Talk To Your Doctor About Hepatitis B Vaccinations
Hepatitis B is a Vaccine Preventable Blood Borne Virus (BBV) and a Sexually Transmissible Infection (STI)
What is hepatitis B?
Hepatitis B is a liver infection that is caused by the hepatitis B virus. It is the most common hepatitis virus in the world. It is major global health issue and it is estimated that nearly 260 million people are living with chronic hepatitis B.
The hepatitis B virus enters through the blood or bodily fluids and travels to the liver via the bloodstream. Once in the liver the virus attaches to healthy liver cells and multiplies.
People are often unaware they have hepatitis B. If not diagnosed and managed appropriately, hepatitis B can lead to cirrhosis (scarring of the liver), liver cancer, or liver failure.
In Australia a safe and effective vaccine is widely available.
who is at risk of chronic disease?
In infants and children:
- 80 – 90% of infants infected during the first year of life develop chronic infections; and
- 30 – 50% of children infected before the age of 6 years develop chronic infections.
- Less than 5% of otherwise healthy persons who are infected as adults will develop chronic infections; and
- 20 – 30% of adults who are chronically infected will develop cirrhosis and/or liver cancer.
Hepatitis B is a vaccine preventable blood borne virus (BBV) and a sexually transmitted infection (STI). It is present in semen, vaginal fluids and blood. Prevention relies on avoiding the risk factors associated with the transmission of the virus.
To avoid hepatitis B:
- Get vaccinated
- Practice safer sex (use condoms and dental dams)
- Use new and sterile injecting equipment each time
- Avoid backyard tattooing and piercings
- Avoid sharing toothbrushes, razors, hair and nail clippers and other personal hygiene products
- Cover open wounds with a bandaid or bandage
- Always wear disposable gloves when cleaning up blood or body fluids or giving someone first aid
- Wipe up any blood spills then clean the area with bleach
- Throw away personal items such as tissues, menstrual pads, tampons and bandages in a sealed plastic bag
People who have been exposed to hepatitis B and are not vaccinated should:
- receive hepatitis B immunoglobulin (HBIG) within 72 hours of exposure, and
- a dose of hepatitis B vaccine within 7 days
Hepatitis B is found in blood and body fluids including saliva, semen, vaginal fluids and breast milk.
- Mother to baby, although the risk is reduced through the Australian vaccination program and the administration of hepatitis B immunoglobulin and vaccination within 12 hours of birth
- Unprotected sex with a person who has hepatitis B
- Sharing of unsterile injecting equipment (including, water, tourniquets, unclean hands and surfaces)
- Unsterile medical, surgical, dental, tattooing or body art procedures
- Child-to-child transmission through household contact such as biting
- Sharing razors, toothbrushes, hair and nail clippers or other personal effects
- Unsterile cultural practices involving blood
- Needle stick injury
- Having received blood products in Australia before 1991
Hepatitis B is NOT spread by:
- contaminated food or water
- through casual or social contact such as kissing, sneezing, coughing or hugging
- eating food prepared by a person with hepatitis B
- sharing food with a person who has hepatitis B
- sharing bathrooms, showers or toilets
Hepatitis B is complex and a number of blood tests may need to be carried out, these blood tests can happen all at once.
The results of these tests can indicate:
- an acute (recent) infection
- if you are immune to hep B
- resolved (cleared and immunity to hep B) infection or
- chronic (long term) infection
Further tests in chronic hepatitis B infection can indicate whether the virus is:
- ‘actively’ replicating (active infection), or
- ‘inactive’ (replicating at a much lower rate)
All test results and an explanation of their meaning should be provided by the doctor in person.
The symptoms of hepatitis B can depend on whether a person has acute or chronic hep B. About half of adults infected with hep B and almost all children will not experience symptoms at all. If a person believes they may have been exposed to hep B, it is important to see a doctor for testing.
Acute (short term) Hepatitis B
Symptoms in adults include:
- jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces/poo) occurring approximately 12 weeks after initial contact
- loss of appetite
- nausea and vomiting
- abdominal pain and
- muscle and joint pain
Many people with acute hepatitis B have no symptoms and never realise they had the virus. A very small percentage of people with acute hepatitis B become very sick in a short period of time. This happens if there is massive damage to the liver and it stops working. This is called ‘fulminant hepatitis’.
Chronic (Long term) Hepatitis B
Often results in no symptoms, meaning people can feel healthy and not be aware they have hepatitis B. However, other people may experience symptoms which are similar to those experienced with other forms of hepatitis.
These can include:
- depression and irritability
- pain in the liver (upper, right side of abdomen)
- nausea and vomiting
- loss of appetite
- joint aches and pains
People with chronic hep B have a higher risk of developing liver cancer.
