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Rates of Newly Reported Chronic Hepatitis B Infection, New York City, By Zip Code, 2010 Hepatitis B is a vaccine-preventable infection of the liver that is often asymptomatic, acute, and self-limited. If the infection becomes chronic, it can lead to permanent liver damage, cirrhosis, liver failure, liver cancer, and premature death.1,2 The hepatitis B virus (HBV) is commonly transmitted by percutaneous or mucosal exposure to infectious blood or body fluids (semen, vaginal fluids) through sexual or close household contact (eg, sharing of razors or toothbrushes, exudates from skin lesions, and contaminated surfaces); injection drug use; or occupational or perinatal exposure.1,3,4 While saliva can be a vehicle of transmission through bites, other types of exposure to saliva, including kissing, are unlikely modes of transmission.5,6 The hepatitis B virus is 50 to 100 times more infectious than HIV7 and can survive for at least 7 days on contaminated surfaces or objects,3 making vaccination of susceptible household and sexual contacts essential.1,7 Nevertheless, children and adults infected with HBV can participate in contact sports, daycare, and school, and can share food and utensils or hug without infecting others.3,8

Comprehensive childhood vaccination programs in the United States (US) have led to a 98% decline in hepatitis B infection between 1990 and 2006 among children younger than 15 years,9 but the burden of chronic hepatitis B in adults remains large, partly due to immigration from highly endemic areas in Asia and Africa.9-11 Many cases of hepatitis B are not detected or reported to health departments,3,12 but it is estimated that 800,000 to 2 million people in the US have chronic infection.2,3,12 In New York City (NYC), about 100,000 people--or 1.2% of residents--are chronically infected with hepatitis B11; 67% of those with newly reported infection are Asian (see above for areas of NYC with high rates of chronic infection).13

Vaccination is the most effective way to prevent HBV infection.3,9,14 Patients should receive 3 doses of hepatitis B vaccine for maximum protection.15,16

It is estimated that up to two-thirds of chronically infected people are undiagnosed, usually because they are asymptomatic.10,17 About 25% of people infected as children and 15% of those infected as adults die prematurely from cirrhosis or liver cancer.14 Primary care providers should ask about potential exposures to HBV (see Box 1 below), provide the hepatitis B surface antigen (HBsAg) test to those at risk, and vaccinate those who are susceptible.3,17 Early detection of hepatitis B infection and appropriate medical management can prevent or delay cirrhosis and liver cancer in patients with chronic infection and permit prompt identification of the patient's susceptible contacts for evaluation,3 including postexposure prophylaxis for those recently exposed.14 Providers should counsel patients to avoid alcohol, explain how to prevent transmission to others, and monitor them for disease progression.14 Active chronic hepatitis C virus (HCV) infection, other liver disease, and/or comorbidities are indications for referral to a specialist or other clinician with experience in managing hepatitis.3,10,14

BOX 1. HEPATITIS B RISK ASSESSMENT
See Table 1 for testing and vaccination recommendations
  • Where were you borna?
  • Do you have hepatitis B or any other liver disease?
  • Have you ever injected drugs or shared any drug use equipment (injection equipment, needles, cookers, cotton, straws, pipes)?
  • Do you travel to any countries where hepatitis B is common (areas with high or intermediatea prevalence)?
  • Have you ever been told you have HIV or any sexually transmitted infection?
  • (If a man) Do you have sex with men?
  • Have you been sexually active with more than one sex partner in the past 6 months?
  • Have you gotten a tattoo or piercing anywhere other than at a professional establishment or shared tattoo or piercing equipment?
  • Have you ever shared an item that may have had blood or body fluids on it (eg, razor, toothbrush, glucometer, sex toy) with a person who has hepatitis B?
  • Have you ever been stuck with a needle or been exposed to someone's blood while on the job?
  • Have you ever been on dialysis, do you have diabetes, or are you now on chemotherapy or immunosuppressive therapy?
  • Are you pregnant?
  • Do you work or receive services at an institution for people with developmental disabilities?

a See Table 1 footnote for areas of higher prevalence of chronic HBV infection.

 

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