Resources for Patients: Overview

What is hepatitis?

Hepatitis is a condition when the liver is swollen or inflammed. It is commonly caused by the hepatitis viruses (Hepatitis A, B, and C), heavy alcohol intake, some toxins and drugs, other systemic diseases and infections.

What are the differences among Hepatitis A, Hepatitis B and Hepatitis C?

Hepatitis A, Hepatitis B and Hepatitis C are three types of viral Hepatitis that may have similar symptoms and manifestations but are caused by three different viruses.

Hepatitis A infection is acquired through intake of contaminated food and drink. It is self-limiting and usually resolves without specific treatment. It is an acute infection (meaning it is newly acquired) and does not cause people to become carriers of the virus for a long time. On the other hand, Hepatitis B and Hepatitis C  are infections that can be acquired from infected blood and body fluids. It can also begin as acute infections, but in some, the virus remains in the body causing lifelong infection that may cause complications in the liver such as liver cirrhosis (scarring of the liver) and liver cancer (tumor of the liver). Hepatitis A and B can be prevented thru effective and safe vaccines. While there is no vaccine for Hepatitis C, its spread can be prevented by avoiding contact with infected blood and body fluids.

What is Hepatitis B?

Hepatitis B is an infectious disease of the liver caused by the Hepatitis B Virus.  In the acute (newly-acquired) phase, the symptoms may be similar to having the flu and some, but not all, can have jaundice (yellowing of the eyes and skin). In some patients, Hepatitis B can become “chronic”, meaning it can be a long term or life-long infection. Persons with chronic hepatitis B infection are at risk for liver cirrhosis and liver cancer.

How common does chronic or life-long infection develop in a person infected with hepatitis B?

It depends on the age that one becomes exposed to or infected. The younger a person is when infected, the higher the chance that he or she will have life-long infection with the virus.

• 90% of infected infants will develop chronic infection.
• Approximately 25%–50% of children infected between the 1 -5 years of age will develop chronic infection.
• The risk drops to 6%–10% when one is infected over 5 years of age.
• In the Philippines and worldwide, most people with chronic hepatitis B acquire the infection at birth or during early childhood.

Statistics How common is chronic hepatitis B in the world?

Hepatitis B affects approximately 350 million people worldwide and contributes to an estimated 780,000 deaths each year.

How common is hepatitis B in the Philippines?

Hepatitis B is a major public health problem in the Philippines. An estimated 7.3 million adult Filipinos (16.7% of the adult population) are chronically infected making our country hyperendemic for hepatitis B. This rate is extremely high compared to other countries and is more than double the 8% average prevalence of HBV infection in the Western Pacific region. A 2003 survey showed the prevalence of hepatitis B to be highest in the 20-49 year age group, which comprise the workforce or those entering the workforce.

Transmission / Exposure How can one get Hepatitis B?

Hepatitis B is spread thru blood, semen, or other body fluids. A person may acquire the infection thru the following activities:

• Birth (spread from a hepatitis B positive mother to her baby)
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment with an infected person
• Sharing razors, nail clippers/manicure or pedicure paraphernalia or toothbrushes with an infected person
• Direct contact with the blood or open wounds of an infected person
• Exposure to blood from needlesticks or other sharp instruments

Can a person unknowingly spread hepatitis B?

Yes, because many of those infected have no symptoms. An infected person can appear and feel normal.  Even without symptoms, people can spread the infection thru the activities or practices mentioned above.

Can one get hepatitis B with unprotected sex?

Yes. In fact, Hepatitis B is 50 to 100 times more infectious than HIV and can be passed through semen, vaginal fluids, and blood.

Can hepatitis B be spread through food?

No.Unlike Hepatitis A, it is not spread through food or water.

What are ways hepatitis B is not spread?

Hepatitis B is not spread by sharing utensils, sharing drinks,  breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

Can the hepatitis B virus survive outside the body?

The Hepatitis B virus can survive in the environment for at least 7 days.

Who are at risk for hepatitis B?

Since the Philippines is considered a hyperendemic area for hepatitis B, almost everyone without the antibody or vaccine can become infected. The following people are at greater risk:

• Infants born to infected mothers
• People who have sex with an infected partner
• People who have multiple sex partners
• People who have a sexually transmitted disease
• Men who have sexual contact with other men
• People who inject drugs or share needles, syringes, or other drug equipment
• People who live in the same household with an infected individual
• Those who work in occupations where they are exposed to infected blood and body fluids
• Hemodialysis patients

I am worried that I may have been exposed to the hepatitis B virus, what should I do?

