Hepatitis B Testing

Activities That Spread Hepatitis B Include:

• Having sex with an infected person
• Using contaminated needles or syringes
• Sharing razors and toothbrushes with an infected person
• An infected mother giving birth
• Receiving blood transfusion
• Other contact with blood or open sores of an infected person

However, hepatitis B is not spread through hugging, coughing, sneezing, or breastfeeding. While kissing by itself does not spread hepatitis B, transmission of the virus is possible if rigorous kissing with dental appliances or braces causes bleeding. Hepatitis B is not spread through food and water.

Due to the way the virus is transmitted, these groups are at risk for hepatitis B:

• Infants born to mothers infected with HBV
• Sex partners of people infected with HBV
• People who live in the same household as others with hepatitis B
• Men who have sex with men
• Health care workers who may be exposed to blood or bodily fluids during their work
• People who inject drugs
• Patients on hemodialysis

Screening means getting tested for a disease before it starts to cause symptoms or serious health problems. The following groups should be screened for hepatitis B:

• Pregnant women
• Men who have sex with men
• People who inject drugs
• People with HIV
• People with evidence of liver damage
• Sex partners of people infected with hepatitis B
• People who live in the same household as others with hepatitis B
• Infants born to mothers infected with hepatitis B
• People born in countries where hepatitis B affects 2% or more of the population
• People with end-stage renal disease or who are on hemodialysis
• People who donate blood or tissue
• People on medications that suppress the immune system

Only 30 to 50% of people aged 5 years or older with acute hepatitis B have symptoms ⁽⁴⁾. Most younger children and people with low-functioning immune systems have no symptoms of the infection. When symptoms are present, they include:

• pale stools
• dark urine
• joint pain
• low appetite
• fatigue
• abdominal pain
• nausea and vomiting
• fever
• yellowing of the skin or eyes

On average, it takes 90 days for a new hepatitis B infection to cause symptoms, but this incubation period can be as short as 60 days or as long as 150 ⁽⁴⁾. When present, symptoms usually last for several weeks or months. The symptoms are usually mild, but in rare cases, can be severe enough to require care in the hospital. Symptoms of hepatitis B can persist for up to 6 months.

The risk of progressing from acute to chronic hepatitis B depends largely on the age when the infection started. Approximately 90% of infants born to infected mothers will develop chronic hepatitis B. The risk of progression is lower when the infection starts in older children (25-50%) and adults (5%) ⁽⁴⁾.
Chronic hepatitis B usually does not cause symptoms.

If the patient develops cirrhosis or liver cancer, potential symptoms ⁽⁵⁾⁽⁶⁾ include:

• Weight loss
• Swelling of the abdomen or lower legs
• Easy bruising or bleeding
• Itchy skin
• Dark urine
• Mental confusion

It is recommended to go to the ER or see a health care provider as soon as possible if you have these symptoms:

• Severe abdominal pain or vomiting
• New onset of yellow eyes or skin
• New onset of abdominal or leg swelling

The hepatitis B virus can damage the liver cells, which causes certain liver enzymes to leak out of the cells and into the bloodstream. The concentration of the liver enzymes is easily measured in a blood test.

Acute hepatitis B can progress to chronic hepatitis B.

Complications of untreated chronic hepatitis B include:

• Cirrhosis
• Liver cancer
• Death

Hepatitis B virus can reactivate after a previous period of inactivity, especially in patients with a weakened immune system or in those receiving treatment for hepatitis C (another virus that infects the liver).

Fulminant liver failure arises out of acute hepatitis B infection as well as reactivation of chronic hepatitis B. Although this complication is rare, hepatitis B is the most common viral cause of fulminant liver failure ⁽⁷⁾. The liver is severely damaged and does not function properly, resulting in rapid onset of symptoms such as the following:

• yellowing of the skin or eyes
• mental confusion
• bleeding
• swelling of the abdomen and/or lower legs

In some cases, patients with fulminant liver failure need to get a liver transplant.

Pregnant women can pass hepatitis to their infant. Reducing the mother-to-infant transmission has been a major focus of lowering hepatitis B rates.

Hepatitis B infection has several potential stages. Not everybody with the infection goes through all the stages.

A panel of blood tests will detect pieces of the hepatitis B virus (antigens) as well as antibodies that your body makes against the virus.

Possible test results ⁽⁴⁾ are:

• Hepatitis B surface antigen (HBsAg) is a protein on the surface of the virus. A positive result means the person is actively infected and can spread the virus to other people.
• Hepatitis B surface antibody (anti-HBs) is an antibody that your body makes to fight against hepatitis B. A positive result means that the person has had the disease, recovered, and is now immune from future hepatitis B infections. A positive result can also mean the person had the vaccine for hepatitis B.
• Total hepatitis B core antibody (anti-HBc) is an antibody that your body makes to fight hepatitis B. A positive result means that the person is currently or has been previously infected.
• IgM antibody to hepatitis B core antigen (IgM anti-HBc) is an antibody that your body makes during the early stages of infection. A positive result means that the person has acute hepatitis B and was infected within the last 6 months.
• Hepatitis B “e” antigen (HBeAg) is part of the virus. A positive result means that hepatitis B virus is replicating (making more copies of itself inside the person’s body). The person is actively infected and can spread the virus to other people.
• Hepatitis B “e” antibody (anti-HBe) is another antibody that your body makes to fight hepatitis B.

