Hepatitis B is a liver infection caused by the hepatitis B virus. Approximately 40 to 45% of all cases of hepatitis in the U.S. are the result of hepatitis B. Over 300,000 new cases of hepatitis B occur annually, and about one million Americans are chronically infected. Approximately 1% of pregnant women have either an acute or chronic hepatitis B infection.
Who's at Risk?
Certain population groups have an increased prevalence of hepatitis B:
- drug addicts;
- transfusion recipients;
- dialysis patients;
- residents and employees of chronic care facilities;
- prisoners; and
- people who get tattoos or have body piercing procedures.
Women with acute and chronic hepatitis B infection can transmit the virus to others, especially their sexual partner. An infected woman may also transmit this infection to her baby. This usually occurs when the baby is exposed to infected blood and genital secretions during delivery. But, transmission can also occur when the virus is passed to the baby through the placenta, breast milk, or close contact between mother and infant.
Women who test positive for the surface antigen for hepatitis B (HBsAg) have a 10to 20% chance of passing the virus on to a baby who is less than one month old and who has not been vaccinated. This chance increases to almost 90% in women who test positive for both the surface antigen and hepatitis E antigen.
All pregnant women should be screened for hepatitis B. Those women who are not screened prenatally are either screened when they present in labor, or they are assumed to be positive. The babies of women with chronic or active hepatitis B receive vaccination and treatment soon after birth. With appropriate treatment, the risk for mother-to-infant transmission is greatly reduced. Therefore, despite the fact that the virus is present in both blood and breast milk, neither elective cesarean delivery nor avoidance of breastfeeding has any role in prevention of transmission to an appropriately treated infant.
What Are the Symptoms and Consequences of Hepatitis B Infection?
Like other forms of viral hepatitis, acute hepatitis B infection is usually associated with the following symptoms:
- malaise (a general feeling that you are sick);
- decreased appetite;
- darkened urine;
- jaundice (yellowing of the skin and the whites of the eyes); and
- pain on the right side of the abdomen over the liver.
Less than 1% of patients infected by the hepatitis B virus develop fulminant (sudden and severe) hepatitis and die.
About 85 to 90% of patients who develop an acute hepatitis B infection experience complete resolution of their physical symptoms and develop antibodies that provide immunity from future infection. The remaining 10 to 15% become chronically infected. Of these, 15 to 30% subsequently develop chronic hepatitis or liver cirrhosis, and a small percentage develops liver cancer. Chronic liver disease is particularly likely to occur in patients who become co-infected with hepatitis D virus.
Attention Health Professionals!
Do Infected Patients Pose a Risk to Health Care Workers?
Patients infected with hepatitis B virus may transmit infection to the medical and nursing personnel who care for them. Each year, approximately 12,000 American health care workers contract hepatitis B as a result of occupational injury, such as a needle stick. Of these, approximately 200 develop fulminant hepatitis and subsequently die.
Health care workers can protect themselves from hepatitis in three principal ways:
- be vaccinated for hepatitis B;
- encourage all young adults and other individuals who have a specific risk factor to receive the hepatitis B vaccine; and
- consistently follow universal precautions to prevent sharp injuries and splashes to exposed mucous membrane or skin surfaces.
Do Infected Health Care Workers Pose a Risk to Their Patients?
Health care workers who are infected with hepatitis B definitely pose a risk to others. They must observe safeguards to prevent transmission of the infection. Infection is most likely to occur due to direct blood-to-blood exposure during invasive surgical procedures.
Unless the patient has documented immunity to hepatitis B, the infected health care worker has an ethical obligation to inform the patient that some risk of transmission exists. The attendant should then perform the procedure only if the patient explicitly consents. During the actual procedure, the operator must take every precaution to insure that a sharp injury and resultant blood-to-blood contact do not occur.