It is important that people know their hepatitis B status. In some cases, a diagnosis of hepatitis B may explain why a person has been feeling ill or fatigued, or why certain foods or alcohol may make them feel unwell. Monitoring (regular check-ups) and treatment for hepatitis B is used to manage the effects of hep B, but is not a cure.
- Treatment for hepatitis B helps maintain good health, but it is not a cure
- Not all people with hepatitis B will need treatment, but will need monitoring by their doctor. People who are chronically infected, but do not have any liver damage do not need treatment but need close monitoring with regular (6 monthly) liver function tests
- Regular liver check-ups to monitor your health will help determine when/if you need treatment
- If a person has liver damage they should speak to their doctor about starting treatment
- The Australian Government through the Pharmaceutical Benefits Scheme (PBS) funds several different medications to treat chronic hepatitis B
The decision on when to start treatment is complex and should be made in consultation with a gastroenterologist or specialised GP.
Hepatitis B treatment is suitable for people who are classified as being in a particular stage of hepatitis B infection, dependent on a person meeting the following criteria:
- Increased virus activity and liver inflammation demonstrated by elevated liver enzymes (ALT)
- Inflammation and activity in the liver as seen in the results of a liver biopsy
- High levels of hepatitis B virus (HBV DNA) in the blood
- To stop the hepatitis B virus from multiplying or to reduce the rate of multiplication as much as possible
- Decrease the risk of serious liver disease
- Make it possible for the liver to repair some of the damage and to work better
During treatment, the patient’s blood tests are monitored very carefully to look for signs of antiviral resistance. If there are signs of resistance such as elevated liver enzymes and high levels of hepatitis B virus in the blood, the antiviral tablets will be changed.
Hepatitis B is a vaccine preventable blood borne virus and a sexually transmitted infection.
- The hepatitis B vaccine is safe and effective
- You cannot get hepatitis B from the vaccine
- Newborns should be vaccinated against hepatitis B at birth. Further doses at 2, 4 and 6 months are important to ensure immunity
- Adults at greater risk for contracting hepatitis B should have a blood test before being vaccinated to check whether they have hepatitis B and to check their immunisation status
- Children born after 1 May 2000 should have been given the hepatitis B vaccine shortly after they were born
- Your doctor or sexual health service will have the hepatitis B vaccine available
- Vaccination consists of three injections over a six-month period and it is important to ensure you receive all three injections
- Most people don’t experience side effects from the hepatitis B vaccine
In the ACT, the hepatitis B vaccination is funded through Australia’s National Immunisation Program (NIP) where it is available for all babies at birth.
Free hepatitis B vaccinations are also available in the ACT for:
- Sexual and / or household contacts of a person with hepatitis B
- People who inject drugs
- Refugees and humanitarian entrants into Australia who have no history of hepatitis B immunisation
List of people recommended to get the hepatitis B vaccine.
The Australian Immunisation Handbook3 (ATAGI 2018) recommends that the following groups of people get the hepatitis B vaccine:
- Infants, children and adolescents
- Aboriginal and Torres Strait Islander people
- People who are immunocompromised, including:
- people living with HIV
- dialysis patients and people with severely impaired kidney function
- people about to receive an organ transplant
- people who have received a stem cell transplant
- People with other medical conditions, including:
- people with chronic liver disease and/or hepatitis C
- people who receive certain blood products
- people with developmental disabilities who attend day-care facilities
- People who are at risk because of their job, including:
- people who work in any occupation that involves direct patient care, handling human tissue, blood or bodily fluids, or used needle and syringes
- healthcare workers
- police, members of the armed forces, emergencies services staff, and correctional facilities staff
- funeral workers, embalmers
- staff involved in care of people with development disabilities
- workers who perform skin penetrating procedures, such as tattooists and body piercers
- People travelling to countries with higher levels of hepatitis B
- Other groups:
- household or other close contacts of people living with hepatitis B
- sexual contacts of people living with hepatitis B
- men who have sex with men
- migrants from countries with higher levels of hepatitis B
- people who inject drugs
- inmates in correctional facilities
- sex industry workers
Pregnancy, Children and Hep B
- Newborns infected with hepatitis B rarely experience symptoms of acute infection, but 80 - 90% will develop chronic or lifelong infection
- Children infected with hepatitis B rarely experience symptoms of acute infection, but 30% will develop chronic or lifelong infection
- Adults or adolescents infected with hepatitis B commonly experience symptoms of acute infection, however less than 5% develop chronic or lifelong infection (Dore, G; et al; 2006)
