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Hepatitis B

What is hepatitis B?

Hepatitis B is a serious disease caused by a virus that attacks the liver. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong infection potentially resulting in cirrhosis (scarring) of the liver, liver cancer, liver failure and death.

What are the symptoms of hepatitis B?

Symptoms of hepatitis B can include:

  • Jaundice (yellow eyes or skin)
  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Stomach or joint pain
  • Fatigue
  • Clay-colored bowel movements

How do you get hepatitis B?

You get hepatitis B by direct contact with the blood or body fluids of an infected person; for example, you can become infected by having sex or sharing needles with an infected person. A baby can get hepatitis B from an infected mother during childbirth. Hepatitis B is not spread through food or water or by casual contact.     

Who is at risk?

Hepatitis B can affect anyone. Each year in the United States, thousands of people of all ages get hepatitis B and close to 2,000 die because of hepatitis B. If you have had other forms of hepatitis, you can still get hepatitis B.

How great is your risk for hepatitis B?

In 2018, a total of 3,322 cases of acute hepatitis B were reported to CDC. After adjusting for under-ascertainment and under-reporting, an estimated 21,600 acute hepatitis B cases occurred in 2018 in the United States. Many people don’t know they are infected or may not have symptoms and therefore never seek the attention of medical or public health officials.

  • Although anyone can get hepatitis B, some people are at greater risk, such as those who:
  • Have sex with an infected person
  • Have multiple sex partners
  • Are men who have sexual contact with other men
  • Inject drugs or share needles, syringes, or other drug equipment
  • Live with a person who has chronic hepatitis B
  • Are infants born to infected mothers
  • Are exposed to blood on the job (health care and public safety workers)
  • Are hemodialysis patients
  • Travel to countries with moderate to high rates of hepatitis B
  • Are residents and staff of facilities for developmentally disabled persons
  • Are diabetic (due to risk from shared blood glucose monitoring equipment)
  • If you are at risk for hepatitis B virus infection, ask your healthcare provider about hepatitis B vaccine.

 

How soon after exposure to hepatitis B can it be detected?

Hepatitis B surface antigen (HBsAg) can be detected an average of 4 weeks after exposure to the virus. If symptoms occur, they begin an average of 90 days (range: 60–150 days) after exposure.

Who is a carrier of hepatitis B?

Hepatitis B carriers are individuals who have the hepatitis B virus even if they don’t feel sick. Between 6% and 10% of adults with hepatitis B infections become carriers.

How do you know if you have hepatitis B?

You may have hepatitis B (and be spreading the disease) and not know it; sometimes a person with hepatitis B virus infection has no symptoms at all. Your doctor can do a blood test to determine if you are infected.

How is hepatitis B treated?

For acute infection, no medication is available; treatment is supportive. For chronic infection, several antiviral drugs are available. Persons with chronic HBV infection require medical evaluation and regular monitoring to determine whether disease is progressing and to identify liver damage or hepatocellular carcinoma.

If you are pregnant, should you worry about hepatitis B?

Screening for hepatitis B during pregnancy is important to identify women at risk of passing hepatitis B virus to their baby. If a mother is HBsAg positive, then medical interventions, hepatitis B vaccine and hepatitis B immune globulin (HBIG), given to the baby within 12 hours of birth can reduce the chance of perinatal transmission. Without postexposure immunoprophylaxis, approximately 90% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection, with approximately one out of every four dying from chronic liver disease.

Hepatitis B and Healthcare Workers

Healthcare Settings and Hepatitis B

The delivery of healthcare has the potential to transmit hepatitis B virus (HBV) to both healthcare workers (HCWs) and patients. Outbreaks of HBV have occurred in outpatient settings, hemodialysis units, long-term care facilities, and hospitals, primarily because of unsafe injection practices, reuse of needles, finger stick devices, and syringes, or lapses in infection control.

To prevent transmission of bloodborne pathogens, HCWs should adhere to recommended standard precautions and fundamental infection control principles, including safe injection practices and appropriate aseptic techniques.

