Facts About Hepatitis B

What is hepatitis B?

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). The virus is found in body fluids, including semen, saliva, blood and urine.

About one-third of people with HBV have a completely "silent" disease. When symptoms are present, they may be mild or severe. They include fever, headaches, muscle aches, fatigue, loss of appetite, vomiting and diarrhea. Later stages may be marked by dark urine, abdominal pain and yellowing of the skin and the whites of the eyes (NIAID, 1992).

Most people recover from hepatitis B within several weeks and develop antibodies (protectants) from HBV. However, some people (about 5-10 percent) never develop antibodies and may harbor the virus for many years or their entire life. These people have chronic hepatitis B and may pass the virus to others. Chronic carriers, as they are referred to, may have very few symptoms and may not be aware that they have the virus. Others have ongoing liver problems resulting in persistent hepatitis, liver failure or liver cancer.

What is the connection between mental retardation and hepatitis B?

First, hepatitis B is found more frequently among people who live in congregate housing situations, such as group homes, institutions and nursing homes. People who work with residents of these types of homes are at increased risk of infection.

Second, for unknown reasons, people with Down syndrome are more susceptible to hepatitis B infection. Their immune systems respond differently to the presence of HBV, and they have been shown to be at increased risk of catching and of being carriers of hepatitis B.

Who else is at risk of hepatitis B?

Anyone can get hepatitis B; however, certain populations have especially high rates of infection. These include: health care workers, Asians and Pacific Islanders, Haitians, Sub-Saharan Africans, Alaskan Eskimos, persons with multiple sex partners who do not practice safe sex and institutionalized populations (AAPCHO, 1992).

How is hepatitis B spread?

Hepatitis B can be spread unknowingly in several different ways.

First, contact with infected blood and bodily fluids containing blood (saliva with blood, urine with blood or menstrual fluid) which penetrate the skin through scratches, cuts, bites or rashes may result in infection. HBV can also be spread by contaminated needles and syringes or razors, or exposure to other objects which may contain small traces of human blood.

Second, HBV found in body fluids such as urine, semen, vaginal fluids, tears, saliva and breast milk can be transferred to inner surfaces of the mouth, the eyes, vagina or the rectum through mouth-to-mouth contact, sexual activity, kissing or biting.

Third, contact with infected household members may spread the hepatitis B virus. While the exact mode of transmission is not always clear, it appears that contaminated objects in the environment may indirectly transfer the virus to a person who has the potential for infection.

Fourth, pregnant women who have the hepatitis B virus can pass it to their babies, usually during the birth process. Vaccination at birth, with additional shots at one and six months of age can prevent hepatitis B in children at risk.

How can hepatitis B be diagnosed?

The only sure way to diagnose hepatitis B is by testing blood for HBV. Blood tests can confirm HBV infection, as well as identify carriers most likely to transmit the disease to others. Blood screening tests can also identify those people who have achieved lifelong immunity due to a prior hepatitis B infection, as well as those who have never been exposed to the virus.

How is hepatitis B treated?

There is no specific treatment other than attempting to relieve the symptoms. Bed rest may be recommended. Those with severe symptoms such as persistent nausea and vomiting may require hospitalization. During recuperation, patients should avoid exertion, eat a balanced, low fat diet, avoid alcohol and use medications advised only by a doctor (AAPCHO, 1992).

Those patients who fully recover from symptoms of acute hepatitis, but remain carriers, are at risk for future liver disease and should seek regular medical attention.

How can hepatitis B be prevented?

People who have never been exposed to the hepatitis B virus may be protected through vaccination. In 1991, the Immunization Practices Advisory Committee of the Public Health Service recommended that all children be vaccinated. The Centers for Disease Control and Prevention estimates that from 200,000 to 300,000 cases occur annually because adults have been reluctant to get the vaccine that has been on the market for over 10 years. If all children receive the vaccine, then eventually hepatitis B can be eliminated.

The vaccine is especially recommended for health care workers, household members of a person with chronic hepatitis, newborn children of mothers with HBV and staff in residences for people with mental retardation when a carrier lives in the residence. In order that pregnant women do not pass HBV on to their newborns, all pregnant women should be tested to make sure they are not silent carriers of the disease. If they are, their infant can then be vaccinated.

How can the spread of hepatitis B be prevented in situations when a person with HBV lives in the home?

Handwashing is the single most important hygiene practice which can reduce the chance that infected blood or contaminated fluids will be transmitted to a susceptible person. Careful handwashing with soap and water should be used after caring for bleeding wounds; after handling items which have been contaminated with blood, serum and saliva; before eating, handling food or smoking; and after each bathroom use.

People should avoid sharing personal items that may have traces of blood or body secretions, such as razors, clippers, toothbrushes, eating utensils and hypodermic needles.

