Hepatitis B is a vaccine preventable blood borne virus and a sexually transmitted infection. It is present in semen, vaginal fluids and blood. Preventing infection relies on avoiding the risk factors associated with the transmission of the virus. Although the virus has been detected in saliva, urine and other body fluids such as breast milk in very small quantities, these are not generally sufficient to cause transmission. Hepatitis B can be transmitted from mother to child during childbirth, so it is important that medical staff are aware of the mother’s hepatitis B status.
Hepatitis B cannot infect a person if their skin and mucous membranes are intact. Intact healthy skin is a protective barrier against harmful micro-organisms such as bacteria and viruses, making the skin, which is the largest organ of the body, a crucial part of the immune system.
Injecting Drug Use
All injecting equipment has the potential to transmit hepatitis B if it comes in contact with infected blood. This includes swabs, spoons, water, tourniquets, filters, unwashed hands and flat surfaces. It only takes a microscopic amount of infected blood to get into a person’s bloodstream for infection to take place. Hepatitis B can survive on a surface at room temperature for up to four weeks, and inside a protected environment such as the barrel of a syringe, it may survive much longer. It is also important to note sharing nasal straws for snorting drugs can potentially create blood-to-blood contact between people.
Tattooing and Piercing
Unsterile equipment or procedures used for tattooing and body piercing can pose a transmission risk. When contemplating body art it is important to access licensed professional studios with sterile practices. Travellers should note that the relatively stringent laws in Australia governing sterile skin penetration procedures are not necessarily reflected in the practice of overseas tattooists and body piercers, particularly in developing countries.
Hepatitis B was identified during the 1960s and screening of the blood supply for the virus began in 1971. Therefore, there are a number of people in Australia living with the virus who acquired it medically.
Household transmission of hepatitis B is extremely unlikely, although there are a few recommended precautions. Personal grooming items such as toothbrushes, razors, body jewellery and nail clippers should not be shared, as they have the potential to break the skin and carry minute amounts of blood (even if blood is not visible, enough may be present to transmit hepatitis B). Any blood spills should be cleaned up immediately using standard infection control procedures; using latex gloves, antiseptic, disposable paper towels and sealed plastic disposal bags.
Mother to Child
The risk of vertical transmission from mother to unborn baby is estimated to be up to 90% with a number of factors contributing to the degree of risk. Pregnant women are routinely screened for hepatitis B in Australia, which allows medical staff to follow preventative procedures, such as avoiding the use of forceps and scalp electrodes, during childbirth to reduce the risk of transmission to the baby. Hepatitis B Immunoglobulin and vaccination is provided to the baby within 24 hours of birth to further reduce the risk of transmission.
It is safe to breast feed if the mother is hepatitis B positive, as viral quantities found in breast milk are not generally high enough to cause transmission. However, if the mother has bleeding or cracked nipples, there is a risk of blood-to-blood contact with the baby.
Hepatitis B is a sexually transmissible infection, as it is present in sexual fluids, such as vaginal fluid and semen in quantities high enough to cause infection. To minimise the risk of infection condoms, dental dams and gloves should be used where appropriate. A water-based lubricant is also helpful in reducing skin damage, as blood to blood contact can occur during some sexual practices.
Transmission of hepatitis B through needle stick injuries ranges from two to thirty per cent risk for people working in health care settings depending on the nature of the injury and viral load and infectivity. There is a reduced chance of contracting hepatitis B from a needle stick injury in the community.