where hepatitis B is common
Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing or by casual contact.
A simple blood test will show whether or not a person has the hepatitis B virus.
Prevention
"It is recommended that all children are vaccinated in this country," Dr. Saeian said, while explaining that in other countries where the vaccine was routinely recommended years ago, like Taiwan, the rates of liver cancer in children dropped dramatically. The number of reported cases of hepatitis B has steadily declined in the US from 260,000 new cases per year in the 1980s to about 60,000 in 2004.
Although the hepatitis B vaccine is recommended for all children, people of all ages can receive the vaccine.
"If you have a person in the household who is infected, the recommendation is for everyone in that household to be vaccinated and also receive immune globulin for the short term until the vaccine kicks in," Dr. Saeian said. Immune globulin works with the body's immune system to diminish the impact of the disease and provide short-term protection (about three months).
A related virus is hepatitis D, which is rare in the United States. "It's a separate virus, but it can't replicate itself unless hepatitis B is present. If you block hepatitis B (with the vaccine), you effectively block hepatitis D. The incidence is very low, predominantly in the intravenous drug user population." Dr. Saeian said if someone has hepatitis B and experiences liver failure, the physician might look for hepatitis D because it can cause a more significant amount of liver dysfunction.
In some people, hepatitis B never causes symptoms. "If you get hepatitis B and resolve it, you develop a surface antibody and are protected from hepatitis B and D for the rest of your life," Dr. Saeian said. Someone may have hepatitis B and never know it. "That's why it's called the silent epidemic," he said. "People die of other causes and never know they had hepatitis B. Especially in patients who don't drink alcohol, hepatitis can stay there a long time without causing cirrhosis. It may cause fatigue. It may cause abnormal liver tests. Or it may cause nothing."
Treatment
"We are a referral center for a lot of patients from across the state for hepatitis B and C," said Dr. Saeian of the Froedtert & Medical College of Wisconsin Hepatitis Treatment Program, located at Froedtert Hospital. "We have ongoing trials, and we also have a database where we try to come up with better means of managing patients with hepatitis B and hepatitis C long term."
Treatment for chronic hepatitis B typically involves a regimen of antiviral drugs; studies within the Hepatitis Treatment Program include additional treatments, "medications we think are going to improve the response rate," Dr. Saeian said.
In cases of advanced disease, liver transplants can save lives. Froedtert and the Medical College have performed over 500 successful liver transplants, says Dr. Saeian, and the availability of the transplant center helps improve outcomes for the sickest patients.
Dr. Saeian is the Program Director of the Gastroenterology and Hepatology Fellowship and Director of the Froedtert & Medical College Hepatitis Treatment Program. He practices at the Froedtert & Medical College of Wisconsin Gastroenterology and Hepatology Clinic.
This article includes information from the National Library of Medicine, the National Digestive Diseases Information Clearinghouse, and the National Center for Infectious Diseases.
Melissa Rigney Baxter
HealthLink Contributing Writer
For more information about hepatitis, see the HealthLink articles Handwashing and Vaccines Reduce Incidence of Hepatitis Aand Hepatitis C Virus Is a Leading Cause of Chronic Liver Disease.
Article Created: 2007-12-30
Article Updated: 2007-12-30
MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.
