Hepatitis B: Questions Commonly Asked by Patients in Doctor’s Offices

The following questions and answers were prepared by a Gastroenterologist, Family Physician, Pharmacist, Hepatitis Nurse, and Public Health Nurse in preparation for a symposium on hepatitis B for the community in Toronto, Canada in June 1996. They reflect the most common questions asked by their patients.

Contents

Questions Commonly Asked by Patients in Doctor’s Offices by: Dr. David Lam, Family Physician

Q. What is hepatitis B?

A. Hepatitis B is a viral infection. It is a common infectious disease in China, Taiwan, Hong Kong and other South-east Asian countries. Most people recover completely from acute hepatitis B infection but some patients with impaired immune systems will become chronic carriers.

Q. How do I get hepatitis B?

A. The main routes of transmission are:
a: mother to child during delivery
b: sexual contact
c: contact with blood or blood products

Q. Do I need vaccination?

A. If you are not immune to hepatitis B i.e. no hepatitis B surface antibody, you should receive 3 doses of hepatitis B vaccine. You should consult your family doctor for vaccination.

Q. What are the long term sequaelae of a hepatitis B carrier?

A. A small proportion of hepatitis B carriers will develop chronic hepatitis. Some of these patients will progress into cirrhosis (liver failure) or even liver cancer.

Q. Does hepatitis B mean a death sentence?

A. No, only a small proportion of hepatitis B carriers will progress to end stage liver failure or cancer. A majority of patients still remain asymptomatic and healthy. However, carriers should still follow-up with their doctor’s office on a regular basis.

Q. Is there any treatment for hepatitis B?

A. Yes, interferon (anti-viral agent) is being used to treat hepatitis B. There are certain criteria for treatment and not everyone will benefit from interferon.


Questions Commonly Asked by Patients in Gastroenterologists’ Offices by: Dr. Florence Wong, Gastroenterologist, The Toronto Hospital

Q. What symptoms do I have if I am suffering from hepatitis B infection?

A. Many patients with hepatitis B do not have any symptoms and feel perfectly well. Occasionally, the hepatitis B infection may become active and make the patient feel ill with nausea, have a loss of appetite and become jaundiced.

Q. What do I need to do if I have been diagnosed to have hepatitis B?

A. Do not panic if you have been diagnosed to have hepatitis B. You should see your family doctor, and depending on the stage of your liver disease, he/she will decide whether you will be followed regularly or if you need to be referred to a liver specialist.

Q. What can a liver specialist do for me if I need to one?

A. The liver specialist will need to perform several more detailed investigations to determine whether the hepatitis B infection has affected your liver. If so, you may need to receive treatment.

Q. What complications can I expect from the hepatitis B infection?

A. A proportion of patients with hepatitis B can develop hardening of the liver called cirrhosis. A small percentage of patients with cirrhosis have an increased risk of developing liver cancer. However, a large number of patients can just carry the hepatitis B virus for life and do not develop liver disease. There is no way that the doctor can predict who will develop liver cirrhosis or who will develop liver cancer, therefore it is very important that you are followed up by your doctor regularly.

Q. What kind of outlook can I expect if I have a hepatitis B infection?

A. Many patients with a hepatitis B infection can expect to lead a full and normal life. It is most important to regard yourself as a normal individual who happens to be infected with hepatitis B. However, it is important to take precautions not to spread the disease and get medical check-ups regularly.

Questions Commonly Asked by Patients to Nurses by Colina Yim, Senior Hepatitis Nurse, The Toronto Hospital

Q. Am I going to get sick with interferon treatment?

A. Interferon is known to cause some side effects such as headaches, fever, chills, muscle aches, joint aches etc. which are manageable with rest and Tylenol. Side effects are most severe during the first two weeks of treatment only and will usually taper off as treatment continues. There may be some other uncommon side effects such as hair thinning, decreased concentration, mood swings, but they are all transient and reversible.

