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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

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.

Get vaccinated!

Hepatitis B is preventable.

How great is your risk for hepatitis B?

In 2012, there were an estimated 18,760 new hepatitis B virus infections in the United States. However, the official number of reported hepatitis B cases is much lower. 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 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.

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 test to

determine if you are infected.

If you have symptoms:

• Your eyes or skin may turn yellow (jaundice)

• You may lose your appetite

• You may have nausea, vomiting, fever, and/or stomach or joint pain

• You may feel extremely tired and not be able to work for weeks or months

• You may have clay-colored bowel movements

 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?

If you have hepatitis B virus in your blood, you can give hepatitis B to your baby, which poses a serious risk to the infant at birth. Without postexposure immunoprophylaxis, approximately 40% 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.

All pregnant women should be tested for hepatitis B virus early in their pregnancy. If the blood test is positive, the baby should receive vaccine along with another shot, hepatitis B immune globulin (HBIG), within 12 hours of birth. The vaccine series should be completed during the first 6 months of life.

Who should be vaccinated?

• All babies, at birth

• All children and adolescents aged < 19 years who have not been vaccinated

• Persons of any age whose behavior puts them at high risk for hepatitis B virus infection

• Persons whose jobs expose them to human blood

• Household contacts of HBV-infected persons

• Residents and staff of facilities for developmentally disabled persons

• Persons with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients

• International travelers’ regions with moderate or high rates of hepatitis B

• Persons with chronic liver disease

• Persons with HIV infection

• Adults with diabetes

• All other persons seeking protection from hepatitis B virus infection

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.

How is hepatitis C diagnosed?

Two blood tests can be done to determine if you have been infected with hepatitis C. Your doctor may order just one or both tests. The following are the types of tests your doctor may order and the purpose for each:

• Anti-HCV (antibody to hepatitis C)

This test is usually done first. If positive, it should be confirmed with a HCV RNA. A positive anti-HCV in a person who has not been previously reported meets the case definition for probable acute hepatitis C if clinical criteria are present or the case definition for probable chronic hepatitis C if clinical criteria are not present.

• HCV RNA (also referred to as NAT or PCR)

This test will tell you if you have the virus present in your blood, which indicates that you are currently infected. A positive HCV RNA without clinical criteria meets the case definition for confirmed, chronic hepatitis C, while a positive HCV RNA with clinical criteria meets the case definition for confirmed, acute hepatitis C.

Who should be tested for hepatitis C?

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 o Health care workers after needle sticks involving HCV-positive blood

• All persons with HIV infection

• Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)

How is hepatitis C virus spread from one person to another?

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)

• Receipt of donated blood, blood products, and organs (once a common means of transmission, but now rare in the United States since blood screening became available in 1992

• Needle stick injuries in health care settings

• Birth to an HCV-infected mother

 HCV can also be spread infrequently through:

• Sex with an HCV-infected person (an inefficient means of transmission)

• Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)

• Other health care procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

• Unregulated tattooing

 Can hepatitis C virus be spread by sexual activity?

Yes, but this does not occur very often. If you are having sex, but not with one steady partner:

• You and your partners can get other diseases spread by having sex (e.g. HIV, hepatitis B, syphilis, gonorrhea or chlamydia);

• You should use condoms correctly and every time you have sex; and

• You should be vaccinated against hepatitis B.

 Can hepatitis C virus be spread within a household?

Yes, but this does not occur very often. If hepatitis C virus is spread within a household, it is most likely due to direct exposure to the blood of an infected household member.

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

• Do not ever shoot drugs. If you shoot drugs, stop and get into a treatment program. If you cannot stop, never reuse or share syringes, water or drug works, and be 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?

• Stop 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 be aware of?

• 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 is the treatment for chronic hepatitis C?

Because of advances in the field of antiviral therapy for chronic hepatitis C, individuals with hepatitis C should consult with physician specialists knowledgeable about hepatitis C to obtain the most up-to-date recommendations regarding treatment.

Can people become infected with a different strain of HCV after they have cleared the initial infection?

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.