Pregnancy and Hepatitis B
- All pregnant women should be tested for hepatitis B
- It is very important that pregnant women who have hepatitis B discuss monitoring the hep B with their doctor
- It may be beneficial for some pregnant women who have hepatitis B to take antiviral medications during their pregnancy to reduce the chances of passing the hepatitis B onto their baby, discuss this with your doctor
- Pregnant women who are unsure if they have been vaccinated against hepatitis B should be checked
- The most common way people contract hepatitis B is through childbirth when they are born
- Babies who are born to women who have hepatitis B can be given hepatitis B immunoglobulin and hepatitis B vaccination at birth. This greatly reduces the risk of transmission from mum to baby
Children and hepatitis B
- The most common way children contract hepatitis B is when it is passed on during pregnancy and birth from their mother
- When children have the hepatitis B virus for longer than 6 months, this is known as a chronic hepatitis B infection
- Most children living with hepatitis B do not show any symptoms and are well and healthy children
- A child’s liver function, growth and development are usually not affected
- A child living with hepatitis B may be at risk of long-term complications
- Monitoring of children with hepatitis B should be discussed with their doctor
- There is no need to exclude children with hepatitis B from day-care or school or to advise staff of the child’s hepatitis B status
When a person has more than one virus at the same time it is commonly known as “co-infection.” It is possible for people to be co-infected with two or three hepatitis viruses or HIV and one or more hepatitis viruses.
- Hepatitis B, C, D and HIV have shared routes of transmission, either blood to blood or sexually transmitted.
- Approximately 5% of Australians living with chronic hepatitis B are estimated to have hepatitis C co-infection
- All people living with chronic hepatitis B after appropriate pre-test discussion should be tested for hepatitis C, hepatitis D, and HIV
- Each virus changes the natural history of chronic hepatitis B and may complicate treatment
- Management of co-infection is complex and requires shared care with the patient, a specialist, and family doctor
Hepatitis B and Hepatitis C Co-infection
- Hepatitis B and hepatitis C is the most common co-infection in people living with chronic hepatitis B in Australia
- This co-infection is most commonly associated with exposure through unsafe injecting drug practices. People with hepatitis B and hepatitis C co-infection can either be exposed due to this shared mode of transmission or have an independent risk factor for chronic hepatitis B such as country of birth, Aboriginal and Torres Strait Islander status, or sexual risk
- Hepatitis B and C co-infection may cause more severe liver disease with an increased risk of cirrhosis and liver cancer and higher mortality rates - 3 times higher than just having hepatitis B or C alone
- Acute (short term) co-infection, which is usually acquired through unsterile injecting drug use, has been associated with an increase of fulminant (rapid loss of liver function) hepatitis
- The recent advances in hepatitis C treatment, which have a 95% cure rate, has changed treatment choices for people living with hepatitis B and C co-infection
- Clearance rates for people co-infected is similar to people who have hepatitis C alone
- All people living with hepatitis C are able to do treatment regardless of the situation – hepatitis B, C, D and/or HIV co-infected, homeless or currently injecting drugs
- Reactivation of previously suppressed and low-level hepatitis B replication can occur while on hepatitis C treatment and should be monitored at regular intervals while doing treatment and after completion of treatment
- Talk with your doctor about your hepatitis B and C. Treatment is important and if you’re unsure about anything ask them to clarify/talk the process through with you
Definition of Fulminant hepatitis https://medical-dictionary.thefreedictionary.com/fulminant+hepatitis severe, rapidly progressive loss of hepatic function due to viral infection or other cause of inflammatory destruction of liver tissue
with associated coagulopathy and encephalopathy.
ACT Health: Hepatitis B Factsheet: https://health.act.gov.au/
ASHM Complex situations Co-infection and Immunosuppression: https://www.hepatitisb.org.au/complex-situations-co-infection-and-immunosuppression/
Australian Government Department of Health: https://www.health.gov.au/health-topics/hepatitis-b
Australian Government Department of Health -Immunisation: https://campaigns.health.gov.au/immunisationfacts
Australian Government Department of Health: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-f-routine-maternal-health-tests/hepatitis-b
Hepatitis Australia: https://www.hepatitisaustralia.com/what-is-hepatitis-b
Hepatitis Australia: https://www.hepatitisaustralia.com/Pages/FAQs/Category/hepatitis-b-faqs
Hepatitis Australia: https://www.hepatitisaustralia.com/hepatitis-b-vaccinations
The Sydney Children's Hospital Network (SCHN): https://www.schn.health.nsw.gov.au/fact-sheets/hepatitis-b-virus-infection-in-infants-and-children
World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b