Hepatitis A, B, C, D, and E

28 07 2015

It’s World Hepatitis Day.

We want to use this day to remind moms and dads that hepatitis is around and some of it can be prevented by vaccination.

Hepatitis C is a bloodborne virus that attacks the liver. It is not vaccine-preventable. If babies are infected it’s usually from their hepatitis C+ mothers or, and this is unlikely these days, from a blood transfusion. It’s unlikely because the screening process of donated blood is pretty darn thorough. But, germs have slipped through that screening process.

Teens and young adults may become infected, primarily through sharing of needles, sex with an HCV+ person, or sharing personal items such as razors or toothbrushes that may be contaminated with HCV.

There are effective treatments that work on a good portion of hepatitis C-infected children. But not on all infected children. Work is ongoing in this area.

Hepatitis C is frequently a chronic infection, meaning that if treatment is not effective, you will be infected for your lifetime.

Hepatitis A is vaccine-preventable. Normally, it’s passed person-to-person through the fecal-oral route, which is when something you eat or drink has been contaminated with hepatitis A+ poop. If you haven’t been vaccinated, chances are you will become infected.

This virus makes you feel lousy and can, rarely, do serious damage to the body. It does not become a chronic infection. It infects you and then goes away, like a cold virus.

Hepatitis B is vaccine-preventable. It’s transmitted in a lot of ways—mom to newborn, sharing needles or personal items, sex with an infected person, even household (nonsexual) contact. If a mom is aware of her infection prior to giving birth, shots can be given to the baby within 12 hours of birth that are effective at stopping tranmission of the virus from mom to baby. However, when babies are infected, almost half of them in the US will become chronically infected. In developing countries, that figure shoots up to 90 percent.

Today, despite the vaccine, approximately 1,000 babies become chronically infected with hepatitis B each year in the US. Many of the moms-to-be who are infected are unaware of their infection. Every pregnant woman should be tested for hepatitis B so that action can be taken at birth to prevent infection of the newborn.

Hepatitis D is an odd virus. You have to be infected with hepatitis B before you can get hepatitis D. It’s vaccine-preventable in that, if you get immunized against hepatitis B, you won’t be able to get hepatitis D.

Hepatitis E is similar to hepatitis A in the way it is transmitted—the fecal-oral route. It’s rarely a chronic infection. For most people, they get it, get sick, and get over it. It can however be dangerous for pregnant women, with a 10% – 30% fatality rate for this group. It’s not often found in the US but can be easily picked up in some other parts of the world.

That’s about it for hepatitis in the US. To prevent a hepatitis infection (and lots of other infections), wash your hands throughout the day, put barriers between yourself and another person’s blood or body fluid, and use the available vaccines. The trick is to do these things with everyone. It’s impossible to tell who is infected with what, most of the time, so the safest course of action is to assume everyone is infected with something and then act accordingly.

Got any tips? Hope you share them will us in the comments.

By Trish Parnell

Image courtesy of Johns Hopkins





Your Student Athlete

27 08 2013

Kids are back in school and signing up for sports.

Some parents wonder about their infected children playing sports and possibly infecting others in the process.  Parents also wonder how concerned they should be about their children becoming infected from other players living with undiagnosed or undisclosed infections.

Playing sports can be risky in many ways and part of that risk is the potential to become infected with all sorts of germs.

Parents of children living with diagnosed infectious diseases worry that they may be responsible for infecting another child.  They wonder if they should inform the coach or the school.  They worry that the adults in charge don’t really follow standard precautions, thereby increasing the risk of infections.  They want their kids to enjoy life and they want to do the right thing.

The American Academy of Pediatrics issued a policy statement on this dilemma in December, 1999: HIV and Other Blood-Borne Viral Pathogens in the Athletic Setting. In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

The AAP’s Redbook still supports this policy.

Participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.

There is no reason to exclude any student from sports if they’re infected with HIV, HBV or HCV.  Nor is there a reason to disclose the infection.  There are many people living with undiagnosed infections, so it is more prudent to ensure everyone is practicing standard precautions rather than simply excluding those with known infections and not properly protecting all athletes from undiagnosed infections.

Dr. Steven J. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests children should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

Pediatricians can avoid reporting a student’s infection, the Academy noted, by making it clear on any participation forms that they support the Academy’s position that all students can participate in all sports and that pediatricians must respect an athlete’s right to confidentiality.

