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http://www.mydr.com.au/ Hepatitis B Hepatitis B is now recognised as the most common disease in the world that can be prevented by vaccination. Hepatitis B is a serious illness, causing many deaths from chronic liver failure and liver cancer. Who should be vaccinated? There is much debate about who should have hepatitis B vaccination. The virus which causes the illness is passed on by contact with the bodily fluids of an infected person. This means that some people, for example hospital workers and those working in blood transfusion centres, are at higher risk. People who inject themselves with drugs and have multiple sexual partners are also more prone to hepatitis B. So, too, are family members of people with the virus. Vaccination is strongly recommended for all these high-risk groups. Recommendations Many experts recommend widespread vaccination for the whole community, starting with newborn babies. Teenagers and young adults, perhaps because of their lifestyles, are thought to be a group that particularly needs the protection of hepatitis B vaccine. So, the Australian Standard Vaccination Schedule recommends vaccination for all children at birth, followed by 3 doses at 2, 4 and 6 or 12 months, with a catch-up dose at 10 to 13 years for those children who have missed being vaccinated. For adults and children who have not been vaccinated as part of the schedule, a simple course of 3 injections, the second and third given one and 6 months after the first, will give protection for several years. The vaccine is readily available and relatively inexpensive. If you are concerned about the risks of hepatitis B for you or your children talk to your doctor. Your Doctor. Dr Michael Jones, Medical Editor. Copyright: myDr, UBM Medica Australia, 2000-2012. All rights reserved. Last Reviewed: 16 October 2003 Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Hepatitis B vaccine What is hepatitis B? Hepatitis B is a serious viral disease that affects the liver. Hepatitis means inflammation of the liver. While about 50 per cent of infected adults may show symptoms in the initial stage of hepatitis infection (the acute stage), young children often do not show any symptoms of the disease at all. Consequently, some people may have had hepatitis B without knowing it; however, blood tests are available to check for this. What are the symptoms of hepatitis B? The symptoms of acute illness resulting from hepatitis B infection may include jaundice (a yellowish discoloration of the eyes and skin), fever, nausea, vomiting, pale faeces, dark urine, a skin rash, or joint and muscle pain. There may also be pain in the upper right region of the abdomen. In a small percentage of cases, the infection may lead to progressive liver failure. However, some people experience no, or few, symptoms. Carriers of the hepatitis B virus Up to 10 per cent of infected adults and 90 per cent of infected newborns may carry the virus in their system for many years without even knowing it they themselves often have no symptoms to alert them. Such carriers of the disease pose a health risk to others by spreading the disease, as well as significantly increasing their own risk of developing hepatitis (inflammation of the liver) and primary liver cancer later in life.

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It has been estimated that the carrier rate for hepatitis B in Australia is about 1 or 2 people in every thousand, although the carrier rate in some Aboriginal populations is considerably higher (1 to 5 per cent). How is hepatitis B spread? Hepatitis B is found in bodily fluids such as blood, saliva and semen of carriers without symptoms as well as those showing symptoms of the disease. It can be transmitted in a number of different ways, including:

contaminated needles and syringes (either during injecting drug use or through needle stick injuries); sexual intercourse (especially anal sex); mother-to-newborn infection during the birthing process; breastfeeding; blood-to-blood contact (through open injuries); contact between children with open sores; non-sterile instruments such as those used for body piercing and tattooing; or, to a lesser extent, sharing personal items that could break the skin, such as toothbrushes or razors. How can hepatitis B be prevented? The most effective way of preventing the spread of hepatitis B is through vaccination. All children are eligible for free vaccination in Australia through their GP or community health centre. Vaccination is especially important in the following high-risk groups:

people such as health care workers, emergency services personnel, police or embalmers who may be exposed to the virus as a result of their occupation; residents and staff of facilities for people with intellectual disabilities; inmates and staff of correctional facilities; injecting drug users; people undergoing haemodialysis, people with HIV and other adults with impaired immunity; people with clotting disorders that require them to receive blood product concentrates; people with hepatitis C or other chronic liver disease; liver transplant recipients; people who have prolonged household contact with a carrier of the disease; people at risk of contracting the disease through sex with an infected person; infants in ethnic groups where the carrier rate of hepatitis B is greater than 2 per cent, or people adopting children from overseas; and babies born to carrier mothers. Australia has adopted the National Health and Medical Research Councils recommendation to promote wider hepatitis B vaccination among infants and adolescents. This move is part of a long-term strategy to reduce the illness and death caused by the virus, and to ultimately eliminate it from the country. In 1997, Australia introduced a hepatitis B vaccination programme aimed at adolescents aged 10-13 years. Subsequently, the immunisation schedule was revised to recommend that all babies born on or after 1 May 2000 be vaccinated against the disease, starting at birth. When should my child be vaccinated? The National Immunisation Program Schedule recommends that the first hepatitis B vaccination is given at birth. Three further doses are then administered at 2, 4, and 6 or 12 months. These are given in combination with other routine immunisations, so that no additional jabs are required. Because the immunity is long lasting, the child will not require further hepatitis B vaccination when they reach adolescence. However, children born before 1 May 2000 should be vaccinated when they are between the ages of 10 and 13. What are the risks?

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The most common side effects of the vaccination are soreness around the injection area, slight fever, joint pain or a feeling of being unwell. However, the risks of not immunising your child are much greater, as hepatitis B is a serious disease with potentially life-threatening consequences. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Hepatitis A, B and C: an overview Compare the differences among hepatitis A, hepatitis B and hepatitis C with this handy table. Hepatitis: a comparison of hepatitis A, hepatitis B and hepatitis C Hepatitis A (HAV) Hepatitis B (HBV) A virus that causes inflammation of the liver. Can possibly lead to cirrhosis and liver cancer in chronic cases. Hepatitis C (HCV)

A virus that causes inflammation of the liver.

A virus that causes inflammation of the liver. What is it?

Can possibly lead to cirrhosis and liver cancer in chronic Chronic (long term) for about 5 Does not lead to chronic (long cases. per cent of adults who contract term) liver disease. HBV. Chronic for about 75 per cent of people who contract HCV. Chronic (long term) for about 95 per cent of children who contract HBV. 2-7 weeks. 6-26 weeks. Average 8-12 weeks. 2-26 weeks. Average 6-9 weeks.

Incubation Average 4 weeks. or window period Incubation/ Window period (from time of exposure until antibodies can be detected). Oral-faecal contact.

Blood-to-blood contact. Blood-to-blood contact. HCV positive mother to newborn baby (low risk).

Transmitted Sexual contact. Contaminated food and water by or contaminated hand-to-mouth HBV positive mother to contact. newborn baby. An infected person's unwashed Sexual activity with HBV hands coming into contact with positive person. food, drinking and eating utensils. Sharing any equipment when Behaviours injecting drugs. Household or sexual contact which put with an infected person. people at Skin penetration (e.g. tattooing risk or body piercing) with nonTravelling through developing sterile equipment. countries. Oral / anal sex with an infected person. Symptoms Adults may have light coloured in acute faeces, dark urine, fatigue, (short term) fever and jaundice (yellowing infection of eyes and, sometimes, the Medical procedures in some overseas countries.

Sharing any equipment when injecting drugs. Receiving blood products prior to Feb 1990 in Australia. Skin penetration (see left) with non-sterile equipment. Medical procedures in some overseas countries.

Flu-like symptoms, dark urine, Mild flu-like symptoms can be light faeces, jaundice, fatigue present but are uncommon. and fever. Very rarely, people may

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skin). Usually lasts for 1-3 weeks.

Most people experience symptoms.

experience symptoms of acute hepatitis.