For continued protection, the Advisory Committee on Immunization Practices (ACIP) recommends that healthcare and public safety workers with reasonably anticipated risk for exposures to blood or infectious body fluids receive the complete hepatitis B vaccine series and have their immunity documented through post-vaccination testing. For additional information, visit the CDC’s website, http://www.cdc.gov/hepatitis/Settings/HealthcareSettings.htm

Is hepatitis B vaccination recommended in certain settings?

Yes, in certain healthcare, evaluation, or treatment settings, a high proportion of clients have known risk factors for HBV infection. The Advisory Committee on Immunization Practices (ACIP) recommends universal vaccination of adults who receive care in those settings, including:

  • Sexually-transmitted disease treatment facilities
  • HIV testing and treatment facilities
  • Facilities providing drug-abuse treatment and prevention services
  • Healthcare settings targeting services to injection drug users
  • Correctional facilities
  • Healthcare settings targeting services to men who have sex with men
  • Chronic hemodialysis facilities and end-stage renal disease programs
  • Institutions and non-residential day care facilities for developmentally disabled persons

Is there an increased risk of hepatitis B transmission in long-term care facilities?

Yes, and it is primarily related to glucose monitoring. Any time blood glucose monitoring equipment is shared between individuals there is a risk of transmitting hepatitis and other bloodborne pathogens. When possible, equipment such as glucometers should be assigned to individual patients. Standard Precautions should always be followed.

What is the risk for hepatitis B virus infection from a needle stick exposure to HBV contaminated blood?
The risk of clinical hepatitis from a needle stick from an HBeAg-positive source (indicating current viral replication) is 22-31%, while the risk from an HBsAg-positive source is 1-6%.

Other than needle sticks, do other exposures, such as mucous membrane exposure, pose a risk to healthcare personnel for hepatitis B transmission?

Transmission of HBV infection among hospital-based workers has been linked to percutaneous and mucous membrane exposures, and HBV infection has been primarily associated with percutaneous exposure. Transmission of HBV has not been associated with intact skin exposures. Avoiding occupational exposure to blood by following Standard Precautions is the primary way to prevent transmission of bloodborne infections among healthcare personnel. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment such as gloves, masks, gowns, and protective eyewear.

Can hepatitis B vaccine be given after exposure to HBV?

Yes, after an unvaccinated person has been exposed to HBV, appropriate prophylaxis, given as soon as possible, but preferably within 24 hours can effectively prevent infection. The mainstay of postexposure immunoprophylaxis is hepatitis B vaccine, but in certain circumstances the addition of hepatitis B immune globulin (HBIG) will provide increased protected. Postexposure prophylaxis including hepatitis B immune globulin (HBIG) and HBV vaccine is believed to be 85-95% effective, while either one alone is thought to be 70-75% effective.

Should hepatitis B virus-infected healthcare workers be restricted in their work?

No, as currently available data provide no basis for restricting the practice of HCWs infected with HBV who perform invasive procedures not identified as exposure prone.
Exposure-prone procedures should be identified by medical/surgical/dental organizations and by institutions at which such procedures are performed. HCWs infected with hepatitis B virus should not perform exposure-prone procedures unless they have been advised and counseled by an expert review panel concerning under what circumstances, if any, they may continue to do so. CDC updated guidelines for the management of hepatitis B virus-infected healthcare workers and students in July 2012 which can be accessed at http://www.cdc.gov/mmwr/PDF/rr/rr6103.pdf. 

Hepatitis C

What is hepatitis C?

Hepatitis C is a virus that uses liver cells to reproduce. As the body’s immune system works to defend against this virus, inflammation, injury, and ultimately scarring of the liver may occur. The hepatitis C virus is found in the blood of persons who have this disease. Hepatitis C is spread by contact with the blood of an infected person.

What are the symptoms of hepatitis C?

Symptoms of hepatitis C can include:
• Jaundice (yellow eyes or skin)
• Loss of appetite
• Nausea
• Vomiting
• Fever
• Stomach or joint pain
• Fatigue
• Clay-colored bowel movements

How do you get hepatitis C?


