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 has been referred to as "serum hepatitis"
because it usually is spread by the transfer of infected blood or serum (for
example, through needle sticks, blood transfusions, hemodialysis, and
childbirth). Hepatitis B also is spread through sexual intercourse and may be
passed from mother to child. Inadvertent exposure to infected blood or body
fluids may occur during tattooing, body piercing, or when sharing razors or
toothbrushes with an infected person. Persons infected with hepatitis B may be
asymptomatic or may develop fatigue, jaundice, and weight loss. Rarely
- though
more commonly than with hepatitis A - acute infection with hepatitis B can cause liver failure and
death.
Up to 95% of infected adults are able to clear the
hepatitis B virus from their body and become immune to further infections with
hepatitis B. However, some people are not able to clear the hepatitis B virus
and it progresses to chronic (persistent) infection and inflammation of the liver.
Approximately 90% of infants infected at birth and 25%–50% of infected children
aged 1–5 years have chronic persistent infection.
Chronic infection may be mild or may damage the liver. The majority of
individuals with chronic hepatitis B who clear the virus and are "cured" still have detectable virus in the liver.
However, the importance of this fact is unclear since there is no evidence of consequences to the presence of the virus except that it can be reactivated with immunosuppression.
Individuals with hepatitis B virus only in the liver are not infectious. Approximately 20% of people with chronic hepatitis B
infection have their lives shortened by complications of liver disease,
cirrhosis, or liver cancer.
Vaccination has reduced the number of new cases of hepatitis B by more than
75% in the United States. 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. For example:
Hepatitis B vaccines are effective and safe. Up to 95%
of vaccinated individuals develop protective antibodies when they get the
vaccine and are protected from infection with hepatitis B. Among individuals at
high risk for infection with hepatitis B include:
A
blood test for hepatitis B antibodies is recommended after vaccination to ensure
that antibodies have been produced. For the few who do not form antibodies,
revaccination may improve the response, especially in infants. However, a small
proportion of individuals will never respond to hepatitis B vaccination. Side
effects from the vaccine usually are mild, primarily soreness at the site of
injection. The risk of serious allergic reactions (anaphylaxis) is less than one
per million doses.
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 receive it 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
products,
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,
Some countries have a high prevalence of
hepatitis B in their population. Travelers who visit these countries for a
prolonged period of time (usually 6 months or longer) and those who may be
exposed to blood or semen should consider vaccination.
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 may also 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 have responded to the vaccine; however, a blood test might be drawn to
verify that the person did respond to the vaccine and form antibodies.
Infected mothers can pass hepatitis B to their newborn
infants. All pregnant women should have blood drawn 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 infection in the infant.
Reference: Centers for Disease Control and Prevention. Hepatitis A Vaccine. <http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-a.pdf>
Centers for Disease Control and Prevention. Hepatitis B Vaccine. <http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf>
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.
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.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
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.
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.
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.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
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.
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.
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.
Early warning signs of job stress include headache, sleep disturbance, difficulty in concentrating, short temper, upset stomach, job dissatisfaction, and low morale. Stress on the job can be damaging to your health in that job stress is the outcome when job demands cannot be met.
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