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Hepatitis B

Hepatitis B is a viral infection of the liver caused by the hepatitis B virus (HBV). It is spread through contact with infected blood and body fluids. The acute illness can range from mild flu like symptoms to severe jaundice, liver failure and even death.

A chronic infection can develop in 0.5% to 20% of individuals leading to cirrhosis and cancer of the liver.

Where does it occur?

Hepatitis B is prevalent in the entire developing world. The highest prevalence is in Africa, South East Asia, Middle East, Pacific Island, Haiti and the Dominican Republic. Map

How is it transmitted?

Hepatitis B Virus is transmitted from person to person through contact with infected body fluids and blood. Examples include engaging in unprotected sex, sharing drug injection needles/syringes, having contaminated needles used in tattoos, acupuncture and body piercing, contact with contaminated medical devices (hemodialysis machines), organ transplantation and blood transfusions.

Is it contagious from person to person?

It is contagious from person to person through sexual intercourse, sharing of injection needles or contact with body fluids through use of toothbrushes and razors.

What is the risk for travelers?

The risk is low unless you engage in unprotected sex, share injection needles/syringes, have your body tattooed, pierced or acupunctured. Receiving unscreened blood, blood products or medical devices also places you at risk for Contracting Hepatitis – B.

How soon after exposure will one develop symptoms?

One generally develops symptoms 2-3 months after exposure however symptoms can be seen as early as 2 weeks to as late as 9 months after exposure.

What are the signs and symptoms?

The symptoms develop gradually and include fever, fatigue, and loss of appetite, nausea, abdominal pain, joint pain and jaundice in some. Individuals generally get better in a few weeks and clear the infection but approximately 1-2% can progress to liver failure and death.

A chronic infection persists in nearly 10% of adults without any outward symptoms initially but which decades later can lead to cirrhosis with abdominal distention, jaundice and pain. The chronic infection also leads to liver cancer.

In infants and children the rate of chronic infection is higher, nearly 30-90%.

Is there any treatment?

There is no specific anti-viral treatment for most cases of ACUTE Hepatitis B infection; supportive care is standard practice. In severe and prolonged cases of illness anti-viral medications like epivir, adefovir, entecavir, tenofovir and telbivudine may be helpful

Are there any lab tests to diagnose illness?

Blood Antibody tests like Hepatitis B Core IgM, Hep B S Antigen, and Hep B S Antibody are useful in diagnosing an acute infection. Other tests like Hep B e antigen are available to diagnose chronic infections.

What preventive measures can be taken?

Hepatitis B Vaccine is protective and is recommended for all travelers to the developing world. It is particularly important if you plan to have sexual contact with the local population, are likely to receive tattoos, acupuncture, body piercing, share drug injection needles/syringes, or are long term visitors likely to seek or are engaged in medical or dental work.

Ideally one needs to have received 3 doses of the vaccine over a 6-month period prior to travel, however there are accelerated schedules that are available.

If you are traveling in an emergency and do not have 4 weeks prior to your departure, the following are options:

  1. Hepatitis B vaccine (Engerix-B or Recombivax-HB) can be administered on days 0, 7 & 14 before travel and a subsequent booster given at 6 months for lifelong protection.
  2. A combination Hepatitis A & B vaccine (Twinrix) that can be administered on days 0, 7 & 21 before travel is also available with a booster given at 12 months for lifelong protection.
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