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Hepatitis B
Description
Symptoms
Transmission
Risk
Diagnosis and Testing
Treatment
Prevention
Hepatitis is a general term used to describe
inflammation (swelling) of the liver. The liver is an important organ
located beneath the rib cage. Some of the liver’s primary functions
include: cleaning and purifying the blood, breaking down certain chemicals
in the blood so that the body can use them, and producing and storing other
important chemicals that the body needs.
Alcohol, certain chemicals and drugs, and viruses
such as hepatitis A, B, C, D, E, and G may cause hepatitis. Hepatitis can
severely damage the liver which may result in death. The hepatitis viruses
typically produce similar symptoms but because they are transmitted,
prevented, and treated in different ways, they are considered different
diseases. This fact sheet will focus on the hepatitis B virus.
Description
Hepatitis B is an infection of the liver caused by
the hepatitis B virus (HBV), a bloodborne virus. The hepatitis B virus can
cause serious damage to the liver which may result in death. The major
cause of death associated with HBV is cirrhosis (hardening and shrinking of
liver tissue), followed by acute hepatitis, and liver cancer.
Between 140,000 and 320,000 new hepatitis B
infections occur each year in the United States. Approximately 1 million to
1.25 million persons live with chronic (long-term) HBV infection. Many of
these chronically infected persons are at risk of developing chronic liver
disease and liver cancer; each year over 5,000 of these persons die from
chronic liver disease.
Health care workers and other workers who are
routinely exposed to blood are at risk of acquiring hepatitis B at the
workplace.
Symptoms
Hepatitis B infection is a serious disease that
can lead to two outcomes: acute (short-term) hepatitis B and chronic
(long-term) hepatitis B viral infection.
Acute hepatitis B
infection causes symptoms of fatigue, loss of appetite, weakness, jaundice
(yellowing of the skin and eyes), and liver enlargement and tenderness. About
50% of those infected with HBV, however, do not experience any symptoms so
they may be unaware that they have contracted hepatitis B. Symptoms, if
they appear at all, typically occur within 3 months of becoming infected
with the hepatitis B virus.
Most people infected with HBV develop antibodies
(produced by the body’s immune system) against disease and will totally
clear the virus from the body without ever getting seriously ill. The 5-10%
of those persons who do not produce antibodies will develop chronic
hepatitis B.
Chronic hepatitis B
usually occurs when the person remains infected with the virus 6 months
after exposure. Although only a small percentage of those infected with HBV
develop chronic hepatitis B, they can still infect others and are at an
increased risk of dying prematurely of liver disease, such as cirrhosis and
cancer. The majority of persons with chronic hepatitis B do not show any
symptoms, but the virus may still be slowly and steadily damaging the
liver. Infected persons that do not show any signs or symptoms of disease
are referred to as "carriers."
A chronically infected mother can pass the
hepatitis B virus to her infant. Without proper treatment, up to 90% of
infected newborns can develop chronic hepatitis B.
Transmission
Hepatitis B is a hardy virus. Although HIV, the
virus that causes AIDS, can only live for 24 hours in dried blood, the
hepatitis B virus can survive for at least a week in dried blood at room
temperature on floors and tables.
Hepatitis B is transmitted primarily by contact
with contaminated blood or blood products -- although saliva, semen, and
vaginal fluids also contain the virus. Infection can occur in several ways:
- direct
injection of infected blood or serums through transfusions or
needlesticks;
- transmission
through skin openings such as burns or scratches;
- direct
introduction of saliva or blood into inner body surfaces;
- sex
with an infected person;
- breathing
microscopic blood droplets or aerosols;
- indirect
transfer of blood or other secretions from obviously soiled surfaces
or objects.
For health care workers, being stuck with
contaminated needles and syringes or being splattered with blood are
important ways of spreading HBV. The risk of infection from an injury with
a needle containing infected blood is between 10% and 35% for hepatitis B.
Health care workers also risk infection by indirectly coming into contact
with infected materials. For example, touching sheets or towels containing
the blood of a patient with hepatitis B or handling surfaces on which
contaminated medical tools or waste have been placed and then touching your
eyes, mouth, nose, or an open wound.
HBV cannot be passed on through casual contact
such as shaking hands or sharing bathroom facilities.
Risk
Any worker who might come into contact with
contaminated blood, sharps, or needles is at risk of becoming infected with
the hepatitis B virus. This means that many AFSCME members are at risk
because they are exposed to the blood and body fluids of people who are
likely to have hepatitis B or carry the virus.
Groups considered at risk for hepatitis B include:
drug users who share needles; anyone who has unprotected sex with someone
who is infected with hepatitis B; clients and staff of institutions for the
retarded; prison inmates; kidney dialysis patients; and babies born to
mothers who have hepatitis B. However, one-third of the new cases each year
are persons with no known risk factors of HBV infection.
The risk of being exposed to hepatitis B at the
workplace depends on the likelihood of exposure to blood and body fluids. Occupations
at risk may include health care workers, dentists and dental hygienists,
emergency medical service personnel, police, firefighters, correctional
officers, some laboratory employees, and hospital or clinic housekeeping
staff who handle contaminated waste.