If you believe that you might have been exposed to the virus, see your doctor. It can be prevented by getting the hepatitis B vaccine with an additional shot called HBIG (Hepatitis B Immuneglobulin) within 24 hours of exposure. If I have recovered from acute hepatitis B and develop the antibody can I still get it? No, if you recover from acute hepatitis B, you develop antibodies that protect you from the virus for life. An antibody is a substance in the blood made by our immune system upon exposure to a virus. Antibodies protect us by destroying the virus. Unfortunately, some infected people are not able to produce antibodies to clear the virus from their bodies and carry the virus for life. If I have hepatitis B, can I be a blood or organ donor?  No, if you have ever tested positive for the Hepatitis B virus, it is recommended that you should not donate blood, organs, or even semen because this can put the recipient at great risk for getting hepatitis B.

Symptoms

What are the symptoms of acute hepatitis B infection?

Not everyone develops symptoms. Although majority of adults (70%) develop symptoms, many young children do not. Adults and children over the age of 5 years are more likely to have symptoms.

Symptoms include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pains
• Jaundice (yellow color in the skin or the eyes)  

How soon after exposure to hepatitis B will symptoms appear?

Symptoms can appear 3 months after exposure to the virus, but can appear any time between 6 weeks and 6 months after exposure.

After infection, how long can acute hepatitis B symptoms last?

People usually have symptoms for a few weeks, but some people can feel ill for as long as 6 months.

Can a person spread hepatitis B without having symptoms?

Yes. Many people with Hepatitis B look and feel healthy and have no symptoms, but they can still spread the virus.

What are the symptoms of chronic hepatitis B?

Most people have no symptoms and feel healthy for many years. About 15% to 25% develop complications in the liver, such as cirrhosis or liver cancer.  In the early stages of liver cirrhosis and liver cancer, patients may remain to have no symptoms. However, tests for liver function and a liver ultrasound may begin to show some abnormalities.

How serious is chronic hepatitis B?

It is a serious infection that can result in liver damage, liver failure, liver cancer, and death. Liver cancer is the third most common cancer in the Philippines, affecting over 7,000 new people each year. Liver cancer is fatal when diagnosed late and left untreated, making it the second leading cause of cancer deaths in the country.

Tests

How will I know if I have hepatitis B?
Talk to your doctor about testing for Hepatitis B. Doctors may order one or more blood tests to check if you:

• have acute or chronic infection
• have recovered from infection
• are immune to hepatitis B
• need to be vaccinated

What are the common blood tests to diagnose hepatitis B?

There are several blood tests your doctor can request for to diagnose hepatitis B. Listed below are some common tests and what they mean. It is important that you ask your doctor for the proper interpretation of your test results.

Treatment

How is acute hepatitis B treated?

Treatment is mostly supportive in the form of rest, adequate nutrition and hydration. In some cases, hospitalization is needed particularly for those who are unable to eat due to vomiting and lack of appetite. Some develop signs of liver failure such as disorientation, confusion or even coma needing urgent hospitalization. These patients may be given antiviral drugs and may need to be evaluated for a liver transplant.

How is chronic hepatitis B treated?

There are several drugs available. The choice depends on several factors. Ask your doctor what is the most appropriate drug for you. However, not all patients need to be treated. Patients should be evaluated by doctors experienced in the management of hepatitis B such as internists, pediatricians, gastroenterologists, hepatologists, and infectious disease specialists.  You can click on this link to gain access to the Hepatology Society of the Philippines (HSP) website. People with chronic hepatitis B, even those without symptoms, need long term monitoring for the early detection of complications in the liver such as cirrhosis and liver cancer. 

How can you help keep your liver stay healthy if you have hepatitis B?

People infected with hepatitis B should have regular check-ups with their doctors.  Alcohol intake should be avoided as this can aggravate liver damage. Infected individuals need to consult their doctor before taking any medications, herbal supplements, and over-the-counter medicines.  Obesity, diabetes and cholesterol problems need to be managed. Patients who do not have protective antibodies (anti-HAV IgG negative or non-reactive) to hepatitis A should be vaccinated.

Prevention / Vaccination

How can hepatitis B be prevented?

There is a safe and effective vaccine to protect yourself from hepatitis B. The vaccine is given as a series of 3 shots over a period of 6 months. It stimulates  the body’s immune system to produce antibodies that protect against the virus. In the Philippines, hepatitis B immunization is included in the Maternal, Newborn, Child Health and Nutrition (MNCHN) Package of the Department of Health (DOH). Republic Act 10152 (An Act Providing for Mandatory Basic Immunization Services for Infants and Children) provides free hepatitis B vaccination and is mandatory to all infants. To increase its effectiveness in preventing transmission of the virus, the first dose should be given to newborns within the first 24 hours of life.

For babies born to mothers infected with hepatitis B, an additional shot called HBIG (pre-formed antibodies against the virus) should also be given shortly after birth.

Who should get vaccinated against hepatitis B?

Because of the high rates of hepatitis B infection in the Philippines, universal vaccination is mandated. 