But strict compliance with standard precautions is critical for this open embrace of all athletes, regardless of their infectious status.  Dr. Anderson notes that, as a parent, he would make sure that there is a plan in place to handle blood spills, including latex gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

Dr. Anderson does feel that students with infectious hepatitis A (spread through close physical contact with contaminated food, water or skin) or with liver or spleen enlargement should be restricted from contact or collision sports until the liver or spleen has returned to normal size, and the person is no longer contagious.

An article that ran in 2004 in the British Journal of Sports Medicine talked about possible methods of transmission in sports and reported incidents of transmission:

Bleeding or oozing injuries could, in theory, transmit the virus through the mucous membrane or injured skin of other athletes.  This risk is considered extremely low.  However, contact and collision sports like wrestling or boxing increase that risk.  The risk goes down a bit for those playing basketball or soccer, and those playing sports with little physical contact, such as tennis or baseball, are at the lowest risk.

It has been suggested that bloodborne infections may be transmitted through sharing a water container, because bleeding around the mouth is common in contact sport.  Therefore it is recommended that water containers should be available individually for each player in contact sports. Athletes should use squeeze water bottles which they do not put in their mouth.

Bloodborne infections can be transmitted through blood doping. There is also a risk from sharing needles which may be associated with drug abuse in sport. Injectable drugs used in sports include steroids, hormones, and vitamins.

Three separate cases of HIV infection associated with sharing needles among bodybuilders have been reported, two in the United States and one in France.  It has also been reported that three soccer players from one amateur club were infected with HCV as a result of sharing a syringe to inject intravenous vitamin complexes. Syringes have often been shared by athletes who inject vitamins minutes before a game.

A 1993 study estimated that, in the United States, there were one million people who were either current or past users of anabolic androgenic steroids. Of these, 50% were intramuscular drug users, and about 25% had shared needles. Therefore it seems that the risk of transmission in this way may be considerable among athletes, especially bodybuilders.

So, if your family is getting involved in sports, it would be worth your time to:

  • Get caught up on all vaccinations
  • Practice standard precautions
  • Wash your hands a lot or, if hands aren’t visibly soiled, use alcohol handrubs
  • Don’t share needles with anyone for any purpose




Hep B Clinical Trial

16 01 2013

When babies are infected with hepatitis B, chances are they’ll stay infected for life. It becomes a chronic condition.

Some live long lives and their deaths are unrelated to their hep B infection.

Others develop cancer or their liver gives out. And then there are those who have minor symptoms, such as jaundice or fatigue.

You never know what or when or if something’s going to happen.

There’s no wonder drug for this disease. The available treatments are anemic at best, and few get favorable results.

My daughter, who was infected as an infant, has lived with hep B for 13 years. We’ve waited a long time for drugs that might work for her stage of the disease.

Hope has just peeked over the horizon.

NIH is running a clinical trial through a few centers in the US and Canada on children whose hep B infection is at a certain stage.

They’re using a combination of entecavir and pegylated interferon. They’re not looking for a cure, but rather hoping to slow it down. Even the best results wouldn’t remove the hep b virus from the cells. It’s integrated now, and there’s no work being done that’s close to getting it out of the cells it’s infected.

But, if the stars align and results are better than expected, it could be that those who respond to this treatment can relax, knowing hep B needn’t remain on their worry list.

That’s what we want. We all want our kids to live long, happy, healthy lives.

We flew to San Francisco yesterday for blood work and to sign forms. Lots of forms. Dr. Phil Rosenthal is running the trial and Shannon Fleck, the clinical research coordinator at UCSF Benioff Children’s Hospital, is assisting. I’ve known Phil for nearly 20 years and was delighted to see how optimistic he is about this drug combo.

This first step is to determine if my daughter is eligible for participation in the study. Her lab results have to match the criteria set for the trial.

If she is eligible, we fly back down within 30 days and her name goes into a computer, which then spits back out her placement. She’ll either be in the control group (no treatment) or the treatment group.

If she’s in the control group and the study is proving successful, she’ll be allowed compassionate use of the drugs, but that won’t be for two or three years.

That’s where we are—not even past the first hurdle.

I know people who’ve been infected with hep B in their adult years and have died from the disease. And I know people who’ve had cancer or liver transplants, or both—all because of this infection.

There are lots of ways to become infected. The easiest way to prevent infection is to get vaccinated. You, your siblings, your parents, your kids . . . ask your healthcare provider about it.

You can’t fix this with an aspirin.

By Hep B Mom





HB FOUNDATION!

