My sister has been diagnosed as a hepatitis B carrier. I believe hepatitis B can be spread by bodily fluids. Does that mean sharing food and drinks makes one susceptible to infection? Does that mean if I have physical contact by accident with her blood, saliva or sweat, I will be infected too? Is there any cure or treatement for hepatitis B carriers? What are some precautions, lifestyle habits, and general advice carriers should be aware of?
Hepatitis C has been so much in the news during the past couple of years, that we have ignored the other very common type of chronic infectious hepatitis, which is the hepatitis B you mentioned. Actually doctors have known about and been able to diagnose hepatitis B for many years, since the development of a test known as the Australia antigen back in the 1970s. A specific test for hepatitis C did not become available until the late 1980s.
There are now several tests which allow us to quickly and accurately determine the stage of a hepatitis B infection, and to get a least some idea about the degree of infectiousness of the person who has it.
Hepatitis B is transmitted through blood products, illegal needle use, sexually, and from mother to child around the time of birth. In the United States, most new cases are transmitted sexually or through drug use and are therefore seen in adolescents or adults. Worldwide, most cases are probably transmitted from mother to newborn child. The age at which one catches the hepatitis B virus is critical in determining whether the infected person will go on to be chronically infected or will fight off the infection. Adults who become infected will suppress the infection 95 percent of the time. They will not become chronic carriers. Newborns who are infected, in contrast, become carriers in around 90 percent of cases, and may remain infectious to others for their entire lives.
A brief summary of the tests that are done might be helpful here. The hepatitis B surface antigen (HBsAg) is a particle of the actual virus. It is present in the blood of someone who has recently contracted the infection, and if it persists for more than six months, diagnoses someone as a chronic carrier, or perhaps as someone with chronic hepatitis B. (A chronic carrier has persistent HBsAg in their blood, but no abnormal tests of liver function. Someone with chronic hepatitis B has HBsAg in their blood, and abnormal tests of liver function).
When an adult fights off the hepatitis B infection, HBsAg disappears from the blood, and is replaced by the comparable antibody, hepatitis B surface antibody (HBsAb). When this happens, the virus is no longer in the blood, and the person is no longer considered infectious, although they will never be accepted as a blood donor. As I mentioned, this is the sequence of events in 95 percent of infected adults.
If someone does not clear HBsAg after six months, another test called hepatitis B e antigen, (HBeAg) can be done. If HBeAg is positive, the person is considered to be highly infectious. Many people will with time develop the antibody to the e antigen,(anti-HBe), although they may continue to have HBsAg. Someone with this pattern of tests is thought to be minimally infectious, although sharing needles, or having unprotected sex would still be very risky.
You do not mention either your sister’s age when she was infected, or the pattern of hepatitis B tests that she currently has. Since you say that she is a chronic carrier, I assume that she remains positive for HBsAg at least six months after her infection. If we knew the status of her HBeAg test, then we would be able to say more about her infectiousness. However, even people who are HBeAg positive are not infectious through ordinary contact. I don’t believe the virus is found in sweat, and although cases of infection through contact with saliva have been reported, this is probably rare. Contact with her blood would be much more risky, especially if someone had some small cuts or sores that the blood touched.
You should also be aware that a very effective vaccine now exists to prevent transmission of hepatitis B. It requires a series of three shots, but should certainly be given to anyone with whom your sister is in close contact, such as her children and husband. Vaccination against hepatitis B is now recommended for all children before adolescence, but many adolescents and adults remain susceptible. Testing to see if you and other family members are susceptible involves a simple blood test, is not too expensive, and if it is negative, vaccination should certainly be done.
Treatment for hepatitis B carriers with interferon and perhaps a drug called lamivudine can be effective, but deciding which patients will benefit is too complicated for me to get into here. Your sister should be under the care of a gastroenterologist experienced in treating people with hepatitis, who will be able to advise her further on this.