Diagnosis and Testing
The hepatitis B virus can be detected through a
blood test. Acute and chronic hepatitis B can also be diagnosed through
blood tests. Evidence of infection usually can not be detected until about
6 weeks after exposure to HBV.
Treatment
A safe and effective vaccine exists to
prevent hepatitis B infection. The vaccine is a series of 3 shots taken at
specific intervals typically within six months. It offers full protection
against the virus and is one of the safest vaccines available having
virtually no side effects. The vaccine can be given to women who are
pregnant or nursing. (The only restriction on the vaccine is for people who
are allergic to yeast.)
OSHA’s Bloodborne Pathogens Standard requires
employers to offer the hepatitis B vaccine to workers who may be exposed to
blood and other infectious materials -- before they begin their jobs. This
includes health care workers, correctional officers, or any other worker
who anticipates exposure to blood or other potentially infectious
materials. The OSHA standard requires that employers make the vaccine
available, at no cost to the employee, during work hours. If the employee
must travel to receive the vaccination, then the employer must pay for
travel expenses.
Although a treatment exists to prevent hepatitis B
infection after an exposure, it is not nearly as effective in preventing
disease as the vaccine. Hepatitis B immune globulin (HBIG) can be
given along with the vaccine within seven days of an exposure incident
(although it is preferable to administer HBIG within 24 hours of exposure).
Unlike the hepatitis B vaccine which 95%-98%
effective, HBIG is only 75% effective in preventing infection. Furthermore,
HBIG only offers temporary protection as it must be given after every
exposure to HBV. Therefore, the vaccine should be given with HBIG to ensure
long-term protection. Note that non-specific immunoglobulins (IG)
are not as effective as HBIG and should not be used.
Another problem with relying on HBIG for
protection against infection is that it may not be administered in time to
be effective. Many exposed workers do not realize that an exposure has
occurred. Also, many employers do not encourage workers to report
needlesticks and other exposure incidents.
If you may be exposed to blood or body fluids in
the course of performing your job duties, your employer should offer you
the hepatitis B vaccine before you are exposed. Providing immune
globulin after an exposure is no substitute for the vaccine and is
less effective. OSHA does not allow such "post-incident"
treatment after an exposure except in the case of workers who have some
first aid responsibilities, but whose main job is not first aid provider.
For chronic hepatitis B, the anti-viral
drug "interferon alfa" can be used to treat certain cases. This
drug, however, is only about 40% effective and is recommended for patients
who show symptoms, such as liver damage, of chronic hepatitis B.
Prevention
As required by OSHA’s Bloodborne Pathogens
Standard, employers must have written procedures that describe methods for
controlling and limiting workplace exposures to bloodborne, infectious
diseases including hepatitis B. Examples of ways to control exposure to
hepatitis B and other bloodborne diseases are listed below.
- Provide all potentially exposed employees with the hepatitis B
vaccine.
·
Practice universal
precautions. Because someone can be infected with
hepatitis B (or hepatitis C or HIV) without showing any signs or symptoms,
all blood, body fluids or tissues, and waste, should be treated as
potentially infectious regardless of whether or not an infection is known.
·
Avoid needlesticks or
accidental wounds from sharp instruments that have been in contact with
potentially infectious materials. Laundry
and housekeeping workers should treat all patient or resident care
materials (including linens and towels) and garbage as if it contains used
needles.
·
Use only disposable needles
and syringes. Needles should be disposed of in
strong, puncture-resistant sharps containers and should never be recapped
or bent. Sharps disposal boxes should be well labeled with the
"biohazard" symbol or other warning sign.
·
Switch to safer medical
devices. Consider using needleless injection
systems, self-sheathing syringes, self-locking needles, or other types of
equipment with built-in safety features that minimize the risk for injury.
·
All potential sources of
contamination should be strictly controlled. All
contaminated articles (dressings and paper tissues) should be bagged,
labeled ("Biohazard" or "Blood Precautions"), and
disposed of properly. Contaminated linen should be placed in a labeled laundry
bag in the infected area.
·
Use personal protective
equipment. Gloves and gowns should be used during
patient contact when blood and other body fluids may be touched. Goggles or
face shields should be worn if blood is likely to be splashed.
·
Practice good hygiene. Hands should be washed thoroughly if they come in contact with
patient blood or body fluids and after removing protective gloves and
gowns.
·
Sterilize or decontaminate
all re-usable equipment.
·
Clean up blood spills
immediately. Use a solution containing one part
bleach (sodium hypochlorite) to 9 parts water or any chemical germicide
approved as a "hospital disinfectant."
·
Train employees in the
nature of hepatitis diseases and other infectious diseases. The training should include the health effects, modes of
transmission, proper work procedures to avoid infection, and safeguards to
protect persons at risk.
·
Treat all needlestick
injuries and cuts immediately.
·
Report all needle sticks and
cuts and fill out a medical report.
May 1997
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