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Infectious Disease

HCA 240 14 August 2011

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Hepatitis B Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, leading to liver failure, liver cancer, or cirrhosis — a condition that causes permanent scarring of the liver. Most people infected with hepatitis B as adults recover fully, even if their signs and symptoms are severe. Infants and children are much more likely to develop a chronic hepatitis B infection. Although no cure exists for hepatitis B, a vaccine can prevent the disease (Mayo Foundation for medical Education and Research, 2011). Hepatitis B infection may be either short-lived (acute hepatitis B) or long lasting (chronic hepatitis B).

Acute hepatitis B infection lasts less than six months. If the disease is acute, your immune system is usually able to clear the virus from your body, and you should recover completely within a few months. Most people who acquire hepatitis B as adults have an acute infection. Chronic hepatitis B infection lasts six months or longer. When your immune system can't fight off the virus, hepatitis B infection may become life long, possibly leading to serious illnesses such as cirrhosis and liver cancer. Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease (Mayo Foundation for medical Education and Research, 2011).

Hepatitis B infection can be spread through having contact with blood, semen, vaginal fluids, and other body fluids of someone who already has a hepatitis B infection or during childbirth (PubMed Health, 2010). Common ways HBV is transmitted include sexual contact,

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sharing needles, accidental needle sticks, and childbirth. One may become infected if one has unprotected sexual contact with an infected partner whose blood, saliva, semen or vaginal secretions enter one’s body. HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts one at high risk of hepatitis B. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood. Pregnant women infected with HBV can pass the virus to their babies during childbirth (Mayo Foundation for medical Education and Research, 2011).

Most of the damage from the hepatitis B virus occurs because of the way the body responds to the infection. When the body’s immune system detects the infection, it sends out special cells to fight it off. The disease fighting cells, however, can lead to liver inflammation (PubMed Health, 2010). Albumin level, liver function, and prothrombin time tests are done to identify and monitor liver damage from hepatitis B. Antibody to HBsAg (Anti- HBs), Antibody to hepatitis B core antigen (Anti-HBc), Hepatitis B surface antigen (HBsAg), and Hepatitis E surface antigen (HBeAg) tests are done to diagnose and monitor people with hepatitis B. Patients with chronic hepatitis will need ongoing blood tests to monitor their status.

If one’s doctor determines one’s hepatitis B infection is acute — meaning it is short-lived and will go away on its own — one may not need treatment. Instead, one’s doctor will work to reduce any signs and symptoms one experiences while one’s body fights the infection. One’s doctor may recommend follow-up blood tests to make sure the virus has left one’s body. If one has been diagnosed with chronic hepatitis B infection, one’s doctor may recommend antiviral medications or a liver transplant. Antiviral medications help fight the virus and slow its ability to

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damage one’s liver. If one’s liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes one’s damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors.

No complementary or alternative medicine treatments have proved helpful in preventing or treating hepatitis B infection. One herb that continues to attract attention for its touted liverhealth properties is milk thistle. Proponents of milk thistle recommend the herb to treat jaundice and other liver disorders. People take milk thistle as a capsule, extract or infusion. Small studies of milk thistle treatment for liver disease have had mixed results. Many of the studies have been poorly designed, making it difficult for researchers to draw conclusions about the usefulness of milk thistle. If you're interested in trying milk thistle, discuss the benefits and risks with your doctor (Mayo Foundation for medical Education and Research, 2011).

If you know you've been exposed to the hepatitis B virus, call your doctor immediately. Receiving an injection of hepatitis B immune globulin within 24 hours of coming in contact with the virus may help protect you from developing hepatitis B. The hepatitis B vaccine is typically given as a series of three injections over a period of six months. One can not get hepatitis B from the vaccine. Almost anyone can receive the vaccine, including infants, older adults and those with compromised immune systems. Side effects include soreness or swelling at the injection site. Although concerns have been raised that the HBV vaccine may increase the risk of autoimmune disease, studies have found no connection (Mayo Foundation for medical Education and Research, 2011).

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Other ways to reduce your risk of HBV include knowing the HBV status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HBV or any other sexually transmitted disease. If you don't know the health status of your partner, use a new latex condom every time you have sexual contact. Remember that although condoms can reduce your risk of contracting HBV, they don't eliminate the risk entirely. Condoms can break or develop small tears, and people don't always use them properly. If you're planning an extended trip to a region where hepatitis B is more common, ask your doctor about the hepatitis B vaccine well in advance. It's usually given in a series of three injections over a six-month period (Mayo Foundation for medical Education and Research, 2011).

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References

PubMed Health. (2010). Hepatitis B. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth

Mayo Foundation for Medical Education and Research. (2011). Hepatitis B. Retrieved from http://www.mayoclinic.com/health/hepatitis-b/DS00398