Hepatitis B is severe irritation and inflammation of the liver due to an infection of the hepatitis B virus (HBV). It is the most common serious liver infection in the world. Infections of hepatitis B occur when the virus enters the blood stream and reaches the liver. Once in the liver, the virus reproduces and releases large numbers of new viruses into the bloodstream. Unfortunately, these infections are often known as the “silent epidemic”, as many infected individuals don’t experience symptoms until they develop serious issues like cirrhosis or cancer.
Hepatitis B is extremely infectious, up to 100 times more so than the HIV virus. Unlike the HIV virus, hepatitis B can survive outside of the body for at least 7 days. During that period, the virus can still cause infections. Approximately 1.5 million people have acute cases, becoming newly infected, each year. For some, hepatitis B infection is a short-term illness but for others it may become chronic. Up to 2.4 million people are chronically infected, having infections lasting longer than six months.
What are the symptoms of hepatitis B?
Most infected individuals experience only mild symptoms if any at all. Symptoms can begin an average of 90 days after exposure to the virus but can appear any time between 8 weeks and 5 months post-exposure.
Most common symptoms include:
- Fever
- Loss of appetite
- Joint and muscle pain
- Mild nausea and vomiting
- Stomach pain
- Dark, cloudy urine
Rarely, people may experience severe symptoms such as:
- Severe nausea and vomiting
- Jaundice (yellowing of the eyes and skin)
- Bloated stomach
A small number of individuals may develop a rare, life-threatening condition called “fulminant hepatitis” which requires urgent medical attention since it can cause sudden liver failure.
Are my employees at risk for hepatitis B?
Prior to the introduction of the Hepatitis B vaccine in 1981, hepatitis B infections were the most frequent occupational infection amongst healthcare, laboratory, and public safety workers. Fortunately, since the inception of the vaccination, transmission rates have been greatly reduced. Infection rates have dropped by approximately 90% since the vaccines have been licensed.
Hepatitis B is transmitted through blood, saliva, and bodily fluids. As such, healthcare workers, and laboratory technicians are classified as high-risk group members. Other individuals who may be at risk are staff that work in institutions for the developmentally disabled, staff who interact with aggressive patients, individuals who work with illicit drug users, corrections personnel, or any employees who must travel to regions with intermediate or high rates of endemic hepatitis B infection.
How do I protect my employees from hepatitis B?
Routine prevention is the best method for protecting your employees from hepatitis B. There are currently three single-antigen vaccines, one three-antigen vaccine, and three combination vaccines are currently licensed in the United States.
Single-antigen hepatitis B vaccines:
- Engerix-B
- Recombivax HB
- Heplisav-B
Three-antigen hepatitis B vaccines:
- PreHevbrio
Combination vaccines:
- Pediarix: Combined hepatitis B, diphtheria, tetanus, acellular pertussis (DTaP), and inactivated poliovirus (IPV) vaccine
- Twinrix: Combined hepatitis A and hepatitis B vaccine
- Vaxelis: Combined DTaP, IPV, Haemophilus influenzae type b, and hepatitis B vaccine
The hepatitis B vaccine is typically given in a series of three injections. The second injection is given one month after the initial vaccination and the third vaccination is given six months after the first. An alternate schedule has been approved for certain populations and vaccines. For example, Heplisav-B has been approved for a two-dose schedule, 1 month apart. In order to have long term protection, the appropriate vaccination schedule must be completed. If there is an interruption in the normal schedule of doses, the series does not need to be restarted; the second and third dose just need to be separated by an interval of at least 8 weeks and if only the third dose is delayed than it should be administered as soon as possible.
How do I screen my employees for hepatitis B?
The CDC estimates that 68% of people with chronic hepatitis B are unaware of their infection. The only way to find out if an employee has hepatitis B is to get them tested. A hepatitis B surface antigen (HBsAg) test can be used to detect the presence of the virus in blood. The hepatitis B surface antigen is a protein on the surface of the hepatitis virus; detecting it in high levels in the blood indicates the presence of the hepatitis B virus and shows that that employee is infectious.
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