25 10 2010

We love the Hepatitis B Foundation and all the folks connected to the organization.  Here’s why: The Hepatitis B Foundation (HBF) has been working for years to find a cure for those infected with HBV and to improve their quality of life. 

To help reach their goals, Joan and Tim Block and their partners at HBF established the Institute for Hepatitis and Virus Research a few years ago. It’s a stunning achievement that continues to give hope to all families affected by HBV. 

The website provides many resources, such as an up-to-date listing of hepatitis B drugs, making it easy for parents and professionals to see what’s been approved by the FDA and what’s happening in clinical trials.

And, a few years ago, HBF received funding from the National Library of Medicine to provide a tutorial on searching for information on the Internet.  It’s a painless way to get an introduction to Medline, PubMed and other sites. Every parent we know wants to find out as much as possible about the virus that’s infected their child.

HBF holds three one-day patient workshops every year, each in a different city.  Workshop goals include increasing liver cancer screenings, informing patients about treatment options, and providing support to those affected by hepatitis b.

The foundation provides copious amounts of information on hepatitis B in English, as well as helpful “chapters” in other languages. 

If you or someone in your life is affected by hepatitis B, you should bookmark this website.  It might come in handy one day.





Hepatitis B and Adoption

3 05 2010

Adoption is fun but scary, and full of love and uncertainty—even when the process goes perfectly.

Sometimes, during the adoption process, the parents-to-be get news that makes them pause, and they wish they could gaze into a crystal ball to see the outcome of each decision they have to make, especially if the news is that the child with whom they’re matched is infected with the hepatitis B virus (HBV).

As you work through your decisions, here are some thoughts for you to consider from PKIDs parents who’ve adopted HBV+ children:

First, ask your healthcare provider about the HBV vaccine. You should be protected against this virus, even if you don’t end up adopting a child who is HBV+.

For persons in developed countries who are adopting domestically and have identified the birth mother, ensure that the birth mother is screened for, among other infections, hepatitis B. If the birth mother is positive for HBV, make sure the baby is vaccinated against hepatitis B and receives hepatitis B immunoglobin (HBIG) within 12 hours of birth. This helps to prevent transmission of the virus to the newborn.

Although this protocol is usually effective, you will not know for sure if the baby is infected until the baby is screened for HBV 1or 2 months after completing the three-shot hepatitis B vaccine series (at least 9 months after birth).

In some countries, the tests for HBV infection may not be reliable or may not be interpreted correctly, and it’s possible the child was never tested for HBV infection, although the paperwork may say otherwise.

If you’re adopting internationally, you won’t know for sure about your child’s HBV status until you get the child home and have him or her screened for the virus.

As you consider whether or not HBV is a disease for which you’re prepared, you can learn more about the infection and treatment options for children in PKIDs’ Pediatric Hepatitis Report. The Hepatitis B Foundation also has lots of information.

Search the Internet for articles and studies specific to HBV infection in children.  Keep in mind that treatment options for children are different than those for adults, so not all of the information you find will apply to kids.

Join and post on PKIDs’ listserv and the HBV_adoption listserv to interact with families living with HBV.

Be aware that there is a stigma associated with HBV.  At PKIDs, many families have experienced severe problems within their own extended families after disclosing, as well as problems at school and among friends and colleagues.  Should you decide to adopt an HBV+ child, you need to be aware of this so that you can determine to whom you will disclose your child’s medical information. You can always choose to disclose at a later time, but you can never take that information back, once it is out.

Your child’s lab results from his or her birth country may not give you the status of your child’s HBV infection.  Test results are often outdated, lacking, or inaccurate, and at best provide a snapshot at the time of the test.  It’s unwise to base your adoption decision on international lab work, and you should not request additional testing.  HBV is readily spread by needle re-use, which is problematic in many countries. You actually put the child at risk by requesting more lab work, which will be re-done anyway when your child arrives home.

It’s impossible to say when or if a child will need treatment.  No two HBV infections are the same. At a minimum, and even if the child is asymptomatic, there will be regular lab work that needs to be done.

All of this is manageable, and daily life with a child with HBV is typically very normal.  However, there are kids who need treatment and for whom the infection is serious.

Most people infected as babies who then go on to develop a chronic or lifelong infection go decades without needing treatment, and many live a long, healthy life and die of old age.

Others need treatment while they’re still kids.

There is no true cure for HBV infection, and those infected at birth are at increased risk for advanced liver disease or liver cancer before they are 30 years old.

A lot to think about, but we hope we’ve given you some tools to use as you determine what’s right for you.

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