Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What Is the Hepatitis B Vaccine, and How Effective Is It?
The hepatitis B vaccine contains a protein (antigen) that stimulates the body
to make protective antibodies. Examples of hepatitis B vaccines available in the
United States include hepatitis b vaccine-injection (Engerix-B, Recombivax-HB).
Three doses (given at 0, 1, and 6 months of age) are necessary to assure protection.
There are also combination vaccines on the market that provide protection
against hepatitis B and other diseases.
Other examples of the hepatitis B vaccine include:
Hepatitis-b-hepatitis-a vaccine - injection (Twinrix), which provides
protection against both hepatitis A and hepatitis B.
Haemophilus B/hepatitis B vaccine - injection (Comvax) provides protection
against hepatitis B and Haemophilus influenzae type b (a cause of meningitis).
Pediarix provides protection against hepatitis B, tetanus, pertussis
(whooping cough), and polio.
Hepatitis B vaccines are effective and safe. Up to 95% of vaccinated
individuals form effective antibodies when they get the vaccine and are
protected from hepatitis B. In healthcare workers, high-risk public safety
workers, dialysis patients, and sexual partners of infected persons, a blood
test for antibodies is recommended after vaccination to ensure that the person
produced antibodies. For the few who do not form antibodies, revaccination may
improve response, especially in infants. However, a small proportion of
individuals will never respond to hepatitis B vaccination. Side effects from the
vaccine are usually mild and include soreness at the site of injection. The risk
of serious allergic reactions (anaphylaxis) is less than one per million doses.
Vaccination has reduced the number of new cases of hepatitis B by more than 75%
in the United States....
The term 'hepatitis' simply means
inflammation of the liver. Hepatitis may be
caused by a virus or a toxin such as alcohol. Other viruses that can cause
injury to liver cells include the hepatitis A and
hepatitis C viruses. These
viruses are not related to each other or to hepatitis B virus and differ in
their structure, the ways they are spread among individuals, the severity of
symptoms they can cause, the way they are treated, and the outcome of the
infection.
What is the scope of the problem?
Hepatitis B is an infection of the liver caused by the
hepatitis B virus (HBV). It is estimated that 350 million individuals worldwide
are infected with the virus, which causes 620,000 deaths worldwide each year.
According to the Centers for Disease Control (CDC), approximately 46,000 new cases of hepatitis B
occurred in the United States in 2006.
In the United States, rates of new infection were highest
among people aged 25 to 44 years (3.1 cases per 100,000 population) and lowest
among those younger than 15 years of age (0.02 per 100,000). This reflects the
major modes of transmission of hepatitis B (sexual transmission, illicit drug
use, exposure to infected blood) and the effect of universal vaccination of infants. In the
United States, there has been a 75% decrease in newly diagnosed cases of
hepatitis B during the past decade. This decrease is attributed to increased
vaccination and to heightened public awareness of HIV/AIDS and the resulting
safer sexual practices.
When a person first gets hepatitis B, they are said to have an 'acute'
infection. Most people are able to eliminate the virus and are cured of the
infection. Some are not able to clear the virus and have 'chronic' infection
with hepatitis B that is usually life-long (see below). In the United States an
estimated 800,000 to 1.4 million people are chronically infected with hepatitis
B.
Hepatitis B is found throughout the world. Some countries have much higher
rates of infection than the United States; for example, in Southeast Asia and
Sub-Saharan Africa, as many as 15% to 20% of adults are chronically infected with
hepatitis B.
What kind of a virus is hepatitis B?
The hepatitis B virus is a DNA virus, meaning that its genetic material is
made up of deoxyribonucleic acids. It belongs to a family of viruses known as
Hepadnaviridae. The virus is primarily found in the liver but is also present in
the blood and certain body fluids.
Hepatitis B virus consists of a core particle (central portion) and a
surrounding envelope (outer coat). The core is made up of DNA and the core
antigen (HBcAg). The
envelope contains the surface antigen (HBsAg). These antigens are present in the
blood and are markers that are used in the diagnosis and evaluation of patients
with suspected viral hepatitis.
How does hepatitis B virus cause liver injury?
The hepatitis B virus reproduces in liver cells, but the virus itself is not
the direct cause of damage to the liver. Rather, the presence of the virus
triggers an immune response from the body as the body tries to eliminate the virus and recover
from the infection. This immune response causes inflammation and may seriously
injure liver calls. Therefore, there is a balance between the
protective and destructive effects of the immune response to the hepatitis B
virus.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Drug-induced liver diseases are diseases of the liver that are caused by physician-prescribed medications, OTC medications, vitamins, hormones, herbs, illicit (“recreational”) drugs, and environmental toxins. There are three types of liver toxicity; dose-dependent toxicity, idiosyncratic toxicity, and drug allergy. The types of liver disease drugs cause include: mild elevations of blood levels of liver enzymes, hepatitis, necrosis, cholestasis, steatosis, cirrhosis, mixed disease, fulminant hepatitis, and blood clots.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Vasculitis is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Optic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Septic arthritis, or infectious arthritis, is infection of one or more joints by bacteria, viruses, or fungi. Symptoms and signs of septic arthritis include fever, joint pain, chills, swelling, redness, warmth, and stiffness. Treatment involves antibiotics and the drainage of the infected joint.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Hemophilia is one of a group of inherited bleeding disorders. Hemophilia A and B are inherited in an X-linked recessive genetic pattern and is more common in males. Symptoms of hemophilia include bleeding into the joints, muscles, GI or urinary tract, or brain or skull. Treatments for hemophilia is generally replacement of blood clotting factors.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Polyarteritis nodosa is a rare autoimmune disease characterized by spontaneous inflammation of the arteries of the body. The most common areas of involvement include the muscles, joints, intestines (bowels), nerves, kidneys, and skin. Poor function or pain in any of these organs can be a symptom. Polyarteritis nodosa is most common in middle age persons. Polyarteritis is a serious illness that can be fatal. Treatment is focused on decreasing the inflammation of the arteries by suppressing the immune system.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Hemophilia is not one disease but rather one of a group of inherited bleeding
disorders that cause abnormal or exaggerated bleeding and poor blood clotting.
The term is most commonly used to refer to two specific conditions known as
hemophilia A and hemophilia B, which will be the main subjects of this article.
Hemophilia A and B are distinguished by the specific gene that is mutated
(altered to become defective) and codes for a defective clotting factor
(protein) in each disease. Rarely, hemophilia C is encountered, but its effect
on clotting is far less pronounced than A or B.
Hemophilia A and B are inherited in an X-linked recessive genetic pattern and
are therefore much more common in males. This pattern of inheritance means that
a given gene on the X chromosome expresses itself only when there is no normal
gene present. For example, a boy has only one X chromosome, so a boy with
hemophilia has the defective gene on his...
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