Hepatitis B – You may have been exposed, and not even know it.

What is Hepatitis B?

Hepatitis B is a virus which specifically targets the liver. It takes on a number of different forms, including a short acute event, or on the contrary it can be a lifelong chronic disease. It is considered a sexually transmitted infection, though there are other ways that this disease can be spread. This includes sharing fluids with an infected individual such as saliva, injecting drugs with unclean needles, or getting a tattoo from an unregulated parlor.

The disease might portray itself as an unspecific fever at first, or you may not know at all that you are infected. However any infected individual is considered contagious, and may pass it on to someone else.

Who should be screened?

The American Association for the Study of Liver Diseases as well as the CDC both recommend screening individuals who are considered high risk. This includes anyone who has ever injected drugs intravenously, anyone who has been diagnosed with HIV, anyone who has had close contact with an infected individual, anyone with a tattoo from an unregulated parlor, and anyone who were born in regions of the world where the prevalence is higher than 2%. Most people today receive vaccines, though if you are not one of these people it is also a good idea to be screened. The test is a simple blood test in which antibodies are checked.

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Prevalence of Hepatitis B as of 2013. See last reference for source.

Other people who should be screened are those who have occupational exposure (health care workers), organ or blood donors, patients receiving hemodialysis, inmates of a correctional facility, or anybody who has multiple sexual partners.

Does screening work?

Although no study compared a population who was screened to a population who wasn’t, there was a study done in France which tried to determine what is the most effective method for screening. When targeting people born in countries with higher risk, 2/3rds of infected patients were missed. When targeting men and unemployed individuals, 98% of cases were caught, though this needs to be taken with a huge grain of salt because this study contained only 49 individuals. Not nearly enough to be mentioned in this blog, but I decided to include it just to emphasize the importance of understanding the quality of information that is published, and the implications.

The rationale behind the screening recommendation is largely based on the fact that Hepatitis B can often be contagious and silent at the same time, which is a dangerous combination. Previous recommendations suggested that the entire population should be screened, however with the substantial efficacy of vaccinations along with lowering infection rates, the recommendations were changed to only high risk individuals.

*Please comment to us if you found this information useful, or if you have any questions about the topic.

Knowledge is power. It’s very important for each of us to understand what our options are, and what evidence supports each option. Preventing diseases before they start is often the most efficient way to be healthy, and this starts by screening for the diseases that are appropriate for us depending on age, gender, and other factors. Download our app to go through a short list of questions, and receive a personalized list of the appropriate screening recommendations for you. More information about each of these tests is provided through the app, so that you can stay informed and educated.

 
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Here are a few studies which give insight into the efficacy of screening and early treatment for Hepatitis B. Feel free to contact us for more information about the matter, we would be happy to provide more information.

Spenatto N, Boulinguez S, Mularczyk M, Molinier L, Bureau C, Saune K, et al. Hepatitis B screening: who to target? A French sexually transmitted infection clinic experience. J Hepatol. 2013;58(4):690-7.

Chou R, Dana T, Bougatsos C, Blazina I, Zakher B, Khangura J. Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 110. AHRQ Publication No. 12-05172-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013. Lancet. 2015;386:1546–55.

 

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