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.
Hepatitis B is a preventable disease.
Vaccination and post-exposure
prophylaxis have significantly reduced rates of infection. Risk can also be
reduced by avoiding unprotected sex, contaminated needles, and other sources of
infection.
How effective is vaccination for hepatitis B?
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) are necessary to assure protection. There are also combination
vaccines on the market that provide protection against hepatitis B and other
diseases.
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.
In the United States, hepatitis B vaccination is recommended for all infants
at birth. Older children and adolescents should receive the vaccine if they did
not do so at birth.
Adults in high risk situations also are advised to receive hepatitis B
vaccine. This includes:
health care workers
dentists
intimate and household contacts of patients with chronic hepatitis B
infection
public safety workers who may be exposed to blood
men who have sex with men
individuals with multiple sexual partners
dialysis patients
injection drug users
persons with chronic liver disease
residents and staff in institutions that care for persons with
developmental disabilities
persons infected with HIV
persons who require repeated transfusions or blood products.
Centers that serve high-risk individuals are encouraged to provide the
vaccine to their clients. Such centers include dialysis units, drug treatment
facilities, sexually transmitted diseases clinics and correctional facilities.
Some countries have a high prevalence of hepatitis B in their population.
Travelers who visit these countries for a prolonged period of time (usually six
months) and those who may be exposed to blood or semen should consider
vaccination.
How effective is hepatitis B immune globulin (HBIG) in preventing hepatitis
B?
HBIG is a product that contains antibodies against hepatitis B. When
injected, it provides temporary protection against hepatitis B. HBIG is used
when people have had significant exposure to the virus. An example would be an
accidental needle stick in an unvaccinated health care worker from a needle
contaminated with blood from a person with hepatitis B. HBIG should be given as
soon as possible after exposure, preferably within seven days. Persons who need
HBIG should also receive hepatitis B vaccine. HBIG also is given to patients
with hepatitis B following liver transplantation to suppress the hepatitis B
virus in the transplanted liver.
What is post-exposure immunoprophylaxis for hepatitis B virus?
Unvaccinated individuals who are exposed to a known case of hepatitis B or to
a person at high risk for hepatitis B should be evaluated by a physician.
Examples of such exposures include needle stick injuries in health care workers
or sexual intercourse with an infected person. If the exposure is significant,
the physician will recommend vaccination and also may recommend an injection of
hepatitis B immune globulin (HBIG). HBIG is prepared from the plasma of blood
donors and contains antibodies to hepatitis B. Vaccination and HBIG can
substantially reduce the risk of disease in persons exposed to hepatitis B if
given within one week of a needle stick or two weeks of sexual intercourse.
Vaccination provides long-term immunity in people who respond to the vaccine.
There is no need for HBIG if an exposure occurs to a vaccinated person who is
known to respond to the vaccine; however, a blood test might be drawn to verify
that the person did respond to the vaccine.
How is transmission of hepatitis B virus from mother to newborn infant
prevented?
Infected mothers can pass hepatitis B to their newborn
infants. All pregnant
women should have blood tested to determine if they are infected. Infants born
to infected mothers should receive HBIG and hepatitis B vaccine at birth. This
is 85% to 95% effective in eliminating the risk of hepatitis B in the infant.
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.
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