Occasionally, very severe Some people, especially young hepatitis. children, may have no symptoms. Symptoms in chronic None. (long term) infection Fatigue, nausea, muscle aches Fatigue, nausea, muscle aches and pains, abdominal and pains or abdominal discomfort or jaundice discomfort. Adefovir, entecavir, interferon and lamivudine. Treatment Not applicable. Some people choose to use complementary therapies for symptom management. Yes. Yes. Vaccine It is safe and effective. It is safe and effective. Part of universal childhood vaccination. Vaccination. Do not share any equipment when injecting. Vaccination. Immunoglobulin after exposure. Washing hands after going to Prevention the toilet and before eating. Immunoglobulin after exposure. Practise safe sex. Avoid blood-to-blood contact. No. Combination therapy with pegylated interferon and ribavirin. Some people choose to use complementary therapies for symptom management.

Do not share equipment when injecting. Avoid blood-to-blood contact. Follow standard infection control guidelines for first aid. Avoid sharing personal items (e.g. toothbrushes or razors) which could allow the transfer of blood from one person to another.

If travelling to developing Follow standard infection countries, consider vacination control guidelines for first aid. and seek advice on food and water risks. Avoid sharing personal items (e.g. toothbrushes or razors) which could allow the transfer of blood from one person to another. Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Hepatitis B: information for travellers Hepatitis B is a viral infection of the liver, causing loss of appetite, nausea, joint pain and jaundice (yellowish discoloration of the eyes and skin) in the acute phase, but sometimes producing no symptoms at all, or only mild symptoms. 'Hepatitis' means 'inflamed liver'. In a very small percentage of cases, the infection may lead to progressive liver failure. In adults, between one and 10 per cent of those infected will remain persistently infected and infectious. This is also true of up to 90 per cent of those infected as newborn babies. The risk of persistent (chronic)

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infection is higher in adults if their immune system is not working properly and can't fight off the virus. Being a chronic carrier of hepatitis B virus infection may eventually lead to liver cirrhosis and liver cancer. Hepatitis B is transmitted primarily through behaviours that result in the exchange of blood or body fluids such as semen or vaginal secretions. Such behaviours include heterosexual or homosexual contact or sharing needles or drug paraphernalia with a person infected with the hepatitis B virus. Unscreened or improperly screened blood or blood products may also transmit the hepatitis B virus. The use of unsterilised medical instruments or needles (such as in acupuncture, piercing or tattooing), or contact with potentially infected people who have open skin lesions due to impetigo, scabies and scratched insect bites, may increase the risk of hepatitis B virus transmission in persons who travel to areas with high rates of hepatitis B. Risk Hepatitis B carrier rates are high (greater than 10 per cent) in many Sub-Saharan African, South-east Asian, and Pacific Island populations. Carrier rates are one to 5 per cent in parts of Eastern Europe, the Mediterranean countries, China, Central and South America and some Australian Aboriginal populations, but rates are low (less than one per cent) in the US, northern Europe, Australia and New Zealand. The risk of acquiring the disease is greater if the traveller has contact with blood or secretions containing blood, has sexual contact with an infected person, or remains in the country for longer than 6 months and has close contact with the local population. Prevention Hepatitis B vaccination should be considered for those travellers to countries with high to intermediate rates of hepatitis B. Travellers who will be providing healthcare and have a reasonable risk of exposure to blood or body fluids containing blood should be vaccinated. Immunisation should ideally begin 6 months before travel, in order to complete the full series of vaccinations. In certain circumstances where more rapid protection is required, an accelerated course of vaccinations is available with injections at 0, 7 and 21 days, with a booster dose necessary at 12 months. Recommendations Vaccination is recommended for any of the following people:

any healthcare worker (medical, dental or laboratory) whose activities might result in blood exposure; any traveller who may have intimate sexual contact with the local population or is considering a tattoo or body piercing; any person travelling to regions of intermediate or high levels of endemic hepatitis B virus transmission, either for a long-term visit or for frequent short visits (including those people intending to spend a month or more in Central and South America, Africa, Asia or Oceania); or any traveller who is likely to seek either medical, dental, or other treatment in local facilities during their stay. Travel vaccination for hepatitis B Hepatitis B vaccination is not required for travel to any country, however, it would be wise to have it in certain circumstances. Your doctor or travel vaccination centre will be able to advise you according to your particular destination and circumstances. Ideally, immunisation should begin 6 months before travel to allow time to complete the full series of vaccinations, however, there is an accelerated schedule available for either hepatitis B alone or for combined hepatitis A and hepatitis B vaccination to give more rapid protection. Australia's domestic vaccination policy for hepatitis B Australia has implemented a long-term strategy to eliminate hepatitis B from Australia. This has involved the introduction of a universal hepatitis B vaccination programme for infants and adolescents. Hepatitis B vaccine is recommended for all infants at birth, as part of the National Immunisation Program Schedule. It

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is also recommended that 3 further doses are given at 2, 4 and 6 or 12 months. A catch-up dose at age 10 to 13 years is recommended for those who have not received a primary course of vaccinations. xxxxxxxxxxxxxxxxxxxxxxxxxx

Liver

The liver is your largest internal organ, weighing about 1.5 kilograms in adults. It sits in the upper, righthand side of your abdomen, just under your diaphragm (a sheet of muscle that separates your chest from your abdomen). Your liver is divided into 2 main lobes the right and left lobes by a membrane called the falciform ligament. The liver is a dark reddish-brown organ, and holds up to half a litre of blood at any one time. It receives blood from the hepatic artery, as well as from the portal vein. The hepatic artery delivers oxygen-rich blood from the heart, while the portal vein delivers blood that has just left your gastrointestinal tract. Blood reaching the liver via the portal vein is rich in nutrients that need to be processed by the liver. Functions of the liver The liver performs more than 500 functions, including:

processing nutrients from food; storing energy; filtering toxic chemicals and bacteria from the body; processing alcohol; producing certain proteins and fats (including cholesterol), and controlling their metabolism; storing iron; making certain vitamins, including vitamin A; helping with blood clotting; and processing medicines. Bile

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The liver also produces bile a yellow-green fluid that consists of water, bile salts and a chemical called bilirubin. Bile is made in liver cells and travels through a system of channels and ducts in the liver before eventually leaving the liver via the hepatic ducts. Bile is then transported to the gallbladder and the duodenum (the first part of your small intestine) to help with digestion of dietary fats and the removal of certain waste products from the body. Damage to the liver The liver is a unique organ because it can lose 80-90 per cent of its cells to disease before it stops functioning, and has the capacity to regenerate itself. However, it is possible for toxins such as alcohol and diseases such as hepatitis or conditions that block the flow of bile to permanently damage the liver. Because the liver has such a large excess capacity, signs and symptoms of disease may not occur until it has been severely damaged. Signs and symptoms of liver disease One indication that the liver may be damaged or not working properly is jaundice a yellow discolouration of your skin and the whites of your eyes, which is caused by a build-up of bilirubin in the body. Other symptoms of liver disease include persistent itching, fatigue, nausea, loss of appetite and sometimes abdominal swelling or pain. Some forms of liver disease cause dark urine and pale stools. Testing the liver and its function A simple blood test, called a liver function test, can be used to assess the basic functioning of the liver. It measures various enzymes and proteins that are produced by the liver, as well as bilirubin, to determine whether the liver is functioning within normal limits. Other tests commonly used to detect problems with the liver include a CT scan or ultrasound of the liver. Xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Liver function testing

Role of the liver
The role of the liver is to keep the bodys complex internal chemistry in balance. It takes raw nutrients from our digestive system (in the form of carbohydrates, protein, amino acids, etc) and processes them so they can be stored and sent to different parts of our body in the right form and quantity. The liver regulates the level of sugars in our blood and manufactures bile (which breaks down fats in our stomach). It also helps remove toxins, drugs and hormones from our bloodstream. This brief explanation does the liver little justice it actually carries out over 1,500 complex biochemical functions. Perhaps it is because the liver is so important that, up to a certain point, like a lizards tail, it can rejuvenate itself.

