Hepatitis B

Hep B or HBV

  • Overview
  • In Depth
  • Vaccines
  • Video

Hepatitis is a viral disease that attacks the liver. There are several types of viral hepatitis, labelled A, B, C, D, and E. Hepatitis B virus or HBV is very infectious and is spread from person to person through bodily fluids including blood, semen, and vaginal fluids. People who are infected with hepatitis B can either develop an acute illness in which they become sick soon after infection or a chronic illness in which the illness does not begin to affect them for a longer period of time with more serious complications. People with chronic hepatitis B infection are likely to suffer from liver disease or liver cancer which can be life threatening. Infected infants and young children are at higher risk for developing chronic disease. Hepatitis B cannot be cured but can be prevented with a vaccine.

A brief history

Hepatitis was first described by Hippocrates over 2000 years ago with signs of jaundice or yellowing of the skin and eyes. Several outbreaks in the 19th and 20th Centuries are documented with global spread mainly a result of warfare. In recent history, cases in New Zealand peaked near 1984 but began declining with the introduction of the vaccine, first intended for infected mothers in 1985 and later for all children in 1988. For the last 10 years, New Zealand has maintained fewer than 100 new cases per year.

NZ Situation

While estimates show that less than 1% of the New Zealand population are carriers of HBV, there are pockets of areas around the country with higher rates than others.

Symptoms

Symptoms of acute hepatitis B include nausea and vomiting, jaundice (yellow skin or eyes), dark urine (pee, mimi), pale faeces (poo, tutae), feeling unwell, lack of energy, loss of appetite, upset stomach or stomach pains, fever, and general aches and pains.

Chronic hepatitis B may be harder to detect as some infected people may not show signs or symptoms.

How do you get it?

Hepatitis B infection can be spread through open cuts or wounds, sexual contact, sharing drug needles, blood transfusion, and passed from infected mother to baby. Newborn babies of infected mothers can receive their first dose of hepatitis B vaccine within 24 hours of birth to prevent spread.

What are the risks?

Hepatitis B can be a life-long illness causing liver disease and liver cancer. Blood remains infective in those with a chronic hepatitis B infection and can infect others.

The Hepatitis Foundation of New Zealand provides a free Hepatitis B Follow-up Programme that provides information, support and regular blood tests that are vital in managing hepatitis B infection. We recommend a visit to their website (www.hepatitisfoundation.org.nz) or you can phone them for free on 0800 33 20 10.

Who is the most at risk?
  • People aged 25 years or over who are of Māori, Pacific Island or Asian ethnicity*
  • People born outside New Zealand*
  • Infants born to a mother with chronic hepatitis B infection
  • Injection drug users
  • Received a tattoo with unsterile equipment*
  • Heterosexuals with multiple partners
  • Men who have sex with men
  • Household or sexual contacts of infected persons
  • Health care and public safety workers who have exposure to blood in the workplace
  • Haemodialysis patients and blood transfusion patients

*Source: The Hepatitis Foundation of New Zealand.

Treating the symptoms

There is no specific treatment for hepatitis B. Chronic hepatitis B infection can be treated with drugs like interferon and anti-viral medication. Patients with liver disease may be recommended for liver transplant. Liver cancer is almost always fatal.

The Hepatitis Foundation of New Zealand provides a free Hepatitis B Follow-up Programme that provides information, support and regular blood tests that are vital in managing hepatitis B infection. We recommend a visit to their website (www.hepatitisfoundation.org.nz) or you can phone them for free on 0800 33 20 10.

Preventing the disease from spreading
  • There is an effective vaccine available to prevent hepatitis B.
  • Contacts and family members of infected persons should practice strict hygiene measures.
  • Avoid injection drug use.
  • Engage in safe sex practices including use of condoms.
Risk of disease vs. vaccine side effects
Hepatitis B Effects of disease Side effects of vaccine

Hepatitis B is one type of hepatitis virus that infects the liver and can cause long term liver damage.

  • Infants and children are less likely to have symptoms than adults, but
  • Infants are more likely to become chronically infected and develop complications later in life.
  • Liver inflammation for around 8 out of 10 adults; around 2 adults out of 10 will not have symptoms.
  • Acute liver failure can require liver transplantation or lead to death.
  • Chronic infection can lead to cirrhosis and liver cancer.
Common side effects
  • Mild pain, redness and swelling around injection site.
  • Decreased appetite.
  • Vomiting or diarrhoea.
  • Irritability, restlessness.
  • Unusual crying.
  • Limb swelling after the 4th or 5th vaccine dose.
Uncommon side effects
Rare/very rare side effects
  • Hives.
  • Itching.
  • Temporary low platelet count.
  • Persistent inconsolable screaming.
  • Muscle or joint pain.
  • Abdominal pain and vomiting
  • Hypotonic, hyporesponsive episode (HHE) in infants.
  • Convulsion.
  • Severe allergic reaction (anaphylaxis).

