Hepatitis B

Hepatitis B is also known as “serum” or “post-transfusion” hepatitis. It can develop into chronic (long-term) infection for five to ten percent of people infected as adults, and up to ninety percent of people infected at birth (Berkman & Bakalar, 2000). There is an average incubation period of up to six months, after which symptoms may or may not occur. During this period a person is at risk of transmitting the virus. If hepatitis B is cleared from the body, antibodies produced in response will provide immunity for life (WA Department of Health 2005b). All Australian jurisdictions are required to report diagnosis of hepatitis B to the National Notifiable Diseases Surveillance System.

It is estimated that approximately 165,000 people in Australia are living with hepatitis B. Many more people may have been exposed to the virus but cleared it naturally with their own immune system, often without developing symptoms, so have not realised they have been in contact with it.

Symptoms

Many of the symptoms of hepatitis B can be attributable to a number of conditions, making diagnosis without clinical testing difficult. Symptoms may be similar to those for influenza, and may include loss of appetite, nausea and vomiting, fever, chills and weakness. Abdominal pain, dark urine and jaundice associated with the liver may also be present (Berkman & Bakalar, 2000). Symptoms generally occur after the window period of approximately three to six months. In acute (short term) infection symptoms come on gradually and last up to five or six weeks. After this time, fatigue and feelings of unwellness may linger for a few weeks (Berkman & Bakalar, 2000).

About half of adults infected with hepatitis B and almost all children will not experience symptoms at all. If a person believes they may have been exposed to the virus, it is important to see a doctor for testing.

Checklist: a person could have hepatitis B if they have:

1. shared injecting drug equipment (needle/syringe, tourniquet, water or spoon)
2. had a tattoo or piercing using un-sterile equipment or procedures
3. worked in an environment which brings them into contact with other people’s body fluids such as blood (eg disability care, nursing, first aid)
4. had a blood transfusion in Australia before 1971
5. had unprotected sex with someone who has hepatitis B
6. experienced dialysis
7. had a medical, surgical or dental procedure or immunization overseas
8. shared a razor, toothbrush or other sharp grooming instrument with someone who has hepatitis B
9. taken part in a ritual involving human blood
10. handled blood-stained clothing or attended to a wound without adequate protection (eg latex gloves, resuscitation masks etc)

Hepatitis B Transmission and Prevention

Hepatitis B is considered both a blood borne virus and a sexually transmitted infection as it is present in semen, vaginal fluids and blood. Transmission can occur via direct blood-to-blood contact, unprotected sex and sharing injecting, tattooing or piercing equipment. The virus has also been detected in saliva, urine and other body fluids such as breast milk in very small quantities, which are not generally sufficient to cause transmission. Hepatitis B can be transmitted from mother to child during childbirth, so it is important that medical staff are aware of the mother’s hepatitis B status.

Hepatitis B cannot infect a person if their skin and mucous membranes are intact. Intact healthy skin is a protective barrier against harmful micro-organisms such as bacteria and viruses, making the skin, which is the largest organ of the body, a crucial part of the immune system.

Injecting Drug Use

All injecting equipment has the potential to transmit hepatitis B if it comes in contact with infected blood. This includes swabs, spoons, water, tourniquets, filters and unwashed hands. It only takes a microscopic amount of infected blood to get into a person’s bloodstream for infection to take place. Hepatitis B can survive on a surface at room temperature for up to four weeks, and inside a protected environment such as the barrel of a syringe, it may survive much longer (fpnotebook.com, 15 April 2010). It is also important to note sharing nasal straws for snorting cocaine can potentially involve blood-to-blood contact between people.

Tattooing and Piercing

Non-sterile equipment used for piercing and tattooing can also pose a transmission risk. When contemplating body art it is important to access licensed, professional studios. There is a Code of Practice for Skin Penetration Procedures (Health Department of Western Australia, 1999), which all body artists should follow.

Medically Acquired

Hepatitis B was identified during the 1960s and screening of the blood supply for the virus began in 1971 (You’ve got what? SA Health, August 2009).  Therefore, there are a number of people in Australia living with the virus who acquired it medically.

