Hepatitis B (Youth Issue)

What's the Problem?

Hepatitis B is a disease caused by the hepatitis B virus (HBV). Although half of all people infected with HBV have no symptoms, others experience loss of appetite, tiredness, pain in muscles and joints, stomachache, diarrhea, vomiting, and yellowing of the skin and eyes (jaundice). HBV infection can also cause chronic (long-term) disease that can lead to cirrhosis (scarring) of the liver, liver cancer, and death. The younger a person is when first infected, the more likely that person is to develop chronic hepatitis B.

HBV is transmitted by direct contact with the blood or body fluids of an infected person. A person can become infected by having sex with an infected person, by sharing needles or "works" when "shooting" illegal drugs, through contaminated needle sticks or sharps exposures on the job, or from an infected mother to her baby during birth. Approximately 15% of people who have acute (newly acquired) hepatitis B cannot identify a source for their infection.

The number of new infections per year has declined from an average of 260,000 in the 1980s to about 79,000 in 1999. An estimated 1.25 million people in the United States have chronic HBV infection and have an increased risk for cirrhosis and liver cancer. About 11,000 people are hospitalized and 5,000 deaths occur each year due to hepatitis B or HBV-related chronic liver disease.

Who's at Risk?

People infected with HBV in the United States usually became infected as young adults or adolescents. Adolescents often go undiagnosed because, on average, they visit a health care provider less than once a year. You are at risk for HBV if you

• have sex with multiple partners and don't use condoms correctly and consistently, or if you have a sexually transmitted disease;
• are a man who has sex with a man;
• have sex with an infected person;
• shoot illegal drugs;
• are a household contact of a person with chronic HBV infection;
• are an infant born to an infected mother;
• are from an area of the world with high rates of HBV infection;
• are a healthcare or public safety worker; or
• are a chronic hemodialysis patient.

Can It Be Prevented?

Yes. Hepatitis B vaccine is a safe, effective vaccine and is the only vaccine currently available that can prevent a form of cancer (HBV-related liver cancer). The most common side effect of vaccination is soreness at the site of injection.

The Bottom Line

Hepatitis B can result in chronic infection, increased risk for cirrhosis, liver cancer, and death. The hepatitis B vaccine, usually given in a three-dose series, is safe, effective and prevents HBV infection. The vaccine is recommended routinely for all infants at birth. If the vaccine is not given at birth, the vaccine should be administered as soon as possible. All infants, children, and adolescents 0 to 18 years of age should be protected against hepatitis B by receiving the hepatitis B vaccine series. Adults at increased risk for hepatitis B should also get vaccinated.

Case Example

Jack, the popular captain of the football team at a suburban high school, starts feeling tired all the time. He has stomach pains, his muscles and joints ache, and finally, he feels so bad that he tells his coach he can't make practice. He figures it's the flu, but when the symptoms persist, his coach makes him go to the doctor. As part of a complete physical exam, the doctor asks Jack if he has ever had unprotected sex. Hesitantly, he admits that he doesn't always use a condom. The doctor orders several blood tests, including those for sexually transmitted diseases and a hepatitis panel. A week later, Jack returns to the doctor and is told he has acute hepatitis B. The doctor must report the case to the local health department and advises Jack to inform his sex partners. Jack refuses at first, but after the doctor explains how serious hepatitis B can be, he finally musters up the courage. After an investigation by the health department, it is found that one of Jack's sex partners has chronic hepatitis B, of which she was unaware. Jack misses several weeks of school. Fortunately, blood tests reveal that his body has cleared the virus and he is not chronically infected with HBV. His infected sex partner is referred to her doctor for a medical evaluation and possible antiviral therapy for her chronic HBV infection.