Hepatitis B is a virus that attacks the liver. Worldwide, it is a common infection and in the United States there are an estimated 1.25 million affected individuals. Hepatitis B virus infection can harm the liver in many ways. The virus can cause liver damage (cirrhosis) and it can also cause liver cancer. However, medical treatment can help prevent these complications.
Persons infected with hepatitis B virus can transmit the virus to other people. The hepatitis B virus is spread by one of the following ways: from mother to fetus during/after pregnancy (perinatal); exposure to blood and bodily fluids including breast milk, urine, sweat, and tears; or sexual contact. The virus is most concentrated in infected blood, serum, and wound exudates. The most common ways the virus is spread are through exposure to blood or other bodily fluids of an infected person. The virus can also be spread by activities such as sharing toothbrushes or towels with an infected person.
If you or your child has hepatitis B virus infection it is important to make sure that everyone in the household is tested to see if they have the virus since the virus can easily be spread among household contacts. All household contacts should receive the hepatitis B vaccine in order to protect themselves.
A simple blood test ordered by your child's doctor can tell if your child has the infection. Your child's doctor will check to see whether your child has an active infection. It is possible to be infected with hepatitis B virus but not know it. Often, people who are infected with hepatitis B virus do not have any symptoms when they contract the virus. This is why hepatitis B virus infection is often called the "silent infection".
The majority of people infected with hepatitis B virus will not have any symptoms or will not have severe symptoms. The common symptoms experienced can include: loss of appetite, fever, fatigue, muscle or joint pain, nausea and vomiting. The more severe symptoms can include: nausea, vomiting, yellowing of the skin or eyes (jaundice), bloating of the abdomen and light colored stools. Teenagers and adults experience symptoms more often than infants and children.
A person who has recently contracted the hepatitis B virus will have an acute infection. Acute hepatitis B virus infection presents following a long incubation period. During this time the infected person may or may not have symptoms but is able to pass the virus to others. If a person has an acute infection blood work will show a positive test for hepatitis B virus (HBsAg), HBc-IgM DNA and possibly the HBe-antigen. If a person has an acute infection, they will need to have follow-up blood work to show if they have total recovery or have developed a chronic infection. If after 6 months blood tests are negative for surface antigen and hepatitis B DNA then the acute infection is considered to be resolved. A person who clears an acute hepatitis B virus infection is now protected from the virus and is unlikely to contract it again. There is no treatment for acute hepatitis B virus infection.
A person who tests positive for hepatitis B virus (HBsAg) over a period more than 6 months is diagnosed as having a chronic infection. A person with a chronic infection was not able to get rid of the virus during the acute infection stage, and the virus remains in their blood and liver. A person with a chronic infection can pass the virus to others. People with chronic hepatitis B virus infection may also be without symptoms. Those who are diagnosed with chronic hepatitis B virus infection are at an increased risk for developing serious liver problems like cirrhosis or liver cancer. Treatments are available which can slow down the rate the virus progresses and help to prevent liver damage. The first two treatments to be approved in the United States are Interferon alpha and Lamivudine. Currently, many new therapies are in development or starting to be marketed. Treatment can take upwards of 1 year to complete. Not all children with chronic hepatitis B virus infection are candidates for treatment. Your child's hepatologist (liver specialist) will determine if your child is a candidate for treatment based on laboratory test results and a physical examination.
The Viral Hepatitis Clinical Care Program participates in a number of treatment trials for children with chronic infection involving both approved and experimental treatments. To learn more about the treatment trials offered at Children's Hospital of Philadelphia or about trials in your area please visit www.clinicaltrials.gov. It is important to remember that children with chronic HBV infection can lead a normal life like their peers. Unlike some other chronic conditions chronic HBV infection should not interfere with your child's ability to do things most children that age can do.
Transmission of the hepatitis B virus can be prevented. A safe and highly effective vaccine is available. The vaccine is administered as a series of three shots. The recommended schedule for infants is first dose at birth, second dose between 1-2 months, and third dose between 4-6 months. A two dose series is available for teenagers ages 11 -15 years who have not previously received the vaccine. Your child's pediatrician can advise you on the routine vaccination schedule for your child. People who complete the three dose series typically have 96% immunity from the virus. The vaccine works by creating antibodies to the hepatitis B virus; this means the body becomes immune (can not catch) to the virus.
You can find out more about the vaccine on the Hospital's Vaccine Education Center site.
If you are pregnant and are a carrier of the hepatitis B virus it is very important that you tell your doctor before delivering your baby. If appropriate precautions are taken it is likely that your newborn will not contract the infection perinatally (after birth).