Mother to Child

The risk of vertical transmission from mother to unborn baby is estimated to be up to 90% with a number of factors contributing to the degree of risk (perinatology.com 15 April 2010). Pregnant women are routinely screened for hepatitis B in Australia, which allows medical staff to follow preventative procedures, such as avoiding the use of forceps and scalp electrodes, during childbirth to reduce the risk of transmission to the baby. Hepatitis B Immune Globulin (HBIG) and vaccination is provided to the baby within 24 hours of birth to further reduce the risk of transmission (The Australian Immunisation Handbook (2003, 8^th edition).

It is safe to breast feed if the mother is hepatitis B positive, as viral quantities found in breast milk are not generally high enough to cause transmission. However, if the mother has bleeding or cracked nipples, there is a risk of blood-to-blood contact with the baby (Australian Institute for Primary Care, 2001).

Household Transmission

Household transmission of hepatitis B is extremely unlikely, although there are a few recommended precautions. Personal grooming items such as toothbrushes, razors, body jewellery and nail clippers should not be shared (Australian Institute for Primary Care, 2001), as they have the potential to break the skin and carry minute amounts of blood (even if blood is not visible, enough may be present to transmit hepatitis B). Any blood spills should be cleaned up immediately using standard infection control procedures; using latex gloves, antiseptic, disposable paper towels and sealed plastic disposal bags.

Sexual Transmission

Hepatitis B is a sexually transmissible infection, as it is present in sexual fluids, such as vaginal fluid and semen in quantities high enough to cause infection.  To minimise the risk of infection condoms, dental dams and gloves should be used where appropriate. A water-based lubricant is also helpful in reducing skin damage, as blood to blood contact can occur during some sexual practices.

Needle Stick

Transmission through needle-stick injuries ranges from two to thirty per cent risk for people working in health care settings (https://www.amh.net.au/downloads/epc/hepatitis%20B.pdf sourced 15 April 2010) depending on the nature of the injury and viral load and infectivity. There is a reduced chance of contracting hepatitis B from a needle-stick injury in the community.

Testing, Treatments & Vaccinations

Testing

Testing for hepatitis B involves a blood test, which can be arranged at most doctor surgeries and health clinics. Test results should be discussed with a health care provider. For more information on testing, please read Living well with Hepatitis.

Treatment

A number of anti-viral medications are available for hepatitis B treatment as well as  Pegylated Interferon.  Treatment is not necessary for everyone living with hepatitis B and there are criteria applied to determining when a person should be offered treatment. More information on treatments. 

Vaccination

Vaccination against hepatitis B has been part of routine childhood programs since 2000. Adult immunisation requires three injections over six months, approximately two months apart. (Australian Society for HIV Medicine Inc, 2004). A combined vaccination for hepatitis A and hepatitis B is also available. It is recommended for people who are living with hepatitis C and/or HIV, people who work in the health or care sector, travellers, men who have sex with men, people who inject drugs, people in prison or people who work in a prison. Vaccinations are available from HepatitisWA, GPs and some specialised clinics. Please contact HepatitisWA for further information.

References

Australian Government Department of Health and Ageing. (n.d.). National Notifiable Diseases Surveillance System: Number of notifications for all diseases by year, Australia, 1991 to 2005and year-to-date notifications for 2006. Retrieved January 4, 2007, from http://www9.health.gov.au/cda/Source/Rpt_2_sel.cfm

Berkman, A. & Bakalar, N. (2000) Hepatitis A to G: The facts you need to know about all the forms of this dangerous disease, Warner Books; New York

Doyle, L. & Urban, E. (2005). Treatment for hepatitis B: Factsheet [online]. Retrieved January 5, 2007, from http://www.accessinfo.org.au/documents/2005FinalVersionTreatmentforHepatitisB_000.pdf

Health Department of Western Australia (1999) Healthy body art [brochure], Health Department of Western Australia; Perth

Hepatitis B Foundation (USA) (n.d.) Transmission [online]. Retrieved January 5, 2007, from http://www.hepb.org/hepb/transmission.htm

WA Department of Health, Sexual Health and Blood-Borne Virus Program (2005b). Hepatitis B [pamphlet]. Perth, Western Australia

Page last updated: Wednesday 15 September, 2010