Dr. Wu's Liver diseases and Hepatitis
for professionals (medical students and residents)
( Last updated Sep. 30, 2005)
Viral hepatitis B
(Key words: HBV, hepatitis B virus, hepatitis B)
For consumers:
- Hepatitis B is the liver disease caused by a virus called hepatitis B virus (HBV). It can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
- Hepatitis B is passed by contact with the blood or other body fluids of someone who has the virus.
- 1. Having sex without condoms with someone who has the hepatitis B virus.
- 2. Being born to a mother who has the virus.
- 3. Sharing needles and syringes
- 4. Getting a tattoo or body piercing with dirty tools that were used on someone else.
- 5. Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way).
- 6. Sharing a toothbrush or razor with an infected person.
- 7. An infected woman can give hepatitis B to her baby at birth or through her breast milk.
- 9 out of every 10 adults will get rid of the virus from their bodies after a few months (acute hepatitis B). 1 out of every 10 people will never get rid of the virus from their bodies (chronic hepatitis B). They are called carriers.
- Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection.
- More information is available at CDC's Web site Hepatitis B and You.
- FAQ about general information on hepatitis B (CDC).
- Fact sheet about vaccination for prevention of hepatitis B (CDC).
- What I need to know about Hepatitis B (NIDDK, NIH).
- For more information, refer to the followings in the "for professionals" section.
For professionals:
- DNA virus ----- 42 nm hepadna virus.
- Blumberg reported "Australia antigen" in Australian
aborigines in 1965.
- Awarded Nobel prize in 1976.
- Infected poppulation:
- 400 million population infected worldwide.
- 1.25 million carriers in the US. 150,000 new infections occuring annually in the US.
- Hepatitis B is responsible for an estimated 4000 to 5000 deaths each year in the United States due to cirrhosis and liver cancer.
- Most in Far East, Southeast Asia, and Africa.
- Serotype: adr, adw, ayr, and ayw.
- Genotype:
- 8 genotypes: A, B, C, D, E, F,G and H.
- In Taiwan: B: 50%, C: 30%.
- Carrier in general population:
- North America and northern Europe: ----- 0.1%
- Taiwan: ----- 17% (15 ~ 20%)
- Japan: ------- 1 ~ 2%
- Carrier in Taiwan: among general population
- born before 1960 ----- over 90% have been infected.
- Born after 1984 ----- 1% (having been vaccinated at birth)
- Blood-born (parenteral transmission) infection with incubation period of 1.5 ~ 4 months.
- Diagnosis: based on test for serum markers and virus:
- HBsAg, anti-HBc, anti-HBs, HBeAg, anti-HBe, and HBV-DNA.
- Carrier ----- "Chronic carrier" and so-called "Carrier".
- Vertical transmission: half of the carriers in Taiwan -----
- Transmission from carrier mothers to newborn babies during delivery
(perinatal period ).
Horizontal transmission:
- Blood transfusion, operation, injection, tattooing, and ear piercing.
- Injury in skin or mucous membrane.
- sexual contact and homosexuals.
- Iintravenous drug abusers (IVDA).
- In western countries: mostly among homosexuals and intravenous drug abusers.
Infected:
- During delivery (perinatal stage) --->vertical transmission
- In infancy ( < 3 years of age ) --->horizontal transmission
- 50% become carrier.
- Horizontal transmission in adult
- Only 5% become carrier.
Symptom: refer to clinical feature of acute hepatitis page.
Prevention: refer to prevention of viral hepatitis page.
Outcome: ----- Carriers --->acute episode (in puberty and young
adult) ---> chronic hepatitis ---> cirrhosis ---> hepatocellular carcinoma
In Taiwan: 85 % of chronic liver disease (chronic hepatitis, cirrhosis,
hepatocellular carcinoma) are associated with HBV infection.
Treatment:Refer to treatment page.
Table: Diagnosis of the stage of HBV infection by hepatitis markers
| HBsAg | anti-HBc | anti-HBs | other markers | Diagnosis |
|---|
| 1. | + | - | - | HBeAg (+) | early infection |
|---|
| 2. | + | + | - | HBeAg (+)
IgM-antiHBc (+) | acute infection |
|---|
| 3. | + | + | - | anti-HBe (+)
IgM-anti-HBc (+) | acute infection
e-antibody-conversion |
|---|
| 4. | - | + | - | anti-HBe (+)
IgM-anti-HBc (+) | convalescent window stage |
|---|
| 5. | - | + | + | anti-HBe (+) | early convalescent stage |
|---|
| 6. | + | + | - | IgM-anti-HBc (-) | chronic infection
compare with 3. |
|---|
| 7. | - | +
low titers | - | IgM-anti-HBc (-) | earlier infection
compare with 4. |
|---|
| 8. | - | - | + | blank | earlier infection
or vaccination |
|---|
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(By Jau-Shin Wu, M.D.;Posted Sep. 1996; Revised Sep. 30, 2005)