Health care providers determine the precise stage of hepatitis B infection by reviewing all the positive and negative results of the above tests as well as the patient’s medical history.

Before starting treatment for Hepatitis B, your health care provider may ask about the following:

• Symptoms
• Risk factors for hepatitis B such as sexual activity and injection drug use
• Hepatitis B in people whom you live with
• Prior liver disease and infections
• Other medical conditions
• Alcohol intake
• Travel history
• Current medications
• Allergies to medications
• Possibility of being pregnant. (You may be asked to take a pregnancy test.)

The health care provider may also run several tests:

• Liver enzymes
• Tests for other causes of liver disease
• HIV test
• Ultrasound or other imaging tests of the liver
• Biopsy of the liver (usually not needed)

The goals of treating chronic hepatitis B are to suppress the activity of the virus and reduce the risk for long-term complications. Currently available treatments can lower the virus DNA concentration but they do not completely remove the hepatitis B virus from the body.

There are 6 antiviral medications approved in the U.S. for treating chronic hepatitis B in adults ⁽⁸⁾:

• Interferon
• Lamivudine
• Telbivudine
• Entecavir
• Adefovir
• Tenofovir

When deciding on a treatment, health care providers must consider many factors such as the extent of liver damage, stage of the disease, amount and type of hepatitis B virus present, and the patient’s other medical issues.

During and after treatment, monitoring is performed on the hepatitis B DNA levels  and liver enzyme levels.

People with active hepatitis B infection should do the following to avoid further liver damage:

• Avoid drinking alcohol
• Ask your health care provider first before starting any new medications, even over the counter drugs or herbal supplements
• Get vaccinated for hepatitis A virus (another virus that can infect the liver)

A vaccine for hepatitis B is available. Vaccines work by stimulating your body to make antibodies against the virus to fight off the infection.

The hepatitis B vaccine is usually given as 3 doses — at month zero, one, and six. Some formulations combine the hepatitis B vaccine with vaccines for other infections.

For healthy people who get the vaccine when they’re older than 6 months, the vaccine protects against hepatitis B infection for 30 years or more ⁽⁴⁾.

The following people should have the hepatitis B vaccine ⁽⁴⁾:

• All infants
• Children younger than 19 years age who were not vaccinated as infants
• People who are at risk for hepatitis B from exposure to blood
  • Health care workers and public safety workers
  • Injection drug users
  • People living with HBsAg-positive individuals
  • People on dialysis
  • People with diabetes
  • Residents and staff of facilities for developmentally disabled people
• People who are at risk for hepatitis B from sexual activity
  • Sex partners of HBsAg-positive individuals
  • People with more than one sex partner during the previous 6 months
  • Men who have sex with men
  • Others at risk for sexually transmitted infection
• People traveling to countries where chronic hepatitis B is common (affecting at least 2% of the population)
• People with HIV
• People with hepatitis C (The goal of vaccination is to prevent further damage to the liver)
• Incarcerated people

The vaccine is safe to administer to pregnant women.

People who have been exposed to hepatitis B should start the vaccine series as soon as possible to reduce the chance of becoming infected. In the case of an infant being born to hepatitis B-positive woman, the infant should be given hepatitis B immune globulin as an additional step to reduce the chance of infection ⁽⁸⁾. The immune globulin contains large amounts of hepatitis B antibodies. There are other high-risk situations when the immune globulin should be given as well.

The U.S. has several strategies to reduce the overall population rate of hepatitis B ⁽⁹⁾:

• Screen of all pregnant women for hepatitis B and treat infants born to HBsAg-positive mothers
• Treat selected hepatitis B-positive pregnant women with antiviral medications
• Vaccinate all infants at birth
• Vaccinate previously unvaccinated children and adolescent
• Vaccinate adults at risk for hepatitis B infection

Certain practices are recommended for people with active hepatitis B infection (positive for HBsAg) to prevent transmission of the virus to others.

• Practice safe sex (e.g. condoms)
• Cover cuts and skin abrasions
• Do not donate blood, tissue, organs, or semen
• Do not share toothbrushes, razors, or needles

The role of antiviral treatment for acute hepatitis B has not been clearly determined.

Researchers continue to search for a cure for hepatitis B.

IMPORTANT:

Question: Why is the hepatitis B vaccine recommended for all infants?

Answer: Hepatitis B infection in infants poses a significant risk for chronic infection later. The vaccine is safe and effective for infants. Hepatitis B test results are not always available for pregnant women.