What is hepatitis B?
What are the key differences among hepatitis A, B, and C?
Why should Asian and Pacific Islanders care about hepatitis B?
What should I do?
How is hepatitis B transmitted?
Why is hepatitis B often not diagnosed?
What are some common myths and misconceptions about hepatitis B?
What should I know about the vaccine?
How severely does hepatitis B affect the United States?
Hepatitis B is a disease caused by infection with the hepatitis B virus (HBV). Chronic (lifelong) infection with HBV can lead to liver cirrhosis, liver failure, and liver cancer. About 60-80% of primary liver cancer worldwide is caused by chronic HBV infection. HBV is found in highest concentrations in blood (as high as 10 billion viruses per mL); concentrations 10 to 100 times lower are found in semen and vaginal fluid.
“Hepatitis” refers to any disease that results in inflammation of the liver, regardless of how that disease is contracted.
- Hepatitis A is an acute infection that is transmitted through contaminated food and water. Infection can be prevented by receiving the hepatitis A vaccine.
- Hepatitis B can be an acute or chronic infection. It is transmitted through contaminated blood through mother to child transmission at birth, blood-to-blood contact, or unprotected sex. Infection can be prevented by receiving the hepatitis B vaccine.
- Hepatitis C can be both an acute and chronic infection that is transmitted through contaminated blood. No effective vaccine is available at this time.
Despite the fact that only 0.2-0.5% of the U.S. population has chronic hepatitis B infection, this is still 1.25 million people, over half of whom are Asian and Pacific Islander (API) Americans. Depending on their country of origin, 5-15% of API immigrants have chronic hepatitis B.
- Get tested: Ask your doctor for the hepatitis B surface antigen (HBsAg) and surface antibody (anti-HBs) tests for both yourself and your family. These are not included in routine physical examination blood tests and must be requested. If you are pregnant, ask your doctor for the HBsAg test to see whether you are infected with hepatitis B.
- Get vaccinated: If both your blood tests (HBsAg and anti-HBs) are negative, you have not been infected with hepatitis B. Get the 3-shot hepatitis B vaccination series to protect yourself for life from future infection. All newborns should receive the hepatitis B vaccine at birth.
- Get involved: Learn more about hepatitis B, educate your friends and family, and proudly wear your Jade Ribbon pin and bracelet in demonstration of your support.
- Although hepatitis B can be transmitted by blood transfusions, sharing or reusing needles for injection or tattoos, and unprotected sex, many APIs become infected when they are infants or young children.
- Hepatitis B can also be transmitted during early childhood through direct contact with blood of infected individuals, occurring from contact between open wounds, sharing contaminated toothbrushes or razors, or through contaminated medical/dental tools.
- Hepatitis B is NOT spread by air, food, water, breastfeeding, casual contact in an office setting, kissing, hugging, coughing, sneezing, or sharing eating utensils or drinking glasses.
- Child-to-child spread generally occurs as a result of contact with skin sores, small breaks in the skin, or mucous membranes with blood. Spread within households from sharing toothbrushes or razors may also occur because HBV can survive for at least 7 days outside the body.
- Frequently, transmission of HBV occurs during the birthing process when the virus is passed on from the infected mother (who is often unaware that she has chronic hepatitis B) to her child.
Ethnicity of Pregnant Women Estimated Incidence (%) Caucasian 0.13 African-American .5 Foreign Born API 8.9 US Born API 1.4 Hispanic .09 Other .5
- The younger a person is when first exposed to HBV, the more likely they are to become chronically infected; about 90% of children who are infected before they turn one year old develop chronic hepatitis B.
Age of Infection Percentage of Infected Patients that become Carriers of Chronic HBV (%) 0-1 90 1-5 60 Adults 10
More than two-thirds of HBV cases exhibit no symptoms, so many people who become chronically infected don’t realize until it’s too late. If symptoms develop, they are often mistaken for those of influenza: fever, fatigue, joint or muscle pain, loss of appetite, nausea, and vomiting. Jaundice (a yellow discoloration of eyes and skin), which is usually a sign of liver damage, may not occur.
- Hepatitis B is NOT transmitted through food/water.
- Hepatitis B is NOT transmitted through casual contact such as hugging or shaking hands.
- Hepatitis B is NOT transmitted through kissing, sneezing or coughing.
- Hepatitis B is NOT transmitted through breastfeeding.
The hepatitis B vaccine provides an easy and effective method for preventing HBV infection and its deadly complications of liver cancer and liver failure. The vaccination is so effective that the World Health Organization calls the hepatitis B vaccine the first “anti-cancer” vaccine. Based on current data, routine booster doses of hepatitis B vaccine are not recommended. Universal hepatitis B vaccination hopefully will one day eradicate this devastating infection.
If not already infected, the following people should receive vaccination for hepatitis B:
- All infants and previously unvaccinated children and adolescents aged 0-18 years
- Sexual partners or household contacts of HBsAg-positive persons
- Persons with multiple sexual partners
- Injection drug users
- Travelers to regions of high HBV endemicity such as Asia
- Persons with occupational exposure to blood or body fluids
- Men who have sex with men
- Clients and staff of institutions for developmentally disabled persons
- Patients with chronic renal failure
- Patients receiving clotting factor concentrates
The CDC recommends hepatitis B vaccination of all infants, children and adolescents aged 0-18, and high-risk patients. Recent reports demonstrate a reduction in the risk of hepatocellular carcinoma in children in Taiwan (N Engl J Med 1997;336:1855-1859) with universal hepatitis B vaccination. Prevaccination testing for previous or current HBV infection is indicated in some high-prevalence groups, and post-vaccination testing to confirm the presence of anti-HBs >10 mIU/mL is useful in high-risk persons such as health care workers. Some nonresponders or partial responders (<10 mIU/mL) will respond to additional doses of hepatitis B vaccine. The duration of protection after hepatitis B vaccination is not precisely known but thought to be long-term, and thus routine booster doses of hepatitis B vaccine are not recommended.
In addition, the Asian Liver Center recommends that all adults of childbearing age (men and women under 45 years of age) receive vaccinations if they are not yet protected against HBV. All Americans, who were born in a country with intermediate or high levels of hepatitis B infection or are children of foreign-born parents, especially APIs, should be tested for HBsAg and anti-HBs to see if they are chronically infected or would benefit from hepatitis B vaccination.
Protective anti-HBs levels of >10 mIU/mL develop in 95% to 99% of immunocompetent adults who receive the hepatitis B vaccine. Antibody levels are reduced in persons over age 40 and in immunocompromised patients, including those with chronic renal failure, human immunodeficiency virus infection and chronic liver disease.
- In the United States, an estimated 60,000 people become infected with HBV each year.
- 5,000 people die each year from HBV related liver cancer or cirrhosis with liver failure.
- Medical and work loss costs for HBV-related conditions total more than $700 million per year in the United States.
- An estimated 1.25 million Americans are chronically infected with HBV. Over half are API Americans.
- As many as 1 out of 10 API Americans are chronically infected with HBV (ranging from 5-15% based on country of origin), compared with 1 in 1000 of Caucasian Americans.
- Up to 20,000 women in the United States who give birth each year have chronic HBV infection; more than half of these women are API.
- Among API men living in California, liver cancer ranks as a leading cause of cancer death: #1 for Laotian Americans, #2 for Vietnamese and Cambodian Americans, #4 for Chinese and Korean Americans, and #5 for Filipino Americans.