WHAT IS HEPATITIS B?

Hepatitis B is an infection of the liver caused by the Hepatitis B virus (HBV).  HBV is one of several types of viruses (infections) that can cause Hepatitis.  There is a vaccine that will prevent HBV infection.

Hepatitis B virus infection may occur in two phases.  The acute phase occurs just after a person becomes infected, and last from a few weeks to several months.  Some people recover after the acute phase, but others remain infected for the rest of their lives. They go in to the chronic phase and become “chronic carriers.”  The virus remains in their liver and blood.

Acute hepatitis B usually begins with symptoms such as loss of appetite, extreme tiredness, nausea vomiting, and stomach pain.  Dark urine and jaundice (yellow eyes and skin) are also common, and skin rashes and join pain can occur.  Over half of the people who become infected with HBV never become sick, but some may later have long-term liver disease from their HBV infection.

About 300,000 children and adults in the US become infected with the hepatitis B virus each year .  More than 10,000 of them need to be hospitalized and 250 die.  Most of the deaths are from liver failure.

HBV is passed from one person to another in blood or certain body secretions.  This may occur during sexual relations or when sharing things like toothbrushes, razors, or needles used to infect drugs.  A baby can get HBV at birth from its mother.  A doctor or nurse may get JBV if blood from an infected patient enters through a cut or accidental needle stick.

Those people infected with HBV who become “chronic carries” can spread the infection to others throughout their lifetime.  They can also develop long term liver disease such as cirrhosis (which destroys the liver) or liver cancer.

WHO BECOMES A CHRONIC CARRIER OR HBV?

Of every 100 young adults who catch HBV, 6 to 10 become chronic carries.  Children who become infected with HBV are more likely to become chronic carriers than adults.  Of every 10 infants who are infected at birth, up to 9 will become chronic HBV carries.  The younger a child is when the infection occurs, the more likely that child will become a carrier.

About one-fourth of hepatitis B carriers develop a disease called “chronic active hepatitis.”  People with chronic active hepatitis often get cirrhosis of the liver, and may die from liver failure.  In addition, they are much more likely than other people to get cancer of the liver.  In the United States, about 4,000 hepatitis B carriers die each year from cirrhosis and more that 800 die from liver cancer.

HEPATITIS B VIRUS INFECTION IS CHILDREN

Each year 22,000 children are born to women who are carriers of HBV.  In the past, 4,000 – 5,000 of these infants were born with HBV infections.  Almost all of these infections can now be prevented.  A pregnant woman can find out if she is infected with HBV by getting a simple blood test.  I she is infected, she can protect her new born infant form infection by getting the child immunized with hepatitis B vaccine and hepatitis B immune globulin (HBIG) as soon after birth as possible. 

Certain groups of children are more likely to get HBV if they or their parents come from countries where HBV infection is much more common than in the United States.  (These are countries in Asia, Africa, South America, the South Pacific and eastern and southern Europe).  It is very important that these children receive hepatitis B vaccine at birth or at lest before they are one year old.

Why All Children Should Receive Hepatitis B Vaccine

Anyone can get HBV infection.  In fact, about 1 out of every 20 people in the United States has been infected with HBV infection, all infants in the United States should be vaccinated against the virus.  This will protect them when they become teenagers and adults, and are most likely to catch hepatitis B.

HEPATITIS B VACCINE AND HEPATITISB IMMUNE GLOBUIN

Hepatitis B Vaccine (HB)

Hepatitis B Vaccine is given by injection.  Three doses on three different dates, are needed for full protection.  Exactly when these three doses are given can vary.  Infant can get the vaccine at the sane time as other baby shots or during regular visits for well child care.  Your doctor or nurse will tell you when the three shots should be given.

The hepatitis B vaccine prevents HBV infection in 85% – 95% of the people who get the three shots.  Studies have shown that in those people, protection lasts at least 10 years.  Booster doses are not recommended at this time.

Who Should Get Hepatitis B Vaccine?

Infants

1.  Infants born to women who are infected with HBV.  Infants born to enfected women or to women who are chronic carries should be given hepatitis B vaccine and HBIG (see below) within 12 hours of birth.  They should get their second and third vaccine doses at 1 and 6 months of age.  If they don’t get these shots, these infants will very likely be infected with HBV and become chronic carries themselves.  Pregnant women can find out if they are infected with HBV by getting a simple blood test, which is now recommended as a routine part of their prenatal care. 
2. Infants born to healthy women (non-carriers of HBV).  Vaccination during infancy and early childhood is recommended for all infants in the United States to prevent HBV infection and chronic HBV carriage.  Infants should get their first dose of vaccine either at birth or at 1-2 months of age.  The second dose can be given 1 to 3 months later, and the third dose between 6 and 18 months of age.  Hepatitis B vaccine can safely be given at the same time as the other vaccines a child normally receives.

