Hepatitis B, which is caused by the hepatitis B virus (HBV), is considered a silent epidemic because it is extremely contagious and most people infected do not know they have it. Prevent liver infections. Hepatitis B virus-related liver disease may develop into cancer later in life. The best way to protect against the virus is to get vaccinated at birth or as soon as possible. We asked Hillsborough pediatrician Dr. Rachel Brauner how hepatitis B can lead to liver damage and cancer, and why that makes getting vaccinated even more important.
New Jersey Families: What is Hepatitis B Virus? What are the signs and symptoms?
Dr. Rachel Brauner: Hepatitis B is a virus that attacks the liver, one of the body’s most important organs. Over time, the liver can become infected and cause serious damage. However, this process is not fast. Hepatitis B infection is often referred to as the silent epidemic because most people infected with the virus do not know they are infected until they begin to show symptoms of liver damage decades later.
Many of the initial symptoms of hepatitis B infection are similar to other viral infections: fever, fatigue, muscle or joint pain, loss of appetite, nausea, and vomiting. There are specific symptoms that require medical attention, such as pale or light-colored stools, dark tea-colored urine, severe nausea, vomiting, stomach bloating, and/or yellowing of the eyes or skin.
NJF: How does the virus spread? Is this virus common?
Dr. Brauner: The most common way to become infected with hepatitis B is through contact with the blood of someone infected with the virus. Hepatitis B is about 100 times more contagious than HIV, so even the smallest amount of contact with blood, such as through sharing towels, toothbrushes or razors, can spread the infection. The virus is also found in saliva and other body fluids, including breast milk, and can be spread through sexual contact.
Approximately 22,000 new cases of hepatitis B infection are reported in the United States each year, and approximately 2.4 million people are chronically infected, and approximately 2 billion people worldwide. Too many infected people don’t know they have the virus, making it difficult to control the spread of the infection.
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NJF: Now that transmission is so widespread, how can contractions be prevented?
Dr. Brauner: The single best way to prevent getting hepatitis B is to get vaccinated before you are exposed to the virus.
NJF: Are there currently treatments for the virus itself before it develops?
Dr. Brauner: Unfortunately, there is currently no treatment for acute hepatitis B infection. There is also no cure for chronic hepatitis B infection. The FDA has approved certain drugs for use in adults and children to try to slow and prevent the infection from progressing to liver failure or liver cancer. These are administered by liver specialists.
NJF: How do viruses develop into cancer?
Dr. Brauner: The hepatitis B virus attacks liver cells and causes damage to them. Over time, this damage can lead to a type of liver cancer called hepatocellular carcinoma. The longer you have been infected with the virus, the higher the risk of damage. Children who become infected with hepatitis B in infancy or childhood are more likely than infected adults to develop chronic infection that can lead to liver damage or cancer. About 25 percent of people infected with hepatitis B in childhood may die from liver failure or cancer.
You may also have inflammation or what’s called cirrhosis, or liver damage, leading to liver failure. A medical professional will determine if a transplant is possible.
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NJF: What screenings are available for cancers caused by hepatitis B?
Dr. Brauner: There are specific markers that assess your liver function, which can be checked with blood tests. If these markers are elevated, your provider will order additional lab tests to help determine the cause of liver damage. If necessary, further diagnostic studies, such as imaging studies or biopsies, will be determined by the gastroenterologist. It is recommended that all adults be screened for hepatitis B at least once in their lifetime.
NJF: You have said before that the way to prevent getting hepatitis B is to get vaccinated. How necessary and effective are vaccines?
Dr. Brauner: The first hepatitis B vaccine was developed in 1981. Initially only recommended for those at high risk of infection. About a decade later, researchers realized that hepatitis B infection rates had not changed. We started vaccinating infants and young children in 1991, and infection rates have been falling ever since.
Before the vaccine, about 18,000 children in the United States were infected with hepatitis B by age 10, which is important because the younger you are when infected, the more likely you are to develop serious complications and liver damage.
About half of these children are infected when their mothers are born. It’s worth noting that the other half didn’t have the disease from birth – they got it from other family members or people they came into contact with, as it only takes small amounts of blood or body fluids to spread the disease . Since most people don’t know, it’s almost impossible to be careful enough to avoid it, which is why vaccines are so important.
In the United States, the hepatitis B vaccine is approximately 90% to 95% effective in preventing hepatitis B infection and disease in children and adults. Infants who receive the hepatitis B vaccine series from birth are almost completely protected against hepatitis B infection, an astonishing success story. With this vaccine we can eliminate this disease worldwide.
Vaccines protect you from viral infections. If you do not have the virus, there is no increased risk of liver damage or liver cancer from infection.
NJF: How to get vaccinated?
Dr. Brauner: All children should be vaccinated against hepatitis B, ideally right after birth as this ensures you are protected early on from being infected by someone who doesn’t know they are infected. It’s offered to every newborn, and the vaccine is available in every hospital and every primary care office. There is no state mandate, so it is the parents’ decision, but all providers strongly encourage these infants to be vaccinated as early as possible.
The vaccine is a three-dose series, and according to the recommended vaccination schedule, the vaccine has the highest immune protection effect at birth, 1-2 months of age and 6 months of age. Any child (or adult) who has not received the hepatitis B vaccine at the recommended age and intervals should receive this series of vaccines as soon as possible. Due to the ongoing risk of exposure, those in the healthcare field who have not shown an immune response will be given booster immunizations. They will repeat the eleventh series. Some immunocompromised people may also be eligible for a booster vaccine. Your health care provider can help determine if you are eligible.
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NJF: Should parents be worried? Are you aware of any side effects of the vaccine?
Dr. Brauner: Babies must be vaccinated to ensure they are protected from unknown exposures and to avoid complications. Hepatitis B vaccines have been around for a long time. Billions of people around the world have received this vaccine, so we know it’s safe and we know it’s effective.
Side effects of the hepatitis B vaccine are similar to other vaccines: the most common are mild fever or mild soreness at the injection site.
NJF: How can we increase believe Vaccination for Communities concerned about the safety of these vaccinations?
Dr. Brauner: I have found that the most successful way to increase trust in vaccines among people concerned about their safety is to listen to their concerns and talk about the data and science to help them understand the risks and dangers of these life-threatening diseases. Prevent with vaccines. There is a lot of misinformation out there about vaccines, which can cause a lot of confusion among parents. I often find that parents are concerned that they will make the wrong decision, and I encourage them to talk to their child’s pediatrician. Our job is to help you care for your children and ensure they grow up strong and healthy by making recommendations and helping you make decisions.
I encourage any parent who has questions about any vaccine to talk to their pediatrician and get their input. We are committed to keeping children safe and healthy and would never recommend anything that could harm your child.
Dr. Rachel Brauner is a pediatrician at Hunterdon Pediatric Associates. Learn more about her here.