Hepatitis B is an infection of the liver, caused by a virus (Hepatitis B virus or HBV).

What type of illness does HBV cause? HBV may cause a variety of problems. Some HBV infected persons appear to remain healthy for many years and are called HBV carriers. However, many infected persons develop symptoms ranging from loss of appetite, nausea, tiredness, skin rashes, jaundice, arthritis and sometimes, severe potentially fatal liver failure. Those with chronic or long-term HBV infection are at high risk of developing cirrhosis and liver cancer in later life. Due to the large numbers of people affected with chronic liver disease including liver cancer as a result of Hepatitis B, it is a disease causing great concern to the world's health authorities. The financial burden of caring for those affected and the cost in human suffering due to Hepatitis B is considered to be quite high.

Which countries are affected by HBV? Hepatitis B affects people all over the world. However, in some areas of the world, a very high percentage of the population is infected by HBV.

Examples include South East Asia, Africa and China, where 70-90 percent of the population has been infected with HBV, and from these, 8-15 percent go onto develop long-term complications. In many western countries such as the United States and Canada 5-8 percent of the population has been infected and of these, less than one percent develop long-term complications of HBV.

You may note that statistically speaking, there is a great difference in the numbers affected by HBV, depending on the country you live in. However, more people from many different parts of the world are brought together in present times, than ever before, due to migration, vacations, college education, student exchange programmes, business and sports programmes, to name a few.

Hepatitis B has now become a truly world wide problem.

How does a person catch Hepatitis B and who is at risk? HBV is transmitted from an infected person to another via blood and body fluids. An infected mother may transmit the virus to her infant around the time of birth, or during early childhood. Those sharing or reusing unsterilised needles or syringes, such as IV drug users, are at high risk of HBV infection. This virus can survive in the dried state, outside the human body for one week or longer. Strict screening procedures for potential blood donors have ensured that those receiving blood or blood products are not exposed to HBV via transfusions. Health care workers, household contacts of a HBV infected person, and those who practice unprotected sex with an infected person or have multiple sexual partners are all at risk of contacting Hepatitis B.

Is there a test to diagnose HBV? There are many tests available to diagnose HBV. Your doctor is the best person to advise you regarding the need for testing, and the type of test required.

Is there a vaccine against Hepatitis B? Yes, there is a safe and effective Hepatitis B vaccine.

Who should receive the Hepatitis B vaccine? In a bid to reduce the world-wide problems caused by HBV, including the cost of caring for persons with chronic liver disease and liver cancer, the World Health Organization is recommending the immunisation of all infants where more than two percent of the population is chronically infected with HBV, e.g., countries in South East Asia, Africa and China. Many western countries such as the United States, where less than one percent of the population is chronically infected with HBV, have also adopted a policy of immunising all infants, in a bid to wipe out Hepatitis B. The Bermuda Government, Department of Health is to soon launch a programme to immunise all newborn infants with Hepatitis B (prior to leaving the hospital), followed by two further shots given at age one month and 6 months.

Any other persons who are considered to be at risk of HBV infection will be immunised, upon recommendation by their physician.

Lalitha Anandagoda, MD Medical Officer Department of Health HEALTH AND SOCIAL ISSUES HTH