Introducing hepatitis B

Transcription

1 Introducing hepatitis B 1

2 Introducing hepatitis B: Contents To jump to the section you require, click on the page number below. Introducing hepatitis B: 10 things you (probably) didn t know about the virus 3 Hepatitis B and the liver 5 Who is most at risk of hepatitis B? 6 Sharps injuries 8 I ve got hepatitis B. What now? 10 Working in a school what s the risk of hepatitis B? A GP s perspective 13 Are hepatitis B vaccinations required for travelling? 14 What about hepatitis A and C? 15 Do I need a booster shot? 16 Vaccinations 17 2

3 Introducing hepatitis B: 10 things you (probably) didn t know about the virus When it comes to viral infections, everyone s heard of HIV and swine flu. They can spread easily and if left untreated they can be deadly. But what about hepatitis B? We don t tend to talk about that one so much, but hepatitis B has actually infected more people than either swine flu or HIV. Hepatitis B is a virus that attacks the liver and is spread through contact with the bodily fluids of an infected person. Many people recover from it, yet some people will develop chronic hepatitis. Lifelong hepatitis may lead to liver cancer or liver failure both of which can be fatal. There is a vaccination which is available on the NHS for high-risk groups such as drug addicts, some people with liver disease and close family members of someone with hepatitis B. However unlike many countries, the UK does not offer hepatitis B vaccinations routinely to all children. Hepatitis B is a potential risk to anyone who has unprotected sex or shares needles. There are also a great number of people who are at risk of the virus because of their job. Anyone who might come into physical contact with other people at work is at risk. This includes police, teachers, social workers, sports players, all health workers and many, many others. Considering that hepatitis B is an occupational risk to many professions (the Hepatitis B Foundation believes that 7 million people in the UK are at high risk and should be vaccinated), it s surprising how little the infection is discussed. So to start that discussion, here are a few little known facts about hepatitis B A misconception about hepatitis B is that it s a rare disease which only affects drug addicts and sex workers. That s not true though. In fact hepatitis B is so common that one in three people in the world has had the virus. To give some perspective, a similar amount of people use the internet. 3

4 2. Despite the prevalence of hepatitis B, there is very little awareness of it. The UK s National Institute for Clinical Excellence found in 2012 that not enough is being done to educate the general public about the risk factors and causes of hepatitis B. It is believed that 50% of people in the UK who have chronic (lifetime) hepatitis B don t actually realise they are infected. 3. Hepatitis B is 50 to 100 times more infectious than HIV. 4. This is because hepatitis B can survive outside of the body for up to seven days. HIV, on the other hand, stops being infectious after a few hours outside of the body. During the seven day period, hepatitis B could infect someone if they haven t been vaccinated. For the virus to survive, it must be contained within a body fluid. So blood or spit at the scene of a crime or accident may still pose a threat days after the incident if it is infected. 5. Hepatitis B often only causes mild symptoms and is highly treatable. 90% of healthy adults who get infected will make a full recovery within six months. However some infected people will carry the disease for the rest of their life. Of these, about 25% will die of liver cancer or cirrhosis. 6. Since 1982 a vaccine to protect against hepatitis B has been available. It is 95% effective in protecting against the infection. 7. However, the UK is one of the only developed countries that does not provide a hepatitis vaccine programme. 8. Tetanus, which is routinely vaccinated against in the UK, infects about 6 people and causes on average one death per year. Although it is hard to put a precise figure on the death rate associated with hepatitis B, the BBC cite it as being the 10th leading cause of death in the world. 9. According to the Hepatitis B Foundation, 90% of babies infected during the time of birth will go on to develop chronic hepatitis. 10. In western Europe and North America you are most likely to get hepatitis B from drug use, unprotected sex or from an incident at work. 4 Molecular structure of the hepatitis B virus.

