In the United States, the CDC estimates 140,000-320,000 infections per year, with 70,000-160,000 being symptomatic. Of the symptomatic infections, 8,400-19,000 deaths are estimated to occur per year. Five to 10% of persons infected with HBV will develop chronic HBV. It is estimated that 5,000-6,000 deaths occur yearly from chronic liver disease, including primary liver cancer, as a result of HBV. It is estimated that 1-1.25 million Americans are chronically infected with HBV.

TESTING:

The earlier you are diagnosed and begin to treat hepatitis, the more likely you are to prevent complications from the disease, minimize potential damage to your body, and avoid spreading the disease to others. If you think you may have been recently exposed to hepatitis, have symptoms (yellow eyes, dark urine, stomach ache, fatigue, loss of appetite, nausea, vomiting, fever) or suspect that you might have had hepatitis at some point in your past, it's a good idea to get tested.

A blood tests screens for specific antibodies. Your doctor can determine exactly what type of hepatitis you have as well. For persons who think they may have had an acute infection with hepatitis B, the doctor will be able to tell if you now have a chronic form of the virus. Ninety percent of all people with hepatitis B will clear the virus (the virus is gone from their body).

Who should be tested?

Testing of pregnant women should include hepatitis B screening. Women who are found to be infected with hepatitis need to be followed during their pregnancy by physicians which understand their risks and needs. Appropriate prenatal care can significantly reduce the risk of transmitting disease.

The following persons are at risk for hepatitis B and therefore should consider testing:

• Men who have sex with men
• persons with an occupational exposure (health care worker receiving a needle stick)
• household or sexual contact with a person who has an acute infection or is known to be a chronic carrier
• received blood
• hemodialysis patient
• persons who have used recreational drugs and shared drug paraphernalia (needles, straws, cookers etc.)

Where to go for testing?

Hepatitis tests are available at most doctor's offices, Planned Parenthood, medical clinics and at some public-health clinics. As part of special awareness campaigns, testing may be offered at other places (i.e. AIDS service organizations).(create link to ASO page.)

More Information on Testing:

• National Guidelines for the Management of the Viral Hepatitises A,B, and C.

PREVENTION/IMMUNIZATION

There is an immunization for HBV. Three doses of the vaccine are needed for complete protection. The following should receive immunization for HBV:

• All pregnant women should be tested for HBV early in their pregnancy. If the blood test is positive, the baby should receive vaccine along with another shot, hepatitis B immune globulin (called H-BIG), at birth. The vaccine series should be completed during the first 6 months of life.
• All babies, at birth
• All children 0-18 years of age who have not been vaccinated
• Persons of any age whose behavior puts them at high risk for HBV infection. This can include multiple sex partners, men who have sex with men, persons who use recreational/street drugs, persons who live with someone that is known to have chronic HBV.
• Persons with HIV and/or HCV.
• Persons whose jobs expose them to human blood
• Recommendations for HBV Immunization by the Immunization Practices Advisory Committee (ACID):
• Hepatitis B Post Exposure Prophylaxis Recommendations from the CDC:

In addition to immunization, the same strategies used for HIV prevention [link to prevention page of HIV] work in preventing the transmission of viral hepatitis. These strategies include: safer sex practices (make a link to text below) ; safer drug use (link to text below) ; and prenatal testing

Safer Sex Guidelines:

• Use of condoms and barriers for all penetrative acts including anal and vaginal intercourse as well as oral sex;
• S & M or rough sex which does not involve blood. When shaving, separate razors should be used. For piercing, use separate needles if possible. If not, soaking in bleach will reduce transmission of HIV, but is less clear for HCV.
• Sex toys should not be shared unless a new condom is used each time.

Drug use guidelines include:

• Not sharing straws;
• Not sharing needles and using needle exchange programs where possible, if no exchange program is available, find a doctor who will write a prescription for needles and syringes;
• Instead of shooting drugs up with a needle, try snorting (sniffing); smoking (chasing the dragon) or keestering (inserting them in the rectum);
• Use an area for shooting up that is clean. An inside unused section of the newspaper is a clean work surface). Do not share works, ties, cooker, cotton and water.

Other Prevention and Immunization Links

• MMWR Recommendations for Prevention and Control of HCV Infection and Related Chronic Disease.
• National Guidelines for the Management of the Viral Hepatitises A,B, and C
• Adolescents, aged 11-15 years, HBV Vaccination Schedule
• Hepatitis B and Immunization Action Coalition

• National Guidelines for the Management of the Viral Hepatitises A,B, and C
• Liver Biopsy Questions and Answers
• Treatment for Chronic Hepatitis B
• Hepatitis B Foundation
• Hepatitis B Research Archives
• A comprehensive guide for Veterans infected with Hepatitis B and C.
• Liver transplant information and resources