| Sometimes described as a "silent killer," because individuals can be chronic carriers without any symptoms of the disease, viral hepatitis type B (hepatitis B) is an inflammation of the liver caused by a viral infection with the hepatitis B virus (HBV). The acute and most common form of the disease typically clears up within several months. If the disease persists beyond 6 months, the individual is said to have chronic hepatitis B. The rate at which individuals develop chronic hepatitis B depends in part on when they acquire the virus. Almost 100% of newborns who acquire the infection from their mother develop chronic hepatitis B, but the rate drops to about 5% for infections acquired as an adult (Cohen 533). Often undetected in its early stages, the disease slowly destroys the liver or leads to liver cancer over a period that sometimes lasts decades. It is estimated that 40% of individuals who contract hepatitis B will go on to have complications of liver scarring (cirrhosis) or liver cancer (Purow).
Individuals with compromised immune systems have a higher risk of getting hepatitis B.Risk: Most hepatitis B virus infections occur in young adults. HBV spreads when people share body fluids, primarily by using shared needles during drug abuse and through sexual activity. The three groups at highest risk of contracting hepatitis B are sexually active heterosexuals, homosexual men, and injection drug users. Healthcare workers are also at risk of accidental infection through punctures from needles contaminated with the blood of an infected individual.
Blacks have a greater chance of contracting the disease than white or Hispanic Americans. In the past, the virus was spread by transfusions of contaminated blood and blood products. This form is called serum hepatitis and has virtually been eliminated in the US because of screening for the virus by blood banks. Incidence and Prevalence: About 1 out of 20 individuals in the US will become infected with HBV during their lifetime ("Viral Hepatitis B"). About 200,000 new cases of hepatitis B are diagnosed in the US each year, and about 5,000 deaths are attributed to the disease annually (Pyrsopoulos). About 1.25 million individuals are thought to be carriers of the disease ("Viral Hepatitis B"). Vaccination of children against HBV began in the US in 1992. As a result, the number of new cases is expected to decline. The incidence of hepatitis B is as high as 20% of the general population in parts of Africa and Asia and 2% or lower in the United Kingdom and Canada (Cohen 529). About one-third of the world's population has been infected with this virus, and about 350 million people are chronic carriers of the disease. Hepatitis B is believed to cause about 1 million deaths annually (Buggs). |
Source: Medical Disability Advisor
| History: Many individuals who are infected with HBV show no symptoms. Those who do may report early symptoms of muscle and joint aches, headache, and weakness. They may also complain of bad breath and a bitter taste in the mouth. Loss of appetite and nausea are common and accompanied by weight loss. A low-grade fever, diarrhea, and constipation may variably occur. The urine may be dark and the stools light-colored. Yellow skin and eyes (jaundice) develop soon thereafter. At this point in the illness, the fever and aches may subside. Individuals with a chronic form of the disease may also report chest pain or itchy skin eruptions. Physical exam: The exam commonly reveals tenderness over the liver when pressure is applied just below the ribs on the right side of the body. Enlargement of the liver (hepatomegaly) and occasionally the spleen (splenomegaly) may be detected. The appearance of jaundice may occur but is variable. Tests: Blood tests (serology) will show general signs of impaired liver function (high ALT, AST, and bilirubin). To specifically diagnose hepatitis B, other blood tests are needed for detection of HBsAg and anti-HBc IgM antibody. CT and MRI scans may be done to rule out other disorders. A liver biopsy may also be done to assess the stage of liver damage. |
Source: Medical Disability Advisor
| The goal of treatment is to improve symptoms and prevent complications. Hepatitis B is treated with a drug called interferon alpha (IFN-a) that weakens viral activity. Other drugs used in treatment include lamivudine, a drug that helps block virus replication, and adefovir dipivoxil, another drug that blocks the virus from reproducing. Liver transplants may be indicated for individuals with an advanced form of the disease that does not respond to treatment, but availability of organs is limited. Rest, a healthy diet, and abstinence from alcohol also help slow the progress of the disease. Since hepatitis B is a serious worldwide health problem, many clinical trials are investigating new treatments.
