ABOUT HEPATITIS B
Hepatitis B is a potentially serious, but vaccine preventable infection of the liver caused by the hepatitis B virus (HBV) and is the leading cause of liver cancer in the world.
About 1 in 30 people in the world (approximately 300 million) is living with chronic hepatitis B infection. Most of them became infected because they were not vaccinated or offered hepatitis B vaccination at birth.
NEWBORNS ARE MOST VULNERABLE
Anyone who is not properly vaccinated against HBV can become infected. Whether one gets sick from HBV is related to the age of infection. Age also plays a role in whether hepatitis B will become a chronic infection. The younger a person is when infected with the hepatitis B virus, the greater the chance of developing chronic infection.
Newborns who become infected from mother-to-child transmission generally have few or no symptoms, but they have the highest risk of developing a life-long chronic infection that can cause liver inflammation, and the risk of premature death from cirrhosis and liver cancer later in life.
When adults become infected, about 30-50% will become sick and develop symptoms including fatigue, loss of appetite and jaundice from liver inflammation, and 0.5% - 1% can die of liver failure. However, most adults will clear the virus and only 2 -6% will develop chronic hepatitis B infection.
Since most of the deaths and complications of HBV infection occurs in persons with chronic hepatitis B infection, prevention of chronic hepatitis B infection through newborn and infant immunization is the pillar of the global hepatitis B elimination strategy.
of infected newborns will develop chronic hepatitis B infection
of infected adults will develop chronic
hepatitis B infection
HOW IS HEPATITIS B
REMEMBER YOUR BBS
An infected mother can transmit hepatitis B to the newborn during the birthing process.
For Asians, this is the most common mode of transmission.
Hepatitis B can be transmitted through infected blood.
Reusing or sharing needles for tattoos, piercings, acupuncture, or injection drugs.
Sharing razors or toothbrushes contaminated by blood.
Reusing syringes or medical devices.
Unsafe blood transfusion.
Hepatitis B can be transmitted through unprotected sex with an infected person.
The use of condoms can reduce the chances of contracting hepatitis B,
but it does not completely eliminate the risk of infection.
- Hepatitis B vaccine is the most effective way to be protected from HBV.
There are many common misconceptions about how hepatitis B is transmitted. Ways that hepatitis B are not transmitted include:
Sharing food or water
Sharing eating utensils or drinking glasses
Coughing or sneezing
Hugging or kissing
Tears, sweat, urine, or stool
PERSONS WITH CHRONIC HEPATITIS B ARE PROTECTED FROM DISCRIMINATION IN THE UNITED STATES
In some countries, misinformation about the ways hepatitis B is transmitted has led to cases of discrimination against those who are infected. In the U.S., individuals with chronic hepatitis B infection are protected from discrimination by the Americans with Disabilities Act.
SCREENING AND SYMPTOMS OF
CHRONIC HEPATITIS B INFECTION
Hepatitis B can live silently in a person for many years before symptoms develop. Many people living with chronic hepatitis B infection are not aware of their infection because most of them do not experience any symptoms, and even their blood tests for liver function can be normal.
A blood test for hepatitis B surface antigen (HBsAg) is the best way to diagnose whether a person has chronic hepatitis B infection.
PRENATAL SCREENING FOR
CHRONIC HEPATITIS B INFECTION
To prevent mother-to-child transmission of hepatitis B, the US Centers for Disease Control and Prevention (CDC) recommends all women in their first trimester (3 months) of pregnancy should have a prenatal hepatitis B surface antigen (HBsAg) blood test to screen for chronic hepatitis B infection.
Prenatal hepatitis B screening is recommended with each pregnancy even if you have previously been tested or vaccinated.
If you test positive for HBsAg, it would imply that you are a hepatitis B carrier and have chronic hepatitis B infection.
If you are not already under the care of a doctor for hepatitis B care or treatment, ask your obstetrician to refer you to a doctor or specialist with expertise in the management of hepatitis B while you are pregnant and for long-term monitoring afterwards.
It is safe for women with chronic hepatitis B infection to become pregnant. During your pregnancy, your doctor will order additional blood tests to protect you and your baby from hepatitis B:
HBV DNA LEVEL AND
to assess how much virus is in your blood and whether antiviral medication is recommended to further reduce the risk of the newborn becoming infected.
to assess whether you have active liver inflammation caused by the hepatitis B virus that would require antiviral treatment.
ANTIVIRAL THERAPY WITH TENOFOVIR
There are 3 instances when tenofovir therapy is appropriate during pregnancy.
If you were receiving oral antiviral therapy for treatment of chronic hepatitis B before you found out you were pregnant, talk to your doctor to see whether you should continue treatment during your pregnancy. In general it is safe to continue to take tenofovir particularly after the first 12 weeks of pregnancy. Stopping therapy run the risk of flare up of the hepatitis.