Hepatitis C virus is spread primarily by direct contact with human blood, particularly through large or repeated percutaneous (i.e., passage through the skin) exposures to infectious blood, including:
• Injection drug use (currently the most common means of HCV transmission in the United States)
• Needle stick injuries in health care settings
• Birth to an HCV-infected mother
• Receipt of donated blood, blood products, or tissue or organs, though unlikely if done in the US after 1992 due to screening of blood for HCV (exception – if recipient gives informed consent for transplant of Hep C positive organ – see Transplantation with hepatitis positive organs section)


HCV can also be spread infrequently through:
• Unregulated tattooing
• Sex with an HCV-infected person
• Sharing personal items contaminated with infectious blood, such as razors or toothbrushes
• Invasive health care procedures

Who is at risk?

HCV testing is recommended for anyone at increased risk for HCV infection, including:


• Current or former injection drug users, including those who injected only once many years ago
• Everyone born from 1945 through 1965
• Recipients of clotting factor concentrates made before 1987
• Recipients of blood transfusions or solid organ transplants before July 1992
• Patients who have ever received long-term hemodialysis treatment
• Persons with known exposures to HCV, such as health care workers after needle sticks involving HCV-positive blood or recipients of blood or organs from a donor who later tested HCV-positive
• All persons with HIV infection
• Children born to HCV-positive

How great is your risk for hepatitis C?

In 2018, a total of 3,621 cases of acute hepatitis C were reported to CDC. After adjusting for under-ascertainment and under-reporting, an estimated 50,300 acute hepatitis C cases occurred in 2018 in the United States. The CDC has estimated that there are 2.4 million people living with hepatitis C in the United States. Many people don’t know they are infected or may not have symptoms and therefore never seek the attention of medical or public health officials.

How soon after exposure to hepatitis C can it be detected?

In those people who develop symptoms, the average period from exposure to symptom onset is 2–12 weeks (range: 2–26 weeks). Hepatitis antibody detection occurs an average of 8–11 weeks after exposure and people with recently acquired acute infection typically have detectable HCV RNA levels as early as 1–2 weeks after exposure to the virus.

Is there a vaccine that can prevent hepatitis C?

No. Currently, there is no vaccine to prevent hepatitis C

How can you protect yourself from getting hepatitis C and other diseases spread by contact with human blood?

• If you use injection drugs, never re-use or share syringes, water or drug works, and get vaccinated against hepatitis A and hepatitis B.
• Do not share toothbrushes, razors, or other personal care articles. They might have blood on them.
• If you are a healthcare worker, always follow standard precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B.

Consider the health risks if you are thinking about getting a tattoo or body piercing. You can get infected if:


• The tools that are used have someone else's blood on them.
• The artist or piercer doesn't follow good health practices, such as washing hands and using disposable gloves.
• The ink used for your tattoo is contaminated with someone else’s blood.

What can persons with hepatitis C virus infection do to protect their livers?

• Avoid drinking alcohol.
• See the doctor regularly.
• Do not start any new medicines or use over-the-counter, herbal and other medicines or supplements without a physician’s knowledge.
• Get vaccinated against hepatitis A and hepatitis B.

What other information should patients with hepatitis C know?

• Hepatitis C virus is not spread by sneezing, hugging, coughing, food, or water, sharing eating utensils or drinking glasses, or casual contact.
• Persons should not be excluded from work, school, play, child-care, or other settings because of their hepatitis C virus infection status. There is no evidence of hepatitis C transmission from food handlers, teachers, or other service providers in the absence of blood-to-blood contact.
• There is a low but present risk for transmission with sex partners.
• Sharing personal items that might have blood on them, such as toothbrushes or razors, can pose a risk to others.
• Cuts and sores on the skin should be covered to keep from spreading infectious blood or secretions.
• Donating blood, organs, tissue, or semen can spread hepatitis C to others.
• Involvement with a support group may help patients cope with hepatitis C.

What are the chances of persons with hepatitis C virus infection developing chronic HCV infection, chronic liver disease, cirrhosis, liver cancer, or dying because of hepatitis C?

Of every 100 persons infected with HCV, approximately:
• 75-85 persons will develop chronic HCV infection
• 60-70 persons will develop chronic liver disease
• 5-20 persons will develop cirrhosis over a period of 20 to 30 years
• 1-5 persons will die from the consequences of chronic infection (liver cancer or cirrhosis)

What is the treatment for chronic hepatitis C?

