Understanding Hepatitis
and the Appropriate Barrier Protection

Hepatitis B DEFINITION Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called Hepatitis B Virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.28 CLINICAL MANIFESTATIONS The clinical manifestations that might present with hepatitis B include: Jaundice Extreme fatigue Abdominal pain Nausea, vomiting Joint pain Anorexia Fever Dark-colored urine Yellowish-tinged skin and eyes Approximately 30% of people infected with HBV never exhibit symptoms. Signs and symptoms are less common in children than adults. They are also dependent upon the infected person’s immune status. People who are infected with HBV, whether they have symptoms or not, can spread the disease to others. INCUBATION PERIOD The incubation period is anywhere from 45-180 days. The average incubation period is 60-90 days.29 CAUSE The cause is the Hepatitis B Virus (HBV), a partially double-stranded DNA virus, enveloped, hepadnavirus.30 DIAGNOSIS The presence of hepatitis B core antigen indicates that a person is infectious for hepatitis B. The occurrence of both antibodies IgM and IgG to the core antigen indicates continuing viral synthesis and infectivity.31 POST-EXPOSURE PROPHYLAXIS The CDC recommends the following: “Recommendations for HBV postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or bodily fluids exposure. Post-exposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed HCP for selecting the appropriate HBV PEP.”32 LONG-TERM EFFECTS WITHOUT VACCINATION Chronic infection occurs in: 90% of infants infected at birth. 30% of children infected at age 1-5 years. 6% of persons infected after age 5 years. Death from chronic liver disease occurs in 15-25% of chronically infected persons.33 TRANSMISSION Hepatitis B transmission occurs when contact with an infected person’s blood, semen, or other bodily fluids allows the virus to enter the body of a person who is not immune. The following situations can lead to infection: Unprotected anal or vaginal sex. Sharing needles used for drugs, body piercing, or tattooing. Contact with open sores. Sharing razors, toothbrushes, nail clippers, or washcloths. Living in a household with a person with ongoing HBV infection. Human bites. Needlesticks or sharps exposures on the job. An infected mother can transmit the disease to her baby during birth.34,35 WHO IS AT RISK? Persons with multiple sex partners or with the diagnosis of a sexually transmitted disease. Those having sexual contact with an infected person. Injection drug users. Infants born to infected mothers. Infants/children of immigrants from areas with high rates of HBV infection. Healthcare and public safety workers. People who live in the same house with someone who has lifelong HBV infection. People who have hemophilia. People who travel to areas where hepatitis B is common. Hemodialysis patients.36 TREATMENT For the patient with acute hepatitis B, the treatment available is primarily supportive. A physician should examine persons with HBV, as it is important to evaluate whether liver disease or damage has occurred. They should also continue to be followed by a physician. Adefovir dipivoxil, alpha interferon, and lamivudine are several drugs that have been licensed for the treatment of chronic hepatitis B. Drinking alcohol and drug use should be completely avoided, as they can worsen liver disease.37 INFECTION CONTROL AND PREVENTION Infection Control For those having sex with multiple partners, a condom should be used every time during sex. This may reduce the risk of transmission. For those who are pregnant or plan on becoming pregnant, a hepatitis B blood test should be given. Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.38 Do not use drugs. If drugs are used, stop and get help through a treatment program. Sharing of syringes/needles, drugs, and water increases risk of infection. Do not share personal daily care items that could have blood on them, such as razors and toothbrushes. Due to the risk involved, reconsider tattooing or body piercing. There is a possibility of becoming infected with the hepatitis virus if the tools have not been adequately cleaned/disinfected between uses. Always follow routine Standard Precautions that include the following: Hand Washing This is the number one way to reduce the spread of the disease. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. Gloves Wear gloves manufactured from proper barrier protection materials when touching blood, bodily fluids, secretions, excretions, and contaminated items. Put on clean gloves just before touching mucous membranes and broken skin. Always change gloves between tasks and procedures on the same patient, especially after contact with material that may contain a high concentration of microorganisms. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient. Wash hands immediately to avoid transfer of microorganisms to other patients orenvironments. Masks, Eye Protection, Face Shields Wear a standard surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and activities that are likely to generate splashes or sprays. Prevention Healthcare personnel that come into contact with blood or bodily fluids should be vaccinated against hepatitis B. Hepatitis B vaccine is the best protection, as hepatitis B is preventable. Currently, there is no cure for hepatitis B. In 2001, the Federal Needlestick Safety and Prevention Act strengthened the requirements related to the use of safetyengineered sharp devices. To reduce employees’ occupational exposure to HIV, hepatitis B, and other bloodborne diseases, the Act requires the use of safety-engineered sharp devices and needle-less systems in hospitals and other healthcare settings.39 Healthcare institutions require reporting of all exposures to blood and bodily fluids. Immediate first aid and follow-up care is extremely important for all healthcare workers. The source patient as well as the healthcare worker will need to be tested for HIV, HBV, and HCV. Those who are HBV positive should not donate blood, organs, or tissue. VACCINE RECOMMENDATIONS Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection. Hepatitis B vaccine has been available since 1982. People of all ages that are “at risk” should be vaccinated. Vaccination programs are available to children 0-18 years old.40 FACTS, STATISTICS, AND TRENDS Hepatitis B is 100 times more concentrated in an infected person's blood than HIV and can survive on surfaces outside the body. Over 5,000 people die every year from hepatitis B-related liver disease. The highest rate of disease occurs in adults (ages 20-49 years). The greatest decline in infection has occurred among children and adolescents, due to routine hepatitis B vaccination. The number of new infections per year has declined from an average of 260,000 in the 1980s to about 78,000 in 2001. There are an estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood. Current data shows that vaccine-induced hepatitis B surface antibody (anti-HBs) levels may decline over time; however, immune memory (anamnestic anti-HBs response) remains intact indefinitely post-immunization. Persons with decreasing antibody levels are still protected against clinical illness and chronic disease. For healthcare workers with normal immune status who have demonstrated an anti-HBs response following vaccination, booster doses of vaccine are not recommended, nor are periodic anti-HBs tests.41

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