There is a vaccine to prevent hepatitis B and also a special protein substance called ‘immunoglobulin’ which can offer temporary protection. Understanding simple safety measures will also help prevent transmission of hepatitis B.
Vaccination
A vaccine is a substance containing an ‘inactivated’ form of hepatitis B. This means it is very weakened or dead and cannot cause disease. It is introduced into your body to cause an immune reaction to protect you from ever getting the hepatitis B virus.
The vaccination is given to you by injection in your arm. A first injection of the vaccine is followed by a second dose a month later and another five months after that. It is also possible to have the vaccine combined with others, including hepatitis A, which is particularly useful if you need to be protected against both diseases.
It is important to have all three doses of the vaccine because you will not be fully protected until you have had the third injection. (A booster injection should be given fi ve years after the initial injection). A blood test is sometimes recommended up to two months after the final injection to find out whether the vaccine has worked.
A few people will not respond to the vaccine and they may have to take another course, though some people may not respond to the vaccine at all.
In cases where you are considered to be at much higher risk of infection you may receive a quicker (‘accelerated’) vaccination schedule. This means the first injection is followed a month later, then another a month after that and a booster at one year.
Who should have the hepatitis B vaccination?
In the UK the government has a ‘selective’ vaccination policy. This means that they recommend vaccination of the following people who are considered to be at ‘high risk’ of getting hepatitis B:
- Babies born to infected mothers
- Close family and friends of infected people such as partners, children and other household members
- Patients who receive blood transfusions or blood products, patients who have renal failure, and people who care for them
- People with any form of liver disease
- People travelling to countries with high to medium prevalence of hepatitis B
- Injecting drug users (IDUs)
- Sex workers, both male and female
- People who change their sexual partners frequently or men who have sex with men
- People whose type of work places them at risk, such as nurses, doctors, prison wardens, dentists, health care workers and laboratory staff
- People who live and work in accommodation for people with severe learning diffi culties
- Prisoners
- Families adopting children from countries with high to medium prevalence of hepatitis B
Additionally, if you have a chronic liver disease or require blood transfusions, vaccination will be recommended for you.
If you are at risk as a result of your working environment, your employer has an obligation to pay for and arrange vaccination.
People who are at-risk can get vaccinated by their GP practice, at travel health clinics or at GUM clinics. If you are at-risk because of clinical reasons, the vaccine is provided on the NHS and free of charge. However, if you need it because your job puts you at risk or you are travelling, GPs may charge for the vaccine or direct you to a private clinic.
Immunoglobulin (HBIG)
Anyone who has been exposed to the virus should be given an injection of antibodies called immunoglobulin (HBIG) immediately, as well as the vaccine. This is because there is not enough time to wait for the vaccine to work. Ideally this should be given within 48 hours, but should be considered up to a week after exposure. People who may be exposed to the virus during the course of their work such as nurses, doctors, prison wardens and dentists may need an injection of antibodies as well as the vaccine if they accidentally injure themselves with a needle contaminated with blood.
Babies born to infected mothers are given an immediate injection of immunoglobulin as soon as possible after they are born to help prevent infection from their mother. A dose of the vaccine is given at the same time, followed by two doses with a month in between and a booster dose 12 months later.
Reducing the risk of exposure
If you suspect or know you have hepatitis B you must reduce the risk of infecting others.
- Clean and cover your cuts, scratches and open wounds with a waterproof plaster
- Clean up blood from floors and work surfaces with undiluted household bleach
- Do not use anyone else’s toothbrush, razor, scissors or other personal items
- Ensure drug injecting equipment is sterile and do not share it
- Practice safer sex by using a condom in all circumstances
- Do not donate blood or semen or register as an organ donor.
Before you test for hepatitis B – and even after a positive result – there are several issues you might like to think about before you take action.
Getting started
You will be able to receive free medical treatment at a GP surgery in your local health authority area if you are ‘ordinarily resident’ in the UK. This means that you are living in the UK legally, and for a settled purpose. You will be registered as a ‘permanent resident’.
If you have been in the UK for less than three months, you will be registered as a ‘temporary resident’. At the moment GP surgeries can choose to offer free NHS treatment to most people, including those who are newly arrived or visiting from overseas. However, the surgery might decide to treat you as a private patient, meaning that you will have to pay for your treatment.
Most adults will have to pay a standard charge when they collect their prescription at the pharmacy.
Information about who is eligible for NHS care is available from the Department of Health website: www.dh.gov.uk/en/Policyandguidance/International/OverseasVisitors
Who to tell
Even though you may be worried about a positive result, do not rush into making announcements. It is important that you take the time to understand how you became infected, whether you can infect others and what course your treatment may take. After this it will be clearer to you as to who needs to know you have the virus.
As you will look for comfort and support from those closest to you, it is likely you will tell them. It will be useful to work out what they will want to know before you do this.
Most people do not know very much about hepatitis B and how it is passed on. The virus is spread by blood to blood contact but a lot of people will think you can catch it like a cold or fl u. They may think that shaking hands, hugging or even kissing an infected person will give them the virus.
Being able to answer their questions will help to calm any unnecessary fears the people you tell may have about the danger to you and to them. Advise close family members such as your partner or children to consult a doctor about testing and vaccination.
It is a good idea to talk about your own concerns with a professional. This might be a doctor, health advisor, counsellor or perhaps a drug worker. Clinical nurse specialists trained to help people cope with hepatitis and its symptoms are based at some hospitals. You can obtain advice by phoning the British Liver Trust Helpline (0800 652 7330).
If you are having any other medical treatment or visiting the dentist you must let the practitioner know that you have hepatitis B. Even though simple measures (and vaccination) should protect healthcare workers from infection, these may not always be effective and it is important to inform them so that they can take additional precautions.
Ignorance about hepatitis B among the general public has caused some people to lose their jobs and to be victimised. In spite of this, there will be helpful people involved in your day to day life that you may find it useful to tell. These include someone you trust at work or someone able do regular errands for you. It might just be a person who is always willing to listen to your problems. Think about who these people are and make a list of them. Letting them know about your illness will help to build your support base as you progress with your treatment.
Confidentiality
Most drug agencies and GUM (genito-urinary medicine) clinics offer a confi dential testing service and your GP can also arrange testing for you. If your test is positive, they will forward on your result to your GP so they can arrange on-going care and treatment.
Any doctor who diagnoses hepatitis is legally required to report this information, in confidence, to local public health doctors who are responsible for preventing the spread of infection. These public health doctors work under the strictest guidance about confidentiality. Anonymised data is then reported nationally to help monitor the spread and to inform the prevention and treatment of hepatitis.
Insurance & mortgages
Most insurance companies will ask applicants if they have been tested for HIV, hepatitis B and hepatitis C. A positive test result may mean a life insurance policy or a mortgage linked to a life policy could be refused or the premium much increased. If this happens, it is worth talking to your doctor as many consultants are willing to write to a mortgage or insurance company stating your health and life expectancy.