Hepatitis leading to liver disease and liver cancer is very common and is a major health problem. Hepatitis B data alone shows that China has a tenth of the population (about 130 million) with chronic hepatitis B infection (carriers). Every minute there is a Chinese person dying from liver disease or liver cancer that originated from Hep B. The majority (80%) of liver cancer are caused by hepatitis. The saying “prevention is better than cure” is accurate. Hepatitis and the resulting liver cancer can be prevented and avoided.
Hepatitis A: generally transmitted through the intestine. The virus is excreted in the patient’s stool and then passed into the mouth through contaminated food, leading to infection.
Hepatitis A prevention:
- Personal hygiene – always wash your hands prior to preparing food or eating; immediately flush the toilet and wash your hands after using the bathroom
- Food hygiene
- Hepatitis A virus needs to be cooked at high temperature (100 degrees Celsius) for 5 minutes to be killed so drink boiled water, and clean and cook food thoroughly prior to ingestion
- Take special note of seafood like oyster, clams, and shellfish
- Food that hasn’t been consumed should be covered or placed in the refrigerator
- Environmental hygiene – proper disposal of sewage and feces to protect drinking water from contamination
Hep B and Hep C: the route of transmission are similar; mainly by blood or bodily fluid (not food). Because Hep B can survival outside of the body for at least 7 days it is more contagious than HIV by a hundred times.
The following are a few preventive measures:
- Properly disinfect and bandage any wounds
- Do not share razors, toothbrushes, needles, syringes or any other products that have the chance of being contaminated by blood or bodily fluids
- Any medical, dental or other equipment (e.g. acupuncture, tattooing, body piercing, manicure) must be thoroughly disinfected prior to use
- Avoid sexual promiscuity and use condoms properly
Can be divided into two types: passive and active immunization
Injecting immune globulin gives a brief instant immunity and protection but cannot produce long-term effects. Appropriate for the following situation:
- Hep A (Immune Globulin A)
- Appropriate for people who have not been infected with Hep A but wanted to have temporary protection or plan to travel to areas where Hep A is prevalent
- Where Hep A vaccine is not suitable for the patient (due to allergy, or adverse side effects, etc.)
- Not appropriate for babies who are less than one-year-old
- Appropriate for people with weak immunity and failed to produce effect to vaccine
- Hep B (Immune Globulin B)
- Accidental contact with blood containing Hep B virus (e.g. acupuncture), preferably inject within 48 hours coming in contact
- From sexual contact with Hep B patient, can inject within two weeks
- Newborn baby of mothers who are carriers, it is very important to receive immunoglobulin injection within 12 hours and the baby can also be vaccinated at the same time
This is the most effective long-term prevention for Hep A and Hep B. This immunization injects hepatitis vaccine into the body, stimulating the body’s immune system to produce enough antibodies to protect long-term from hepatitis viral infection. Only Hep A and Hep B vaccines are available. There is not yet a vaccine for Hep C or other types of hepatitis.
Hepatitis A vaccine:
Involves a total of two injections. After the first injection the body usually takes two to four weeks to produce sufficient antibodies to fight against the Hep A virus. The second vaccine injection (booster shoot) usually happens within 6-12 months to accomplish long-term immunity (10-20years).
The following people in particular should consider having Hep A vaccine:
- People without Hep A antibody
- People who travel regularly, especially to places where Hep A is prevalent
- People who often ingest uncooked food, especially shellfishand seafood
- People working in the food industry
Hepatitis B vaccine:
The full course includes three injection within 6 months for the best immune protection. The first and second injection should be a month apart; the second and third injections should be 5 months apart. Hep B antibodies are produced one to two weeks after injection. If the three doses of vaccines are completed in a timely matter about 90-95% of people will produce enough Hep B antibody to enjoy 15 years or more of immunity. People with immunity will not need booster vaccines once a sufficient level of antibody is reached.
The following people should be vaccinated with Hep B vaccine:
- Anybody who has never been infected with Hep B
- The family members, sexual partners and people in close contact with a Hep B carrier
- Medical personnel as the nature of their work requires coming in contact with patient’s blood and bodily fluids
- People who are using street drugs
- People who are on dialysis
- People who often receive blood transfusion or blood products
- Newborn babies, especially when the mother is a carrier
Twinrix (Combined hepatitis A and B vaccine)
Hep A and Hep B combination vaccine can protect the person from both Hep A and Hep B viral infection. The vaccination also involves 3 injections within 6 months. It will be effective for at least 15 years. The Universal Immunization plan in Canada provides all elementary school students and new born babies with Hep B vaccination. However, there is yet to be a Hep A vaccination program.
Hopefully with a better understanding of hepatitis and its prevention, along with the wide spread of vaccination plans, hepatitis along with its complications and subsequent disease will completely eliminated in the near future.
Content by Dr. Thomas Ho, Family Practice