Hepatitis B (cont.)
What can be done to prevent hepatitis B?
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.
Examples include:
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.
Next: What is new in the treatment of hepatitis B? »
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