The hepatitis B virus (HBV) attacks the liver and can result in both acute and chronic disease. It is spread via blood and bodily fluids. The most common routes of infection are through sexual contact, injection drug use, and occupational hazards for health professionals. The age at which someone is infected is a good predictor of disease outcome and severity. Roughly 2 billion people worldwide have been infected with the majority of cases in developing countries. Hepatitis B is vaccine preventable and the vaccine is included in the New Zealand National Immunisation Schedule.

Causative organism

The hepatitis B virus is is a DNA-containing hepadnavirus. Hepatitis B is extremely virulent and is 50-100 times more infectious than the human immunodeficiency virus (HIV).

Clinical signs, symptoms and complications

Adults with acute hepatitis B infection may not display symptoms. The disease may only be detectable by liver function tests.

  • Acute hepatitis B can cause symptoms that include anorexia, abdominal discomfort, malaise and fatigue, nausea and vomiting, and jaundice.
  • Acute hepatitis B infection may cause an acute hepatic necrosis, requiring an emergency liver transplantation or causing death.
  • About 10% of adults with acute hepatitis B infection will develop chronic hepatitis B infection.
  • Chronic hepatitis B infection occurs in 90% of infected infants and 30-50% of infected children between 1-4 years of age.
  • Chronic hepatitis B infection may result in cirrhosis of the liver, which increases the risk of hepatocellular carcinoma.
Method of transmission
  • Exposure to infected blood or body fluids, e.g.
    • During sexual contact.
    • Through injection drug use.
    • Perinatal transmission.
    • Occupational exposure for health care or public safety workers.
Public health significance
  • More than 2 billion people are infected worldwide.
  • There is a 70-90% vertical transmission rate from infected mother to newborn.
  • Roughly 90% of infected infants will become chronic hepatitis B infection carriers.
  • Hepatitis B related cirrhosis and liver cancer are almost always fatal.
New Zealand epidemiology

Some regions in New Zealand show a significantly higher rate of hepatitis carriage. In recent history, cases in New Zealand peaked near 1984 but began declining with the introduction of the vaccine, first intended for infected mothers in 1985 and later for all children in 1988. For the last 10 years, New Zealand has maintained fewer than 100 new cases per year.

Prevention
  • Strict hygiene measures.
  • Prophylactic immunisation for newborns to carrier mothers.
  • Safe sex practices.
  • Avoiding injection drug use or use of clean disposable needles.
  • Effective vaccines to protect against hepatitis B are available in New Zealand.

Hepatitis B vaccine (HBvaxPRO®) is recommended and funded for:

  • Children under 18 years of age.
  • Adults (from 18 years of age) who are household and/or sexual contacts of a person known to have acute or chronic hepatitis B infection, individuals who are HIV-positive or hepatitis C positive, individuals following immunosuppression due to steroid or other immunosuppressive therapy longer than 28 days, transplant recipients, individuals on renal dialysis, following needle-stick injury, or following non-consensual sexual intercourse.
Treatment

There is no specific treatment for hepatitis B infection. Chronic disease may be treated with interferon or anti-virals but management revolves mostly around comfort and nutrition.

Health professionals are encouraged to refer patients who are hepatitis B positive to The Hepatitis Foundation of New Zealand (www.hepatitisfoundation.org.nz) for enrolment in the Hepatitis B Programme. An online referral form is available or phone 0800 33 20 10 for more information.

Infanrix®-hexa

DTaP-IPV-HepB/Hib

Infanrix®-hexa is used for primary and booster vaccination of infants and children to protect against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and disease caused by Haemophilus influenzae type b. Infanrix®-hexa can also be used for catch-up immunisation for children up to their 10th birthday.

HBvaxPRO®

Hepatitis B

HBvaxPRO® is used for primary vaccination of infants, children and adults to protect against the hepatitis B virus. HBvaxPRO® is also given to newborn babies whose mothers are hepatitis B positive, at the same time as hepatitis B immunoglobulin (HBIG), to reduce the risk that they will get sick with hepatitis B from contact with the virus during the birth process.

Engerix®-B

Hepatitis B

Engerix®-B is a privately purchased vaccine to protect against hepatitis B for adolescents aged 18 years and over and adults who do not meet the eligibility criteria for funded HBvaxPRO®.

Listed below are the available videos for this disease