5 Hepatitis B and the liver What is the liver? If we re going to talk about hepatitis B, an overview of the liver is a good starting point as this is the vital organ that is damaged by hepatitis B. Being about the size of a rugby ball, the liver is the largest internal organ. It weighs roughly 1.8Kg in men and 1.3 kg in women. At any one time, the liver holds a tenth of the body s total blood supply. So what does it do? The liver actually has around 500 different functions, making it a pretty important part of our anatomy. It helps the digestive process by extracting nutrients and breaking down harmful poisons such as alcohol. The liver also helps release energy quickly and is vital in fighting infections as it filters out bugs that enter the bloodstream. How does hepatitis B affect the liver? Sometimes hepatitis B causes jaundice because the liver is no longer able to remove a substance called bilirubin from the blood. Bilirubin is a breakdown product excreted in bile and urine. When hepatitis stops the liver from removing bilirubin, the substance builds up in the body and causes the skin and whites of the eyes to turn yellow. Occasionally, hepatitis B attacks the liver so quickly that rapid liver failure develops. This is rare, but can require a life-saving liver transplant. Liver 5

6 Who is most at risk of hepatitis B? If there is a chance that you might contact body fluids whilst doing your job, you have a higher risk of getting hepatitis B. High risk professions include: Nurses, doctors, dentists, dental nurses, health visitors, midwives, healthcare assistant and primary/secondary care support workers Fire fighters, police officers, army and other military personnel Prison and correctional staff, youth offender and secure psychiatric workers, immigration removal centre staff, staff in community based criminal justice services Teachers and teaching assistants, nursery workers, staff working with looked-after children Morticians, crematorium, embalming and mortuary workers Sportspeople especially contact sports Sewage or effluent process workers Plumbers, electricians, carpenters, fitters, joiners, and similar occupations Refuse workers and street cleaners Lab technicians Hairdressers and beauticians, tattooists, body piercers, acupuncturists Care home workers, social workers, people working in drug services, and staff in voluntary and community organisations who have contact with people at increased risk of Hepatitis B (including migrant populations, people who inject drugs, people with HIV, or men who have sex with men) First aiders in any workplace This is not an exhaustive list. Anyone who might come into contact with discarded needles or equipment, or who might get bitten, scratched, cut, glassed or spat on at work has a higher risk of catching hepatitis B. 6

7 But there are other groups at risk of hepatitis B too. Hepatitis B is endemic in China and other Asian countries. In this region most people become infected during childhood and, according to the World Health Organisation, around 10% of Asian adults have chronic hepatitis B. The virus is a major cause of liver cancer in the region. There is also a high prevalence of hepatitis B in some countries in Africa, South America, Eastern Europe and the Middle East. This means that people from these areas have a higher risk of catching hepatitis B. Even if you were not born in a high prevalence area but your parents or family were you class as a high risk group and may need to consider getting vaccinated. There are also a few lifestyle factors that can put you at a higher risk of getting hepatitis B. For example, men who have sex with men, people who inject recreational drugs and sex workers are all considered high risk groups.

8 Sharps injuries What are sharps? Sharps are pieces of equipment used for healthcare and social work that could prick your skin. They include things like: scalpels needles blades scissors What is a sharps injury? A sharps injury occurs when a sharp medical instrument cuts you or pierces your skin. Some call it a needlestick injury. The cut or scratch might not seem that deep or severe, but if the sharp has been contaminated with blood from a patient, there is a risk of contracting any blood-borne infection the patient is carrying. What diseases can be spread by sharps injuries? Hepatitis B is a risk with sharps injuries, as the infection is spread via contact with infected blood or other bodily fluids. But a number of other blood-borne pathogens can be spread through sharps injuries, including: HIV Hepatitis C Tetanus (especially if the sharp has been in contact with soil) Who is at risk of a sharps injury? Anyone who works in healthcare or social care runs the risk of accidentally piercing their skin with a needle or a similar piece of equipment. Others are at risk too. For example, there s a chance that tattoo artists, cleaners and refuse collectors could all suffer a sharps injury at work. Sharps injuries could also happen in a non-work situation. For example, children picking up needles or family members providing informal care to their relatives might pick up a sharps injury. 8