Over 90% of people infected with hepatitis C virus (HCV) can be cured of their infection, regardless of HCV genotype, with 8–12 weeks of oral medication. Individuals with hepatitis C should consult with physician specialists knowledgeable about hepatitis C to obtain the most up-to-date recommendations regarding treatment.

Can a person become re-infected with hepatitis C after treatment?

Yes. Prior infection with HCV does not protect against later infection with the same or different genotypes of the virus. This is because people infected with HCV typically have an ineffective immune response due to changes in the virus during infection. For the same reason, no effective pre- or post-exposure prophylaxis is available.

Pregnancy and Perinatal Hepatitis C

What is the risk of a pregnant woman passing hepatitis C to her baby?

Hepatitis C can be transmitted from an infected mother to child during pregnancy and childbirth. Of every 100 infants born to mothers with hepatitis C, about six will become infected with the hepatitis C virus. However, the risk is greater if the mother has both HIV and hepatitis C.

If I am pregnant, should I be tested for hepatitis C?

The CDC recommends that all pregnant people be screened for hepatitis C during each pregnancy.

Can I be treated for hepatitis C while pregnant?

Treatment prior to pregnancy is the only current way to prevent your child from getting hepatitis C. There are currently no treatments approved for use in pregnancy to prevent transmission of hepatitis C to infants. However, if you have hepatitis C and are pregnant, your provider can identify future care needs for both you and your baby.

Can women with hepatitis C breastfeed their babies?

Yes. There is no evidence that breastfeeding spreads hepatitis C, so infected women can safely breastfeed their babies. However, women with cracked or bleeding nipples should stop nursing temporarily until their nipples have healed. Hepatitis C is spread through contact with blood, and not enough is known about whether this practice is safe.

When should my baby get tested?

Children can be tested for HCV RNA between 2 and 36 months of age. Antibody tests should not be done until 18 months of age or older and should be reflexed to test for HCV RNA if positive

How old does my child have to be to be treated?

Children can be treated as young as 3 years old, though more commonly at 12 years old. Contact your child’s healthcare provider or hepatitis specialist for the treatment and timing that works best for your child.

Hepatitis C and Healthcare Workers

Healthcare Settings and Hepatitis C

Avoiding occupational exposure to blood is the primary way to prevent transmission of bloodborne illnesses among health-care personnel. To promote blood safety in the workplace, health-care personnel should consult infectious-disease control guidance from the National Institute for Occupational Safety and Health and from the CDC.

What is the risk for hepatitis C virus infection from a needle stick exposure to hepatitis C virus contaminated blood?

After needle stick or sharps exposure to HCV-positive blood, the risk of HCV infection is approximately 0.2%.

Other than needle sticks, do other exposures, such as splashes to the eye, pose a risk to healthcare personnel for hepatitis C transmission?

Although a few cases of hepatitis C transmission via blood splash to the eye have been reported, the risk for such transmission is expected to be very low. Avoiding occupational exposure to blood by following Standard Precautions is the primary way to prevent transmission of bloodborne infections among healthcare personnel. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment such as gloves, masks, gowns, and protective eyewear.

What is the recommended management of a health care worker with occupational exposure to HCV?

Postexposure prophylaxis (PEP) for hepatitis C is not recommended. The CDC recommends that the source patient should be tested for HCV RNA or hepatitis antibodies. Baseline testing of the source patient and the health-care personnel should be done as soon as possible (preferably within 48 hours) after the exposure. For health-care workers exposed to a patient testing positive for hepatitis C infection, or whose status remains unknown, management should be guided by CDC’s testing algorithm (https://www.cdc.gov/hepatitis/hcv/pdfs/HealthCarePersonnelExposedToHCV-Algorithm.pdf)

Should hepatitis C virus-infected healthcare workers be restricted in their work?

There are no CDC recommendations to restrict a healthcare worker who is infected with hepatitis C virus. The risk of transmission from an infected healthcare worker to a patient appears to be very low. All healthcare personnel, including those who are hepatitis C virus- positive, should follow strict aseptic technique and Standard Precautions, including appropriate hand hygiene, use of protective barriers, and safe injection practices.