What are liver function tests?

A liver function test (LFT) is a blood test that gives an indication of whether the liver is functioning properly. The test is also very useful to see if there is active damage in the liver (hepatitis) or sluggish bile flow (cholestasis). Liver function tests measure the amount of particular chemicals in the blood. This gives a gauge of possible damage to liver cells damage that can be caused by many things including HCV. So a more correct term for a liver test would actually be a liver dysfunction test. Its important to remember that diagnosis of liver disease depends on a combination of patient history, physical examination, laboratory testing, biopsy and sometimes imaging studies such as ultrasound scans. Diagnosis of hepatitis C usually also involves antibody tests or PCR tests. People reading this page should keep in mind that abnormalities within liver tests dont necessarily point to specific diseas es. Only a physician who knows all the aspects of a specific case can reliably make a diagnosis.

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What are the substances measured in an LFT blood test and whats so important about them?
Total protein
Total protein is simply a combined measure of the concentrations of proteins in the blood. This information can provide clues to several diagnostic possibilities. There are 2 major types of protein: albumin and globulin.

Albumin
Albumin provides a gauge of nutritional status. It can be reduced due to liver damage and kidney disease. Because albumin is made in the liver, levels tend to drop with cirrhosis.

Globulin
This describes the specific level of globulins which include antibodies. This measure can be raised when liver cells are damaged due to autoimmune liver damage or to long-standing liver disease of many types, particularly when cirrhosis exists.

Bilirubin
Bilirubin is a by-product of the breakdown of red blood cells. It is the yellowish pigment responsible for jaundice. Bilirubin levels can be raised due to many different liver diseases, as well as conditions other than liver disease, e.g. gallstones. In cases of long-term liver illness (chronic hepatitis), the level usually stays within the normal range until significant liver damage has occurred and cirrhosis is present. In cases of short-term liver illness (acute hepatitis), elevated bilirubin levels indicate the severity of the acute illness.

GGT
GGT (Gamma Glutamyl Transpeptidase) is an enzyme produced in bile ducts that may be elevated due to bile duct illness. The GGT test is extremely sensitive and may be elevated due to any type of liver disease or by different drugs, including alcohol, even when liver disease is minimal. GGT levels are sometimes elevated even in the case of a normally functioning liver.

ALK Phos
ALK Phos refers to Alkaline Phosphatase, a family of enzymes produced in the bile ducts, intestine, kidneys, placenta and bones. These levels may rise when disease of the bile ducts or bone disorders occur.

ALT
ALT (Alanine Transaminase) is an enzyme produced in hepatocytes (the major type of liver cells). ALT level in the blood is increased when hepatocytes are damaged or die all types of hepatitis (viral, alcoholic, drug-induced etc) cause hepatocyte damage. Levels of ALT may equate to the degree of cell damage but this is not always the case, particularly with hepatitis C. An accurate estimate of liver cell damage can only be made by liver biopsy.

AST
AST (Aspartate Transaminase) is similar to ALT above, but less specific for liver disease because it is also produced in body muscle cells. It does tend to be higher than ALT in cases of alcohol-related liver disease.

Platelet count
Platelets are the smallest of all blood cells and are involved in promoting clotting of the blood normally a process of healing. In cases of chronic liver disease where cirrhosis exists, the platelet count can be lowered although this can occur due to many conditions other than liver disease.

Adult range or normal range

This figure allows you to compare your various LFT readings with what is considered to be the upper limit of normal (by your particular laboratory).

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To make sense when comparing results to other peoples, someones readings should be quoted as 108/45, i.e. their actual resu lt (108) as compared to their laboratorys normal upper limit (45).