How can healthcare workers and hospital staff prevent hepatitis B?

In this article, we discuss hepatitis B, the risk for healthcare workers, and how healthcare workers and hospital staff can help prevent the spread of hepatitis B.

What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus (HBV). It causes inflammation of the liver (hepat- = liver; -itis = inflammation).

Although there are many causes of hepatitis, the most common causes are viral. Of all people living with chronic viral hepatitis infection, hepatitis B is the most common.

Hepatitis B is spread when a person comes into contact with blood or bodily fluids that are contaminated with HBV. If the virus gets into the body, it can cause infection. The most common ways of transmission are:

• Vaginal, anal or oral sex
• Sharing needles
• Needlestick injury
• Blood transfusions (more common in countries where screening is not routinely performed on donated blood)
• During pregnancy or childbirth if pregnant mother has hepatitis B

What are the stages of hepatitis B and what are the symptoms?

There are two main infection stages to hepatitis B: acute and chronic. Not everyone will get chronic hepatitis B.

Acute hepatitis B is the first stage of infection and can last for up to six months. Many people don’t have any symptoms, but some symptoms can include:

• Fever
• Flu-like symptoms
• Fatigue
• Nausea
• Vomiting
• Jaundice (yellowing of skin and/or whites of the eyes)
• Abdominal pain

Most people who are infected with hepatitis B as adults won’t require any intervention and will be able to clear the virus from their body within six months.

If the body is unable to clear the infection in less than six months, the infection becomes chronic. Chronic hepatitis B infection happens in about 5% of people who contract hepatitis B as adults. Conversely, 95% of infants or children who become infected with hepatitis B will go on to develop chronic hepatitis B infection.

Chronic hepatitis B infection is usually life-long. There are some medications that can help slow the progression of liver damage caused by the infection, such as tenofovir and entecavir. These medications help to stop or slow the virus from replicating, thus slowing down the damage in the liver.

As the liver becomes more damaged, there is an increased risk of getting liver cancer. The liver also becomes more scarred, leading to cirrhosis. Cirrhosis can prevent the liver from working properly, and eventually cause liver failure if particularly advanced. The more advanced the cirrhosis is, the shorter the life expectancy of the affected individual. If a person has both hepatitis B and hepatitis D, then the time it takes for cirrhosis to develop is quicker than if a person is only infected with hepatitis B.

Many people won’t have any symptoms at the beginning of a chronic hepatitis B infection, whereas other may experience mild symptoms similar to the ones found in the acute stage of infection. As chronic hepatitis B infection progresses, and the liver becomes more damaged, more serious symptoms may begin to show. However, it can take decades for any symptoms of chronic hepatitis B to show, meaning the advancement of liver disease may go unnoticed and untreated.

It’s therefore important that someone with chronic hepatitis B seeks out treatment early to reduce the risk of getting liver cancer, slow the progression of liver disease, and to increase life-expectancy. Many people with hepatitis B are able to lead fulfilling, long lives if their illness is managed correctly.

Is hepatitis B different to hepatitis A or C?

There are five main viral causes of hepatitis: hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. They are all caused by different viruses, so immunisation against one does not protect you from another. The only exception to this is hepatitis D. A person can only be infected with hepatitis D if HBV is already present, so vaccination against hepatitis B in turn protects you against hepatitis D.

All viral hepatitis viruses cause very similar symptoms. This is because the viruses, despite being different from each other, all cause inflammation of the liver.

It is not possible to distinguish one hepatitis virus from another based on clinical presentation alone. Blood tests and nucleic acid tests are able to tell one virus from another, so if viral hepatitis is suspected, it’s important that these tests are done quickly.

The main ways in which these viruses are different from each other is how they are spread (transmitted).

Hepatitis A and E are usually transmitted when someone eats or drinks contaminated food or water. They are most common in areas where there is poor sanitation and less access to clean water. These viruses can be shed in human faeces.

Hepatitis B, C and D are usually transmitted through contaminated blood or bodily fluids. People become infected when they come into contact with the blood or bodily fluid, e.g. via sex or intravenous drug use with shared/unsterile needles. You can also become infected if you have a blood transfusion from contaminated blood, or from having a medical procedure with contaminated medical equipment. Hepatitis B and C can be passed from a pregnant mother to her child, either during pregnancy or childbirth.

