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Hepatitis B

Condition Overview:

Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic infectious diseases worldwide. An effective vaccine is available that will prevent the disease in those who are later exposed.

Commonly called "serum hepatitis," hepatitis B ranges from mild to severe. Some people who are infected by HBV develop no symptoms and are totally unaware of the fact, but they may carry HBV in their blood and pass the infection on to others. In its chronic form, HBV infection may destroy the liver through a scarring process, called cirrhosis, or it may lead to cancer of the liver.

When a person is infected by HBV, the virus enters the bloodstream and body fluids, and is able to pass through tiny breaks in the skin, mouth, or the male or female genital area. There are several ways of getting the infection:

• During birth, a mother with hepatitis B may pass HBV on to her infant.
• Contact with infected blood is a common means of transmitting hepatitis B. One way this may happen is by being stuck with a needle. Both health care workers and those who inject drugs into their veins are at risk in this way.
• Having sex with a person infected by HBV is an important risk factor (especially anal sex).

Although there are many ways of passing on HBV, the virus actually is not very easily transmitted. There is no need to worry that casual contact, such as shaking hands, will expose one to hepatitis B. There is no reason not to share a workplace or even a restroom with an infected person.

More than 300 million persons throughout the world are infected by HBV. While most who become chronic carriers of the virus live in Asia and Africa, there are no fewer than 1.5 million carriers in the United States. Because carriers represent a constant threat of transmitting the infection, the risk of hepatitis B is always highest where there are many carriers. Such areas are said to be endemic for hepatitis B. When infants or young children living in an endemic area are infected, their chance of becoming a chronic hepatitis B carrier is at least 90%. This probably is because their bodies are not able to make the substances (antibodies) that destroy the virus. In contrast, no more than 5% of infected teenagers and adults develop chronic infection.

With the exception of HBV, all the common viruses that cause hepatitis are known as RNA viruses because they contain ribonucleic acid or RNA as their genetic material. HBV is the only deoxyribonucleic acid or DNA virus that is a major cause of hepatitis. HBV is made up of several fragments, called antigens, that stimulate the body's immune system to produce the antibodies that can neutralize or even destroy the infecting virus. It is, in fact, the immune reaction, not the virus, that seems to cause the liver inflammation.

Hepatitis B is diagnosed by detecting one of the viral antigens--called hepatitis B surface antigen (HBsAg)--in the blood. Later in the acute disease, HBsAg may no longer be present, in which case a test for antibodies to a different antigen--hepatitis B core antigen--is used. If HBsAg can be detected in the blood for longer than six months, chronic hepatitis B is diagnosed. A number of tests can be done to learn how well, or poorly, the liver is working. They include blood clotting tests and tests for enzymes that are found in abnormally high amounts when any form of hepatitis is present.