Hepatitis B can be prevented by vaccination, and in the US a vaccination program was begun in 1992. Complete vaccination provides immunity in 95% of individuals (Pyrsopoulos). |
Source: Medical Disability Advisor
| The duration of acute hepatitis B illness is variable. Most healthy adults with hepatitis B usually recover completely within 6 months, but about 6% of individuals in the US develop a chronic form of the disease; up to 40% of individuals infected with the virus experience complications, mainly liver cancer or cirrhosis (scarring and destruction) of the liver (Purow). |
Source: Medical Disability Advisor
| Individuals with hepatitis B require no specific rehabilitation. They may wish to consult with a physical therapist and develop an exercise program to maintain endurance and strength. Psychological counseling may help individuals deal with fears of dying and depression that accompany the illness. Because distress and depression lower the immune system, counseling has a beneficial effect on an individual's physical health. For individuals infected through sexual contact, counseling may help them deal with issues of trust and betrayal. Psychologists and psychiatrists also develop behavior modification programs for individuals infected through intravenous drug use. These programs can help individuals recover from drug addiction. |
Source: Medical Disability Advisor
| Progressive liver disease (cirrhosis) and liver cancer (hepatocellular carcinoma) are the most serious complications that may develop. Other possible complications include arthritis, inflammation of the arteries (polyarteritis nodosa), inflammation of small structures in the kidney (membranous glomerulonephritis), pancreatitis, and reversible nerve damage causing paralysis of the extremities, breathing muscles, and face (Guillain-Barré syndrome). Inflammation may also affect the heart muscle or tissue (myocarditis). Individuals over 40 and those with drug addictions are more likely to develop a worsening of the disease (subacute hepatic necrosis). Older individuals may also develop muscle pain similar to rheumatism (polymyalgia rheumatica). |
Source: Medical Disability Advisor
| Individuals usually do not work during the jaundice phase of hepatitis B, but this recommendation varies according to the type of job. Absence of jaundice is not required before a return to work, but employees with significant social interaction may need to limit their contact with the public. Customers at a restaurant or other places of business may fear contact with a contagious disease when it is obvious that an employee is jaundiced. Employees required to perform strenuous tasks may need to limit their job-related activities in the first few days after returning to work. Individuals who develop complications from hepatitis B, such as paralysis or joint pain, may need easy accessibility to work stations and accommodation such as appropriate seating and support. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of viral hepatitis type B been confirmed?
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Has individual had appropriate blood tests to confirm impaired liver function and the specific presence of the hepatitis B virus?
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Were other conditions ruled out, such as hepatitis A, C, and E, infectious mononucleosis, cytomegalovirus, or jaundice resulting from prescription drugs, poisons, alcohol, or gallstones?
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Has individual developed complications such as cirrhosis, arthritis, polyarteritis nodosa, membranous glomerulonephritis, Guillain-Barré syndrome, myocarditis, subacute hepatic necrosis, or polymyalgia rheumatica?
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Does individual have an underlying condition such as alcoholism, blood clotting disorder, chronic liver disease, or liver transplant that may affect recovery?
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Has co-infection with hepatitis D (delta antigen) been identified?
Regarding treatment:
- Is individual considered a candidate for newer therapies such as interferon injections?
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Has individual received adequate rest, nutritional, and fluid intake?
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Is individual registered in an organ transplant program?
Regarding prognosis:
- Since the virus must run its course, has individual had an appropriate length of time to recover?
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Does disease appear to be progressing? Is there evidence of liver tissue death?
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Is a more aggressive treatment now indicated?
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Is individual a carrier?
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What precautions must individual now take for self and for others with whom he or she comes in contact?
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Is there evidence of liver cancer?
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Is individual a candidate for interferon drug therapy? If not, why not?
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Have all associated individuals received appropriate vaccination for hepatitis B, or treatment with immune globulin injection?
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Source: Medical Disability Advisor
| Buggs, Adrienne M. "Hepatitis B." eMedicine. Eds. Scott H. Plantz, et al. 23 Sep. 2002. Medscape. 1 Nov. 2004 <http://emedicine.com/aaem/topic246.htm>.Cohen, Jonathan, and William Powderly, eds. Infectious Diseases. 2nd ed. St. Louis: Mosby, Inc., 2003. Purow, David B., and Ira M. Jacobson. "Slowing the Progression of Chronic Hepatitis B." Postgraduate Medicine 114 1 (2003): Postgraduate Medicine. Jul. 2003. McGraw-Hill Companies. 1 Nov. 2004 <http://www.postgradmed.com/issues/2003/07_03/2jacobson.htm>. Pyrsopoulos, Nikolaos T., and K. Rajender Reddy. "Hepatitis B." eMedicine. Eds. George Y. Wu, et al. 2 Sep. 2004. Medscape. 1 Nov. 2004 <http://emedicine.com/med/topic992.htm>. "Viral Hepatitis B." Centers for Disease Control and Prevention. 1 Oct. 2004. U.S. Department of Health and Human Services. 1 Nov. 2004 <http://www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm>. |
Source: Medical Disability Advisor
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