Hepatitis D infection only occurs if someone is already infected with hepatitis B. This is because the hepatitis D virus needs a part of the hepatitis B virus to be able to replicate and cause infection. People infected with both hepatitis B and hepatitis D viruses are more likely to suffer from more serious disease and usually have a worse outcome. Having the vaccine for hepatitis B also protects you from hepatitis D.

Almost all people with hepatitis A only suffer an acute illness. The same is true for those with hepatitis E, however chronic hepatitis E infection can occur if they are immunosuppressed, although this is still uncommon. People with hepatitis B or C can go on to have chronic infection. The likelihood of developing chronic hepatitis B or C depends on age, genetics, environment and overall well-being.

Why are healthcare workers at high risk for contracting hepatitis B?

Hepatitis B is spread through blood or bodily fluids that contain the hepatitis B virus. If the virus gets into an uninfected person, they can contract hepatitis B.

Healthcare workers, such as doctors, nurses, healthcare assistants and laboratory staff are at higher risk of contracting hepatitis B than the general public. This is because they are likely to be in close contact with many patients and handling a variety of different samples every day.

Many people have hepatitis B and do not know it because they are asymptomatic. Not everyone with hepatitis B will have symptoms, and some symptoms are non-specific, such as fatigue. This means that, particularly in hospital settings, doctors and nurses could be dealing with patients who have hepatitis B and do not know it.

Laboratory staff who handle samples such as blood or semen are also at risk. There are many different types of tests that require blood or other bodily fluid specimens. Many tests performed in hospitals are not looking for infectious diseases, but if a sample contains HBV, then it is a risk to the laboratory staff or anybody else who needs to handle the specimen.

Healthcare workers are not only at risk for contracting hepatitis B, but also for unknowingly spreading it between staff and patients. There are very strict rules in place in UK hospitals around sanitation and hygiene to minimise the risk of hospital staff transmitting infectious diseases to patients. For example, medical equipment must be sterile. If you go to a hospital, you’ll notice that the nurse or doctor treating you will change their gloves and will always use a fresh pair of gloves between patients. This keeps us and them safe.

To minimise the risk of healthcare workers and laboratory staff catching and spreading hepatitis B, they can get the hepatitis B vaccine.

The hepatitis B vaccine works by forcing your immune system to create antibodies to the virus without making you sick. When you are immune to hepatitis B, you can’t get infected with it and therefore cannot pass it on to other people.

The vaccine therefore protects the healthcare workers and the patients that they look after every day.

How can healthcare workers protect themselves from hepatitis B?

In their day-to-day job, healthcare workers can protect themselves from hepatitis B by ensuring they are wearing the correct personal protective equipment (PPE). They should always change gloves between patients, and if their gloves become torn. They should ensure their working environment is kept sanitised, and that all medical equipment is sterile. This protects both the patient and the worker.

Healthcare and laboratory workers should also take precautionary measures outside of work, just like the general public. This includes using condoms or dams during sex, to prevent the spread of hepatitis B through vaginal, anal or oral sex, and taking precautions when travelling abroad, particularly to countries where prevalence is high.

The most effective way to prevent healthcare workers from getting hepatitis B is to get the vaccine.

The vaccine works by tricking your body into thinking you are infected with hepatitis B. The immune system then creates specific antibodies that fight against hepatitis B without you getting sick from the virus. Once your immune system has made these antibodies, it remembers how to make them for a long time. If HBV was to get into your body after being vaccinated, your immune system would release the antibodies which then ‘attack’ the virus. This stops the infection from occurring and therefore you don’t get sick with hepatitis B.

A full vaccine course for hepatitis B usually consists of three doses that are administered over the course of three appointments.

According to the National Institute for Health and Care Excellence, healthcare and laboratory staff should be given a booster vaccine around five years after their completed hepatitis B vaccination course. This ensures that they remain immune to hepatitis B.

In the UK, most healthcare workers will have a follow-up appointment after their vaccination to check the immune system’s response to the vaccine. It’s important to check, as not everybody’s immune system responds in exactly the same way, and additional doses could be required.

With an AlphaBiolabs Hepatitis B Immunity Test you can continue to check whether you have sufficient immunity to hepatitis B whenever you like, from the comfort of your own home. Perhaps it has been several years since you last had the vaccine, and you want to check that you are still immune to hepatitis B, or you want to see how your antibody levels have changed after receiving another dose of the vaccine (e.g. a booster). The test can ensure peace of mind that you remain sufficiently immune to hepatitis B.

