Considered a silent epidemic because it’s extremely contagious and most people who are infected don’t know they have it, hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus (HBV). Hepatitis B virus-related liver disease can progress into cancer later in life. The best way to ward off the virus is by getting vaccinated at birth, or as soon as possible. We asked Dr. Rachel Brauner, a pediatrician in Hillsborough, how hepatitis B can lead to liver damage and cancer, and why that makes getting the vaccine that much more important.

New Jersey Family: What is the hepatitis B virus and what are the signs and symptoms?

Dr. Rachel Brauner: Hepatitis B is a virus that attacks the liver, which is one of our body’s most important organs, and injures it over time, causing significant damage. The process, though, is not quick. Hepatitis B infection is often referred to as the silent epidemic, as most people who are infected with the virus don’t know they have it until decades later when they start to present symptoms of their liver being injured.

Many of the initial symptoms of hepatitis B infection are similar to other viral infections: fever, fatigue, muscle or joint pain, a reduction in appetite, nausea and vomiting. There are specific symptoms that you should seek medical attention for, such as pale or light-colored stools, dark tea-colored urine, severe nausea, vomiting, bloated stomach, and/or yellowing of the eyes or skin.

NJF: How is the virus transmitted and is it very common?

Dr. Brauner: The most common way to contract hepatitis B is by contact with the blood of a person who has been infected with the virus. Hepatitis B is about 100 times more infectious than HIV, so even the smallest amount of blood encountered through things like sharing a washcloth, a toothbrush or a razor can transmit the infection. The virus is also present in saliva and other bodily fluids, including breast milk, and can be transmitted through sexual contact.

Each year in the United States, there are about 22,000 new cases of hepatitis B infection reported, and about 2.4 million people are chronically infected – with a worldwide rate of about 2 billion people. Too many of those who are infected don’t know they have the virus, so it’s been difficult to control the spread of the infection.

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NJF: Being that transmission is so common, how do you prevent contraction?

Dr. Brauner: The single best way to prevent contracting hepatitis B is by being vaccinated against the virus before you’re exposed to it.

NJF: Are there current treatments for the virus itself before it progresses?

Dr. Brauner: Unfortunately, there is currently no treatment for acute hepatitis B infection. There’s no cure for chronic hepatitis B infection either. There are specific medications approved by the FDA for use in adults as well as in children to try to delay and prevent the progression of the infection to liver failure or liver cancer. These are managed by liver specialists.

NJF: How does the virus develop into cancer?

Dr. Brauner: The hepatitis B virus attacks liver cells and causes damage to them. Over time, this damage can cause a form of liver cancer known as hepatocellular carcinoma. The longer you’re infected with the virus, the higher the risk of the damage occurring. Children who are infected with hepatitis B during infancy or childhood are more likely to develop chronic infections that result in liver damage or cancer than adults who are infected. About 25% of people who are infected with hepatitis B during childhood may die from liver failure or cancer.

You can also have inflammation or what’s known as cirrhosis or damage of the liver that causes the liver to fail. A medical professional would determine if a transplant is possible.

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NJF: What are the screenings for cancer caused by hepatitis B?

Dr. Brauner: There are specific markers that assess your liver function that can be checked through blood tests. If these markers are elevated your provider would conduct additional lab tests to help identify the cause of the liver injury. Further diagnostic studies, if needed, such as imaging tests or biopsy would be determined by a gastroenterologist. It is recommended that all adults be screened for hepatitis B at least once in their lives.

NJF: You said earlier that the way to prevent contracting hepatitis B is by getting vaccinated. How necessary and effective is the vaccine?

Dr. Brauner: The first hepatitis B vaccine was developed in 1981. It was originally only recommended for those at high risk for the infection. After about 10 years, researchers realized the rates of hepatitis B infections were unchanged. Then in 1991, we started vaccinating infants and young children and the rates of infection have been declining ever since.

Before the existence of the vaccine, in the U.S., about 18,000 children were infected by hepatitis B by the time they were 10, which is important because the younger you are when you’re infected, the more likely you’ll develop serious complications and liver injury.

About half of those children were infected during birth from their mother. It’s important to note that the other half did not contract the disease from birth – they caught it from another family member or person they were in contact with because it only takes a small amount of blood or bodily fluid to transmit. With most people not knowing, it’s virtually impossible for you to be careful enough to avoid it, which is why the vaccine is so important.

In the United States, the hepatitis B vaccine has about 90% to 95% efficacy for preventing hepatitis B infection and disease among children and adults. Those babies who receive their hepatitis B vaccine series starting at birth have virtually complete protection against the infection with hepatitis B, which is just an amazing success story. We can eradicate this disease worldwide through this vaccine.

The vaccine protects you from getting the virus. If you’re not getting the virus, you won’t have an increased risk of having liver damage or developing liver cancer from the infection.

NJF: How is the vaccine administered?

Dr. Brauner: All children should receive the hepatitis B vaccine, and the best time is to get the dose right after birth as it ensures that you’re protected as early as possible from catching it from people who don’t know they’re infected. It’s offered to every newborn, and every hospital and every primary care office will offer the vaccine. There’s no state mandate so it is parents’ decision, but it’s strongly encouraged by all providers that these babies get vaccinated as early as possible.

It is a three-dose series, and the immune protection of the vaccine is highest following the vaccine schedule recommendations, which is at birth, between the ages of 1-2 months, and at 6 months. Any child (or adult) who has not received the hepatitis B vaccine at the recommended age and interval should get the series as soon as possible. A booster would be given would be for someone in the healthcare field not showing an immune response, because of their ongoing risk for exposure. They will repeat the series once. There are certain immunocompromised people who may qualify for a booster as well. Your healthcare provider can help determine if you qualify.

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NJF: Should parents be concerned at all? Are there any side effects that you’re aware of for the vaccine?

Dr. Brauner: Infants must be vaccinated to ensure they’re protected from unknown exposure and to protect them from complications. The hepatitis B vaccine has been around for a long time. Billions of people worldwide have received this vaccine, so we know it’s safe and we know it’s effective.

The side effects from the hepatitis B vaccine are similar to other vaccines: mild fever or a little soreness at the injection site are the most commonly reported.

NJF: How can we increase trust in vaccinations for communities that are concerned about the safety of these vaccinations?

Dr. Brauner: I find the most successful way to increase trust in vaccines in people who are concerned about their safety is to listen to their concerns and talk about the data and the science to help them understand the risks and dangers of these life-threatening diseases that we can prevent with vaccines. There’s a lot of misinformation available regarding vaccines, which can create a lot of doubt in parents’ minds. I often find that parents are worried they will make the wrong decision, and I encourage them to speak to their child’s pediatrician. Our job is to help you care for your child and to ensure they grow up strong and healthy by making recommendations and helping you make those decisions.

I encourage all parents with questions about any vaccine to talk to their pediatrician and listen to what they say. We’re in the profession of keeping kids safe and healthy and would never recommend anything that would harm a child.

Dr. Brauner
Dr. Rachel Brauner is a pediatrician with Hunterdon Pediatric Associates. Learn more about her here.