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Hepatitis B

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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