Why is it important to get vaccinated for hepatitis B?

Vaccinating against hepatitis B protects you from getting hepatitis B. The vaccine contains dead hepatitis B virus. As the virus is not ‘alive’, it cannot give you hepatitis B. Your immune system can’t distinguish between ‘dead’ or ‘live’ virus, but it recognises that the dead virus from the vaccine is foreign, so it creates antibodies that are specific to the virus. Your immune system remembers how to make these antibodies, so if it encounters real hepatitis B virus in the body, it launches an immune response, and the antibodies clear the virus before you can get sick.

Getting vaccinated helps protect you and those around you. This is particularly important if you belong to a high-risk group (those more at risk of getting hepatitis B than the general population).

Most adults who acquire HBV will likely make a full recovery. Many won’t even know they have hepatitis B. However, most infants and young children are very likely to develop chronic hepatitis B infection, and some adults, particularly those who are immunosuppressed or have another illness or infection, are also more likely to develop chronic hepatitis B. Chronic hepatitis B is usually life-long and can lead to serious health problems, including liver cancer. Roughly 4% of the world’s population is living with chronic hepatitis B, so it is important to reduce the spread of the virus to decrease the burden of disease.

The more people who are vaccinated against an infectious disease, such as hepatitis B, the more protection there is for those who cannot get the vaccine. This is sometimes referred to as ‘herd immunity’.

When a sufficient number of the population are vaccinated against an infectious disease, the chance of an unvaccinated individual within that population getting infected (e.g. with HBV) is greatly reduced. Some people cannot get the vaccine – this could be for a number of reasons, such as being allergic to the vaccine ingredients or simply their age.

It’s really important as a healthcare or laboratory worker to get vaccinated against hepatitis B. This protects you in your job and the community, as well as protecting your patients and those around you, including anyone you may live with. Being vaccinated against hepatitis B not only prevents you from becoming infected with HBV and passing the virus to other people, it also increases the protection of vulnerable members of society who cannot get vaccinated.

Where can I get a hepatitis B immunity test?

You can buy a hepatitis B immunity test from AlphaBiolabs for just £42.

The immunity test detects hepatitis B antibodies. If we find hepatitis B antibodies in your sample, it means you have either had at least one dose of the hepatitis B vaccine, or you have had a previous hepatitis B infection.

The immunity test cannot tell you whether the presence of the antibodies has come from the vaccine or a hepatitis B infection. If you have never received a vaccine, then the presence of hepatitis B antibodies indicates that you have had hepatitis B in the past.

The immunity test cannot tell you if you currently have a hepatitis B infection. Hepatitis B antibodies will be present in your blood within a few weeks of a hepatitis B infection, but the presence of the antibodies can’t tell you whether you are still infected with hepatitis B, only that your immune system is responding to the infection by producing an immune response.

If you think that you might currently have a hepatitis B infection, you need to test for hepatitis B antigens. Antigens are foreign substances, like proteins from viruses or bacteria, which cause your body to produce an immune response like the production of antibodies. Our hepatitis B infectivity test looks for hepatitis B surface antigens. Antigens are first found in the blood around 4-10 weeks post-exposure to HBV. The presence of these hepatitis B surface antigens means that you are currently infected with hepatitis B and can spread the infection to other people. You can buy a comprehensive screening panel from AlphaBiolabs which detects hepatitis B antigens, as well as hepatitis C, syphilis and HIV.

The immunity test will tell you if hepatitis B antibodies are present, and how much antibody is in your sample. Included in your report is a table to help you interpret your results, and the measures you should take if you have insufficient immunity.

The immunity test is ideal for those wanting to check if they still have immunity, particularly if you were last vaccinated many years ago. You might also find this test helpful to check how your antibody levels have changed, e.g. before and after receiving a booster vaccination. You can take the AlphaBiolabs hepatitis B immunity test as much as you feel is necessary – although we recommend you speak to a doctor should you have any concerns about your immunity to hepatitis B, as well as if an insufficient amount of hepatitis B antibody is detected, as you may need an additional hepatitis B vaccine.

You can buy an AlphaBiolabs hepatitis B immunity test here for just £42.