What is hepatitis B and how can university students prevent and manage it?

Hepatitis B: Essential Information for University Students

What is Hepatitis B?

Hepatitis B is a viral infection caused by the hepatitis B virus (HBV) that attacks the liver and can lead to both acute and chronic disease, including cirrhosis and liver cancer. 1

• HBV is a small DNA virus that infects more than 300 million people worldwide and represents a major public health problem causing significant morbidity and mortality 1, 2
• The virus contains partially double-stranded DNA surrounded by core antigen (HBcAg) and an outer envelope containing surface antigen (HBsAg) 3
• HBV replicates through an RNA intermediate and can integrate into the host genome, giving it a unique ability to persist in infected cells 1

How is Hepatitis B Transmitted?

HBV spreads through contact with infected blood, semen, and other body fluids. 2

• Transmission occurs through sexual contact, sharing needles, or exposure to infected blood 4
• Healthcare workers and students face higher risk due to potential occupational exposure to blood and body fluids 5
• The virus does NOT spread through casual contact like sharing food or hugging 6

Clinical Course and Outcomes

The outcome of HBV infection depends heavily on age at infection and immune status. 3

Acute vs. Chronic Infection:

• 90% of newborns who become infected develop chronic hepatitis 3
• 29-40% of children infected develop chronic disease 3
• Only 5-10% of adults infected progress to chronic infection 3, 2

Long-term Consequences:

• Up to 40% of men and 15% of women with perinatally acquired HBV will die of liver cirrhosis or hepatocellular carcinoma 2
• Five-year survival rates vary: 97% for chronic persistent hepatitis, 86% for chronic active hepatitis, and 55% for chronic active hepatitis with cirrhosis 3

Prevention: The Hepatitis B Vaccine

The hepatitis B vaccine is the single most effective tool for preventing HBV infection and is the first anticancer vaccine ever developed. 7

Vaccination Recommendations for Students:

• All healthcare providers and students should receive the complete 3-dose hepatitis B vaccine series 8
• Vaccination should be followed by testing for hepatitis B surface antibody (anti-HBs) 1-2 months after completing the series to confirm immunity 8
• Protective antibody level is defined as >10 mIU/ml 8
• If initial series doesn't produce immunity, revaccination with 3 additional doses (total of 6 doses) should be given 8

Vaccine Effectiveness:

• The vaccine is safe, effective, and affordable 7
• Global coverage reached 85% in 2019 compared to only 30% in 2000 7
• Implementation of vaccination programs has substantially decreased HBV carrier rates and related morbidity and mortality 7

Current Trends and New Options

Testing Recommendations:

• Students at increased risk should undergo prevaccination testing, including those born to mothers from endemic countries (Asia, Africa, Middle East) and sexually active men who have sex with men 8
• Testing involves checking for HBsAg (surface antigen), anti-HBc (core antibody), and anti-HBs (surface antibody) 8

Treatment Options for Chronic Infection:

Two main antiviral medications are available for chronic HBV:

1. Tenofovir disoproxil fumarate 6:

   • Taken once daily on an empty stomach
   • Can cause kidney problems, so monitoring is required
   • Effective at suppressing viral replication

2. Entecavir 9:

   • Taken once daily on an empty stomach (at least 2 hours after and before meals)
   • Generally well-tolerated with headache, tiredness, and dizziness as common side effects
   • Long-term treatment can reverse cirrhosis and reduce hepatocellular carcinoma risk 2

Important Treatment Considerations:

• Never stop antiviral medication without consulting a healthcare provider, as this can cause severe liver problems 6, 9
• Patients must continue medication even when feeling well to prevent viral rebound 6, 9
• Regular monitoring of kidney function and liver enzymes is essential during treatment 6

Protection Practices for University Students

All students should adopt standard precautions to prevent HBV transmission: 4

Essential Safety Measures:

• Never share needles, syringes, or any injection equipment 4, 6, 9
• Avoid sharing personal items that may contact blood (toothbrushes, razors, nail clippers) 6, 9
• Always practice safe sex using latex or polyurethane condoms 6
• Wear gloves when touching blood or body fluids 4
• Never recap needles using both hands or any technique directing the needle toward your body 4

For Healthcare and Public Health Students:

• Chronic HBV infection should not preclude studying medicine, dentistry, or allied health professions 8
• Students performing non-invasive or minimally invasive procedures face no restrictions on their activities 8
• Standard precautions must be followed rigorously in all healthcare settings 8
• No transmission from a dental or medical student has ever been reported in the United States 8

Knowledge Gaps Among Students

Recent studies reveal concerning gaps in HBV knowledge and prevention practices among university students: 5

• In a study of public health students in Ghana, only 73.9% had moderate knowledge about HBV 5
• 50.4% had never been tested for HBV infection 5
• Only 30.5% completed the full vaccination series 5
• Students with better knowledge were significantly more likely to get tested (nearly 5 times more likely) 5
• Female students and regular (non-mature) students were more likely to complete vaccination 5

Critical Pitfalls to Avoid

• Do not assume you're protected without confirming antibody response after vaccination 8
• Never share multi-dose medication vials or IV bags between patients in clinical settings 4
• Inadequate hand hygiene between patients increases transmission risk 4
• Do not delay getting tested if you're from an endemic region or have risk factors 8
• Never discontinue antiviral therapy without medical supervision, as severe liver flares can occur 6, 9