Hepatitis B vaccination is especially recommended for:

• All infants, starting with the first dose of the vaccine within 24 hours of birth
• All children and adolescents younger than 19 years of age who have not been vaccinated
• People whose sexual partners have Hepatitis B
• Sexually active persons who have multiple partners
• Persons undergoing treatment for sexually transmitted diseases
• Men who have sexual contact with other men
• People who share needles, syringes, or other drug equipment
• People who have close household contact with someone infected
• Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
• People with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Residents and staff of facilities for developmentally disabled persons
• People with chronic liver disease  (aside from Hepatitis B)
• People with HIV infection
• Anyone who wishes to be protected from hepatitis B virus infection

When should a person get the hepatitis B vaccine series?

Children and Adolescents:

• All children should get their first dose of the vaccine at birth ( or at least within 24 hrs of birth)  and complete the vaccine series by 6–18 months of age.
• All children and adolescents younger than 19 years of age who have not yet received the vaccine should be vaccinated. “Catch-up” vaccination is recommended for those who were never vaccinated or those who did not complete the vaccine series.

Adults:

• Any adult who wants to be vaccinated should talk to their doctor about getting vaccinated.

Is the hepatitis B vaccine effective? 

Once the prescribed vaccination series has been completed, the vaccine gives greater than 90% protection to those immunized.

Is the hepatitis B vaccine safe?

The hepatitis B vaccine is safe. Soreness at the injection site is the most common side effect reported. Over 1 billion doses of the Hepatitis B vaccine have been used worldwide. The safety of the vaccine has been evaluated by many leading health authorities including the WHO and the United States Institute of Medicine. 

I cannot remember how many doses of the hepatitis B vaccine I have received, is it bad to get extra doses of Hepatitis B vaccine?

No, getting extra doses of hepatitis B vaccine is not harmful.

Who should not receive the hepatitis B vaccine?

The hepatitis B vaccine is not recommended for people who have had a serious allergic reaction to a prior dose of the vaccine or to any component of the vaccine. It is not recommended for people allergic to yeast because yeast is used when the vaccine is made. Inform your doctor if you have any severe allergies.

Those who are infected with the virus should not receive the vaccine.  It will no longer be helpful if one is already infected. 

When are booster doses of hepatitis B vaccine necessary?

A “booster” dose is given to increase or extend the effectiveness of the vaccine. They are particularly recommended for patients undergoing hemodialysis or other people with compromised or “weak” immune system. 

Pregnancy and Hepatitis B

Should all pregnant women be tested for hepatitis B?

Yes. Hepatitis B testing should be included in routine prenatal examinations. Knowing whether a pregnant mother has hepatitis B is important because transmission of the virus can be prevented by giving her newborn infant the HBIG and the first dose of the vaccine within 12 to 24 hours of birth. Completion of the vaccine series should be done as prescribed. 

What if a pregnant woman has hepatitis B?

If a pregnant woman has hepatitis B, she can transmit the infection to her baby during birth. But this can be prevented through giving the first dose of the vaccine and HBIG to her baby as soon as possible within 12 to 24 hours of birth. Without vaccination, babies born to women with Hepatitis B can develop chronic or life-long infection, which can lead to serious complications in their liver.

How does a baby get hepatitis B?

A baby can get hepatitis B from an infected mother during childbirth.

What happens if a baby gets hepatitis B?

Most newborns who become infected do not have signs or symptoms, but have a 90% chance of developing chronic or life-long hepatitis B. This can lead to liver cirrhosis, liver cancer, and even death.

Do babies need the hepatitis B vaccine even if a pregnant woman does not have hepatitis B?

Yes. The hepatitis B vaccine is recommended for all infants. Republic Act 10152 mandates the administration of three hepatitis B vaccines for all newborn infants starting at birth and over a period of 6 months. Why is the hepatitis B vaccine recommended for all babies? It is recommended for all babies  because it protects them from acquiring the infection and thus prevent them from developing serious liver disease as they get older. Compared to adults, babies and young children are more likely to develop life-long infection and  the vaccine is effective in preventing  this.

Hepatitis B and Getting Employed

Because hepatitis B is transmitted through blood and body fluids, it is not spread through usual workplace activities. The current practice of screening for HBsAg as a basis for employment has no evidence except in certain occupations in the health care setting which pose a high risk of transmission because it involves exposure to potentially contaminated blood and body fluids.

Being positive for HBsAg alone should not be a basis for discrimination, work restriction and disqualification from employment.  Job applicants should not be declared unfit to work without a proper medical evaluation and counseling.

For further guidance, refer to the Department of Labor and Employment Advisory No. 05 (series of 2010) on the Guidelines for the Implementation of a Workplace Policy and Program on Hepatitis B.  Furthermore, the Hepatology Society of the Philippines (HSP) also formulated guidelines for physicians involved in the evaluation of HBsAg positive workers for employment.  These guidelines can be downloaded from the HSP website http://www.liverphil.org/guidelines.php