Effort should also be made to reduce the possibilities of blood contact. Bleeding or oozing cuts should be covered. Surfaces contaminated with blood from a carrier should be cleaned immediately with soap and water followed by disinfection with household bleach. People doing the cleaning should protect themselves by wearing disposable gloves, especially when discarding soiled materials. (See universal precautions below.)

What workplace protection is required by federal law?

The Occupational Safety and Health Administration (OSHA), Department of Labor, requires employers to eliminate or minimize occupational exposure to the hepatitis B virus, the human immunodeficiency virus (HIV) and other bloodborne pathogens. This means employers must institute protections for employees who may come in contact with blood in the course of performing their job.

Under new OSHA standards effective in 1992 (Federal Register, December 6, 1991), employers who have employees at risk of exposure to bloodborne pathogens must:

• Develop a written exposure control plan. This plan describes the exposure risks, methods of eliminating or minimizing exposure to bloodborne pathogens and how the employer will handle exposure incidents.
• Require employees to follow universal precautions. This is an approach to infection control which calls for treating all human blood and certain human body fluids as if known to be infectious for HIV, HBV and other bloodborne pathogens. The three main features of universal precautions are (SAFE, 1992): 1) cover hands with latex or vinyl gloves, so as not to touch the body fluids directly; 2) clean up the body fluid with absorbent material; and 3) contain the soiled material in a plastic bag and discard it.
• Utilize engineering and work practice controls, as appropriate, to eliminate or minimize exposure. This includes suitable handwashing facilities or an appropriate antiseptic substitute and towels, and work practice controls which eliminate or minimize exposure to infectious materials.
• Provide personal protective equipment, such as gloves, masks, gowns, etc. where occupational exposure remains after instituting these controls.
• Ensure that the worksite is maintained in a clean and sanitary condition and decontaminated as appropriate.
• Make hepatitis B vaccine and vaccination series available to all employees who have occupational exposure, at no cost to the employee. Any employee who declines the vaccine must sign a declination statement.
• Offer post-exposure evaluation and follow-up to any employee who has had an exposure incident. A healthcare professional must provide a written opinion informing the employee of the results of the evaluation and recommendations for further treatment.
• Communicate hazards to employees. Warning labels must be displayed for hazardous materials. Red bags or red containers may be substituted for labels. (While this rule is more specifically related to hospitals and laboratories, OSHA has required red containers and/or labeling for used menstrual pads) (Collins, 1992).
• Train all employees annually regarding bloodborne pathogens and exposure prevention, including information on the hepatitis B vaccine.

References

Collins, A., Ed. (1992). NAPRR Handbook on OSHA Rules on Bloodborne Pathogens. Annandale, VA: NAPRR (Now ANCOR).

Federal Register. (December 6, 1991). Occupational Exposure to Bloodborne Pathogens; Final Rule. Department of Labor.

AAPCHO (Association of Asian Pacific Community Health Organizations). (1992). Hepatitis B. Oakland, CA.

NIAID. (June 1992). Viral Hepatitis. Factsheet. Bethesda, MD: NIH.

SAFE: Stopping AIDS through Functional Education. (1992). The Arc and Oregon Health Sciences University.

Additional Sources of Information About the OSHA Regulations for Occupational Exposure to Bloodborne Pathogens:

American Network of Community Options & Resources (ANCOR), 4200 Evergreen Lane, Suite 315, Annandale, VA 22003, (703) 642-6614. Contact for purchase of NAPRR Handbook on OSHA Rules on Bloodborne Pathogens.

Association for the Help of Retarded Children (ARCH), 200 Park Avenue South, New York, NY 10003-1582. (212) 254-8203. (1993). Infection Control Policy and Plan Book ($250) and OSHA Compliance Travel Pack ($12).

New Jersey Association of Community Providers, Inc., 599 Springfield Avenue, Berkeley Heights, NJ 07922, has two items available for cost of copying and mailing ($25 each). 1) Policy: A Generic Exposure Control Plan (plus other materials related to OSHA standards) and 2) OSHA Bloodborne Pathogens Interpretive Quips (published twice a year by OSHA). Call Daisy Horn at (908) 464-8263 for information.

Spectrum Center for Educational and Behavioral Development, Inc., 2855 Telegraph Avenue, Suite 312, Berkeley, CA 94705-9974. OSHA Bloodborne Pathogens Compliance Kit. Call 1-800-522-7432 for price and information.

Cooperative for Human Services, Inc., Chuck Howard, President, 110 Pleasant Street, Malden, MA 02148. OSHA Bloodborne Pathogens Exposure Control Plan. (The Arc, National Headquarters, has a copy of this plan which can be adapted to other agencies. To order a copy, contact Ann Balson.)

Revised Jan. 1994

The Arc
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