9 When is there a high risk of infection? You are more likely to become infected if: the cut, scratch or wound is deep it is known that the source patient has hepatitis B, hepatitis C or HIV blood is visible on the sharp that caused the injury the needle that caused the injury has been in a patient s vein or artery What should you do if you suffer a sharps injury? avoid sucking the wound let the cut bleed gently and run it under a tap wash the wound using running water and soap dry the cut and dress it with a waterproof plaster What infections should you get tested for? After you ve washed the wound, speak to your GP. Or, if you get injured while at work, talk to an occupational health advisor. They may be able to offer you Post Exposure Prophylaxis (PEP). PEP can be given for potential exposure to HIV. PEP is not guaranteed to work but the sooner it is taken, the more likely it is to be effective within 24 hours of exposure is best. Similarly, you should be given immunoglobulin if you re not immune to hepatitis B. If you suffer a sharps injury, you need to get tested for hepatitis B, hepatitis C and HIV. If the injury resulted from an encounter with a patient then both you and the patient should be tested as soon as possible, even if the patient is considered low risk. You should then be tested again three months later. If there s a chance the sharp has been in the ground or soil, it s important to get your tetanus immunisation up to date. Your GP can help you with this. 9

10 I ve got hepatitis B. What now? There is no definitive picture of what living with hepatitis B is like, but this guide is designed to give you a general idea of the adjustments you may have to make. It is important that you work closely with your GP in order to manage the virus in the best way possible. Do 1. Talk to your doctor. Whether you have short-term or chronic hepatitis B, your GP can help you. 2. Get vaccinated for hepatitis A. If your liver is already weakened from hepatitis B, it s a good idea to protect against other types of the virus. 3. Make your partner get vaccinated against hepatitis B. Don t 1. Panic. Hepatitis B can be treated and many people live a normal life with the virus. 2. Drink alcohol. You don t need to help hepatitis B damage your liver even further. 3. Have unprotected sex this is one of the most common ways the virus is spread. The majority of people diagnosed with hepatitis B only have the infection for a few months. If this is the case, you are likely to experience some symptoms which could include nausea, aching muscles and mild fever before the infection goes away completely. However, around one in 20 infected adults will develop chronic hepatitis B, which means the infection is persistent and could last forever. Even so, many people with chronic hepatitis B don t show any symptoms unless the infection damages their liver. Whether or not you experience symptoms, it s important to be up to speed on a few adjustments you may need to make in your life. 10

11 Getting treatment If you have acute or short term hepatitis B like most infected people, it s likely that you need no specific treatment. But occasionally the symptoms can be fairly severe with short-term hepatitis B. In this case, your GP or hepatologist (liver specialist) can provide further treatment. Usually though, hepatitis B symptoms are fairly manageable. It s important to discuss your condition with your GP they can advise you on managing the symptoms. If you have chronic hepatitis B, you may be symptomless for the majority of your life. However you may still need medication. This will help prevent the virus damaging your liver. You will also need to have regular check-ups and tests. For example, blood testing, ultrasound scans and liver biopsies can all help assess damage to your liver. Even if you have short term hepatitis B and even if the symptoms have stopped you should see your GP for regular blood tests and check-ups. If you have chronic hepatitis B and the infection causes damage to your liver, you may be put on antiviral medicines. Although the treatment probably won t clear the virus completely, antivirals are very effective in slowing down damage to the liver, meaning the body can recover. Many people live a long and normal life with hepatitis B because of antivirals. Having a relationship Antiviral medicines are very effective in limiting the damage hepatitis B can cause to your liver, but they won t cure you of the virus. This means you could still potentially infect someone. Contact with infected body fluids passes hepatitis B from person to person, so having unprotected sex is a huge risk. This includes anal and oral sex. It would be silly to think you can t have a relationship if you have hepatitis B but it would also be naive to think you don t need to make adjustments. If you have a long term partner, you need to make sure they get fully vaccinated against hepatitis B. Although this isn t available on the NHS, the vaccination process is made up of three simple injections and protects against the virus for life. A blood test to confirm your immunity is also available. There are also a few fairly easy adjustments you should make if you are living with hepatitis B whilst in a relationship. Infection can be spread by sharing a toothbrush or razor. So if you have hepatitis B, you should make sure not only your partner, but housemates and family members are fully vaccinated to prevent the infection spreading further. 11