If your monitoring blood tests for ALT and HBV DNA levels showed you have evidence of active liver inflammation that would require treatment.
If your antenatal HBV DNA level is very high (over 200,000 IU/mL) which increases the risk of mother-to-child transmission.
Entecavir (the other first line drug to treat chronic hepatitis B) therapy is not approved for pregnant women.
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (PMTCT)
Women with chronic hepatitis B can have a normal pregnancy and give birth to healthy babies. Delivery by Cesarean section does not prevent or reduce the risk of mother-to-child transmission of hepatitis B.
The Hepatitis B vaccine is the
first anti-cancer vaccine
Hepatitis B vaccination is safe and effective and will protect the infant from hepatitis B infection and liver cancer caused by hepatitis B.
Non-vaccinated infants born to HBsAg positive mothers have an 80-90% chance of developing chronic hepatitis B infection .
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HEPATITIS B:
A few simple steps will protect your baby from hepatitis B
For pregnant women with HBV DNA level greater than 200,000 IU/mL
• antiviral therapy with tenofovir (TDF), a pill a day, is recommended starting at 28-32 weeks of pregnancy until 1 month after giving birth as an additional precaution to prevent mother-to-child transmission of hepatitis B.
For pregnant women who are already on antiviral treatment before they became pregnant
• recommend consulting the prescribing doctor to discuss whether to continue treatment or change medication. (Stopping antiviral treatment can result in hepatitis flare. Women on entecavir are recommended to switch to tenofovir because entecavir is not approved for treatment in pregnant women.)
Make sure as soon as the newborn is stable and within 12 hours after birth, the baby receives 2 shots:
• The first hepatitis B vaccine dose (birth dose)
• Hepatitis B immune globulin (provides additional short-term protection against hepatitis B)
ENSURE YOUR BABY COMPLETES
THE VACCINE SERIES TO BECOME PROTECTED
Infants with low birth weight (less than 2000 grams) will need an additional hepatitis B vaccine dose.
Infants receiving the hepatitis B vaccine should be given
• the second and third dose at age 1-2 months and 6 months.
Infants with low birth weight (less than 2000 grams) will need an additional hepatitis B vaccine dose given at age 1 month or at hospital discharge.
Infants receiving Pediarix (combination Hepatitis B, diphtheria, tetanus, polio, and pertussis vaccine)
should be given
• the second, third and fourth dose at age 2, 4 and 6 months
WHEN YOUR BABY IS
9-12 MONTHS OLD
Make sure your baby is protected from hepatitis B with a blood test for hepatitis B surface antigen and hepatitis B surface antibody.
HEPATITIS B SURFACE ANTIGEN (HBsAg)
A negative hepatitis B surface antigen test means the baby has not become chronically infected with HBV.
HEPATITIS B SURFACE ANTIBODY (ANTI-HBs)
A positive hepatitis B surface antibody test with a level of 10 IU/mL or greater and a negative test for HBsAg would confirm that the baby is protected from HBV.
BOTH HBsAg AND ANTI-HBs ARE NEGATIVE
The baby is not infected or protected and should be revaccinated with 1 -3 hepatitis B vaccine dose and get retested.
HBV is not transmitted through breast milk.
Risk of mother-to-child transmission of hepatitis B through breastfeeding is negligible if the newborn received hepatitis B vaccine and hepatitis B immune globulin.
There is no need to delay breastfeeding until the baby has completed the hepatitis B vaccine series.
Since HBV can be transmitted by infected blood, mothers with cracked nipples are recommended to stop breastfeeding temporarily until the nipples are healed.
BREASTFEEDING IS SAFE
PROTECT YOURSELF FROM HEPATITIS B
Not everyone with chronic hepatitis B infection will develop liver cirrhosis or liver cancer or require antiviral drug treatment. Most if not all of the complications and deaths from chronic hepatitis B can be prevented with regular monitoring and antiviral therapy when indicated.
Regular monitoring is recommended every 6-12 months to monitor for disease progression and to assess whether antiviral therapy is indicated:
blood level of ALT for active liver inflammation
alpha fetoprotein level for for liver cancer surveillance
HBV DNA level for viral activity
Liver ultrasound for liver cancer screening if you have cirrhosis or have a first degree family member with history of liver cancer or after you turn 50 years old
Oral antiviral therapy with tenofovir or entecavir is recommended when there is evidence of:
active liver inflammation
cirrhosis or severe fibrosis
or if you receive cancer or immunosuppressive or hepatitis C treatment to prevent hepatitis flare (reactivation)