Special Child hood Populations

Immigrant and refugee children from parts of the world where HBV infection is common (Asia, Africa, South America, South Pacific, and eastern and southern Europe) are at high risk of HBV infection.  All immigrant and refugee children 7 years of age and younger should get the hepatitis B vaccine.

Adults and Other Groups

Hepatitis B vaccine is also recommended for adolescents and adults at high risk of getting HBV infection.  This includes: 1)people who are exposed to blood or blood products in tier work; 2)clients and staff of institutions for the developmentally disabled, as well as clients and staff of group homes, where any of the residents is a chronic carrier of HBV; 3) hemodialysis patients; 4) men who have sex with men; 5)users of injectable drugs; 6)people with medical conditions (such a hemophilia) who receive blood products to help their blood clot; 7)people who lice with, or have sex with HBV carriers; 8)people who have more than one sexual partner within 6 months, or people who are treated for sexually transmitted diseases; and 9)people who travel , or live in, parts of the world where HBV infections are common.

Hepatitis B vaccine is also recommended for people who have been exposed to HBV.  This includes people who have never been vaccinated for hepatitis B, and who; 910 have an accident in which blood containing HBV enters their body through the skin or mucus membrane; or (2) have sexual contact with someone with acute hepatitis B.  In some cases, hepatitis B vaccine could be started at the same time as treatment with HBIG (see below).

Hepatitis B immune Globulin (HBIG)

HBIG is recommended for the following people. (For most people, the first dose of hepatitis B vaccine should be given a the same time as the HBIG.)

Infants

1. Infants born to women who are infected with HBV.  These infants should get one dose of HBIG and the first dose of vaccine within 12 hours of birth (see above).
2. Unvaccinated infants less than 12months old whose mother (or primary caregiver) has acute hepatitis B.  A infants less than 12 months can easily become HBV carriers after Hepatitis B intentions.  Exposed infants who have not been vaccinated should get one dose of HBIG and begin the hepatitis B vaccine series.

Adults and Others

1. Persons accidentally exposed to blood or body fluids that may contain HBV.  Exposed persons who have been vaccinated should get one dose of HBIG and begin the B vaccine series.  Exposed person who have had hepatitis B shots may also need HBIG.  A doctor or nurse should make that decision.
2. People having sexual contact with anyone who has acute hepatitis B.  These people should get a dose of HBIG within 14 days of the most recent sexual contact with anyone who has acute hepatitis B.  They may also need to get hepatitis B vaccine.

POSSIBLE SIDE EFFECTS FROM HEPATITIS B VACCINE AND HBIG

The most common side effect of hepatitis B vaccination is soreness where the shot is given.  Tenderness at the injection site has been reported in up to 46% of the infants vaccinated.  Of children who get the vaccine, 2 – 5% may get a fever greater than 102 degrees F, or become irritable.  When hepatitis B vaccine is given with other childhood vaccines, it does not make these mild reactions worse than would be seen with the other vaccines alone.  HBIG has sometimes been associated with swelling and hives.  As with any drug, where is a slight chance of allergic or more serious reactions with either the vaccine or HBIG.  However, no serious reactions have been shown to occur due to the hepatitis B recombinant vaccines.  (These are the ones currently in use.)  A person cannot get hepatitis B or AIDS form a hepatitis B shot or from an HBIG shot.

Before recombinant vaccines were used in the United States, another type of hepatitis B vaccine (plasma-derived) was used.  Surveillance showed that getting the first dose of plasma-derived hepatitis B vaccine may have been associated with the paralytic illness Guillain-Barres syndrome (GBS).  However, the recombinant vaccine, which is the only vaccine currently used in the US has not been shown to be associated with GBS.

PREGNANCY

Very little information is available about the safety of the vaccine or HBIG for unborn babies.  If a pregnant woman gets an HBV infection, it can cause severe disease in the mother and chronic HBV infection in the unborn baby.  On the other hand, both the vaccine and HBIG should be safe for the unborn baby because they contain no infectious material.  Therefore, pregnant women who are at risk of HBV infection can be given both Hepatitis B vaccine and HBIG.

QUESTIONS

If you have any questions about hepatitis B, HBIG, or hepatitis B vaccine, please discuss them with your doctor.

Prepared from material from the US Department of Health and Human Services.