Q. Should I take sick leave in anticipation of the unpleasant side effects I might get during interferon treatment?

A. No, all patients receiving interferon are encouraged to continue with their regular work, exercise programs and daily living activities. The best way to cope is to have a positive attitude towards treatment. Talk to your doctor and nurse when you have problems coping. In fact, over 90% of treatment patients are able to continue work full time with no sick days taken.

Q. How is interferon given?

A. Interferon is given with a syringe and a small needle into the fat directly under the skin. You will be taught how to do the injection yourself even though it might sound a bit scary at first. The self-injection is similar to the way insulin is given by diabetics. If you are absolutely terrified with needles, you may want to get family members or friends or even your family doctor involved.

Q. Who should I tell about my hepatitis B?

A. You have an obligation to tell your doctors and dentists about your hepatitis B but not your employer. Tell your friends only if you know that they understand about hepatitis B and will give you support.

Q. As a hepatitis B carrier, do I need to practice safe sex at all times?

A. If you have a steady partner and in a monogamous relationship, your partner should be checked for hepatitis B and vaccinated if there is no prior exposure to hepatitis B. If you have multiple sexual partners, use of condoms is a must to prevent transmission.


Questions Commonly Asked by Patients in the Pharmacy by: Debbie Kwan and Tracy Lam, Pharmacists

Q. Can I get hepatitis from the vaccine?

A. No. The hepatitis vaccine is a safe and highly purified vaccine. It does not contain any blood products or living or dead viruses.

Q. If I am allergic to eggs, can I receive the hepatitis B vaccine?

A. Yes. The vaccine is made with yeast, not egg products.

Q. What should be done if the second vaccine dose or the third vaccine dose is delayed?

A. If the doses are delayed for less than 1 year, the remaining doses can be resumed to complete the vaccination without the need to restart the vaccination series. For infants born to hepatitis B carrier mothers, immunocompromised and haemodialysis individuals, the antibody titre must be checked 1-3 months after the last vaccine dose to ensure sufficient protection. If the lapsed doses are more than 1 year, extra vaccine doses or restarting of the series may be required for high risk individuals.

Q. What should a pregnant or lactating individual do after accidental blood or bodily fluid contamination?

A. Significant contamination is defined as the direct contact of blood or body fluids with the open skin or mucous membranes (ie. eyes, nose, mouth, anus, or vagina). The contaminated individual should seek immediate medical attention (best within 24 hours or no later than 7 days post exposure). Information regarding the source of the blood or body fluids, the time of exposure, and history of hepatitis B vaccination must be provided to the health care workers. This information will assist them in assessing the likelihood of hepatitis contamination and in prescribing the appropriate treatment. Since hepatitis B immune globulin and vaccines are not contraindicated in pregnant and lactating individuals, both treatments may be given. In addition, the infants are highly recommended to receive hepatitis B vaccination if it has not been given already.

Q. Is hepatitis B vaccination required when travelling to China or Hong Kong?

A. The risk of hepatitis B depends on the extent of direct contact with blood, secretion, or intimate sexual contact with infected persons and duration of travel. China and Hong Kong have high incidence of hepatitis B. It is highly recommended for vaccination before travelling, especially if the travellers will be living in rural areas. In addition, hepatitis A vaccination is also recommended because hepatitis A is transmitted via contaminated food.


Questions Commonly Asked by Patients in Public Health Offices by: Anna Leung, Nurse, York Region Public Health

Q. What does the Public Health Department do in terms of preventing hepatitis B?

A. Provision of hepatitis B information hot line (1-800-461-2315) by knowledgeable staff.

Provision of education and awareness workshops for the general public, school communities, institutions, etc.

Hepatitis B case and contacts follow-up. Working in collaboration with physicians and other health units, laboratories, data collecting and epidemiology.

Provision for free vaccine for high risk groups.

School based immunization program for grade 7 students.

Immunization program for Birth Control and Sexually Transmitted Diseases Prevention clinic clients.

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