12 Having kids If you have hepatitis B you can still plan to have a child, but it is naturally best to do so under guidance of your GP. A man with hepatitis B can have unprotected sex with a woman without infecting her or their future child as long as she is fully vaccinated against the virus. If the woman has been successfully vaccinated against hepatitis B, there is no risk that she will get the virus, or that it will be passed down to the baby. It is important that the baby is vaccinated against hepatitis B. However a pregnant woman with hepatitis B is very likely to pass the infection down to her baby. About 90% of these babies will develop chronic hepatitis if there is no immediate treatment. If you test positive for hepatitis B whilst pregnant, you should see a liver specialist. It is rare for hepatitis to cause pregnancy complications, but seeing a specialist will put your mind at rest and will help reduce the risk of your baby developing chronic hepatitis. The baby will need to be given interferon and antibodies immediately after birth and requires a full vaccination within the first few months to reduce the risk of a lifetime infection. Changing lifestyle Living with hepatitis B means your liver is likely to be put under strain and could be damaged by the virus. Alcohol also attacks and damages the liver. So anyone with inflammation of the liver which results from hepatitis B should avoid drinking alcohol. Drinking in combination with hepatitis B increases the chance of suffering liver cirrhosis or liver failure. Smoking should also be avoided by anyone living with hepatitis B for the same reason that it can speed up liver damage. It s also a good idea to consult your doctor before taking any medicines whether they are over the counter, prescription or herbal. It s important that you don t take anything that might have a bad reaction with your hepatitis B treatment or consume anything that could potentially harm your liver your GP will be able to advise you on this. There is no specific diet required if you have hepatitis B. However, maintaining a healthy, well-balanced diet with plenty of vegetables will help give you every fighting chance against the virus. 12

13 If you have hepatitis B, you should speak to your doctor about the best way to manage the virus. Lloydspharmacy Online Doctor offers a convenient hepatitis B service which includes vaccinations, immunity (titre) tests and booster shots. Click here to check out the service as an individual customer or, if you represent several staff members at a school or similar organisation, contact us to talk about a package to meet your needs. Working in a school what s the risk of hepatitis B? A GP s perspective: Dr Tom Brett GP and Medical Director of Lloydspharmacy Online Doctor Working with children means you might be exposed to blood when a fight or accident occurs, for example. You may also come across used needles discarded by drug users in and around the school grounds. Similarly there is a chance even if it seems unlikely of a child biting, cutting or scratching you. All of these scenarios carry a risk of Hepatitis B transmission. Hepatitis B is not a common disease and the risks may depend on what your role within a school is. You ll know how likely it is that fighting or drug-use will occur in your school and how likely it is that you ll be the one dealing with such an incident. But the infection can have potentially serious long-term consequences, including death. It is, however, completely preventable with a course of injections. 13

14 Are hepatitis B vaccinations required for travelling? Hepatitis B vaccinations are not a strict travel requirement, but they are recommended for some situations and in certain parts of the world. The Journal of Travel Medicine advises that a full course of vaccinations should be considered for anyone going on an extended trip or travelling to an area of high prevalence of hepatitis B. As we mentioned on page 7, hepatitis B is far more widespread in certain areas than in others in fact the virus is endemic in China. Common destinations such as south east Asia, south and central America and eastern Europe all have a relatively high prevalence of hepatitis B. Fit For Travel offers a map service which advises you on all health risks of any given destination, so it s worth taking a look before you go travelling. One of the main risk factors is the amount (and type) of sex you have. If you travel with your partner, you are likely to be perfectly fine. If, on the other hand, you have sex with someone new or have a range of partners whilst in a high prevalence zone, you are much more likely to contract hepatitis B. There is a chance of encountering unsterile or reused equipment if you need dental or medical treatment while travelling. Accidents and emergency treatment can also be unpredictable. For these reasons, it is worth considering getting vaccinated if you are going away for a long period of time or if you are travelling to enjoy adventure sports. You may also need to be vaccinated against hepatitis B if you are going abroad as a volunteer or aid worker especially if your trip involves medical help or construction work. There are also a few less obvious hepatitis B risk factors some may be relevant to your trip and some not, but it s worth being aware. Such activities include: body piercing tattoos acupuncture IV drug use sharing of razors 14

15 What about hepatitis A and C? Hepatitis B isn t the only type of hepatitis. There are multiple strands of the virus and each presents specific health concerns. Hepatitis A, B and C are the most common in the UK. Hepatitis A Like hepatitis B, hepatitis A is a viral infection that attacks the liver. However it is much less common in the UK than hepatitis B. It is mostly spread through the faecal-oral route. This happens when something that touches your mouth has been contaminated by the faeces of someone infected with hepatitis A. It is most common in places of poor sanitation, such as some parts of Africa, India, Pakistan and the Middle East. At first, the symptoms of hepatitis A are similar to flu and can include the following. Fever Joint ache Nausea These early symptoms might lead to a further inflammation of the liver. If this happens, you might experience jaundice, abdominal pain and itchy skin. No specific drugs can cure hepatitis A, but the body will normally fight off the infection completely; leaving you immune to further attacks. This can take several weeks, so it s important to get plenty of rest. Even so, the liver may be damaged by the infection. Hepatitis A can become more serious if already have hepatitis B as both infections attack the liver. If you have hepatitis B, you should get vaccinated against hepatitis A. You may have already had the hepatitis A vaccination if you ve travelled to countries where hepatitis is considered high risk. Hepatitis C Hepatitis C is spread from person to person in a very similar way to hepatitis B mostly through contact with an infected person s blood or, less commonly, other bodily fluids. It can be spread during sex, but not as easily as hepatitis B. The majority of hepatitis C cases in the UK are believed to be caused by sharing needles for illegal drug use. Hepatitis C can be a risk to others too sex workers and healthcare workers, for example. 15

16 Hepatitis C will sometimes go unnoticed until the liver is damaged. A number of hepatitis C symptoms are vague enough to be confused with other illnesses: A loss of appetite Feeling sick High temperature Tiredness Depression Stomach pains Unfortunately there is no vaccine that protects against hepatitis C. To reduce your risk of catching the virus, you should use a condom during sex and never share needles. However, hepatitis C can be successfully treated with antiviral medicines. But because hepatitis C often shows no symptoms, getting tested is important if you belong to a high risk group. The World Health Organisation recommends testing for the following groups: Anyone living with HIV Anyone with liver disease People who inject or used to inject drugs Children whose mothers are infected If you are living with hepatitis B, you should also get tested for hepatitis C. Do I need a booster shot? Most people who get the full course of hepatitis B vaccinations will be protected against the virus for life. But there is a very small chance that immunisation could fade over time. That s why the Department of Health recommends a booster shot for anyone at continued risk of hepatitis B such as healthcare workers or someone whose partner is infected. A hepatitis B booster is only needed once and should be taken about five years after the first vaccination. 16

17 Vaccinations The vaccine for hepatitis B is believed to be up to 95% effective in preventing infection. To become fully vaccinated, you need to have three injections. The second dose is usually taken a month after the first and the third dose taken five months after the second. There is also a rapid immunisation schedule available in certain situations. However, the UK is unusual in not routinely providing a free vaccination programme. Most other developed countries do. In fact, the World Health Organization reported in June 2011 that 179 countries vaccinate infants as part of their vaccination schedules. If you work in a high risk profession, it should be the responsibility of your employer to pay for you to get vaccinated. The risk factors vary a lot from profession to profession but hopefully this guide has given you an idea of how the virus can spread and whether or not you might be at risk. Lloydspharmacy Online Doctor offers a range of hepatitis B services. If you re not sure if you ve already had some or all of the hepatitis B vaccinations, you can order an immunity test here. We also offer a free online immunity status checker for anyone who is unsure if they completed the full hepatitis B vaccination programme. Go to the bottom of this page for more details. Lloydspharmacy Online Doctor also offers a convenient hepatitis B package that includes full vaccinations and booster shots. You can view the service as an individual patient here. Or, if you represent a number of staff members at the same organisation, please get in touch to discuss how we can help protect your staff against hepatitis B. We are available by support@drthom.com Or, if you prefer, you can give us a call on