Symptoms
Symptoms of all forms of hepatitis may include fever, fatigue, loss of appetite, nausea and/or vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice
(yellowing of the skin and eyes). Diarrhea may also occur with Hepatitis A. Importantly, many people with hepatitis do not have symptoms and do not know they are infected. If there are symptoms, they may develop suddenly after infection (acute) or many years later.
- Acute infection: symptoms start between 2 weeks to 6 months
- Chronic infection: symptoms may not appear for years (e.g. up to 30 years)
Military Impact
Diagnoses of Hepatitis A, B, and C (determined by a health care provider based on symptoms, medical history, examination, blood tests, and possibly additional imaging tests and/or a liver biopsy) are monitored in the military's medical system as a reportable medical event (RME). While hepatitis is not common in the military due to military medical screening and vaccination requirements, some members of the military family occasionally develop one of these forms of viral hepatitis.
- Evidence suggests that military veterans, especially if they served during the Vietnam era, may have a higher risk of developing a Hepatitis C infection. This may be because those veterans had more traditional risk factors for the condition, such as using injected drugs, or along with having had transfusions or tattoos at that time when safety protocols were less established.
- In contrast with older veterans, people on active duty in the military today have a lower risk of hepatitis. Risk reduction is due to vaccinations, safety protocols for blood use and tattoo facilities, and less frequent injection drug use due to mandatory testing for harmful drugs in the service.
- Hepatitis B can be transmitted to infants during childbirth, even if mothers have no symptoms.
- Risks can vary depending on the different types of hepatitis. For example:
- Risk is higher with most of the viral types if you have unprotected sex.
- People who drink heavily over long periods are at risk for alcoholic hepatitis.
Prevention
The best way to prevent Hepatitis A and B is by getting vaccinated. Risk of infections with these forms of hepatitis as well as Hepatitis C can be reduced by practicing safe (protected) sex, as well as through good hygiene (washing hands after using the bathroom, changing diapers, and before preparing or eating food) and:
- Do not share needles or equipment to inject cosmetic substances, drugs, or steroids.
- Do not use personal items that may have contacted an infected person's blood (such as razors, nail clippers, toothbrushes, or glucose monitors).
- Do not get tattoos or body piercings from an unlicensed facility.
More About Hepatitis B
“Hep B" ranges in severity from a mild illness lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead to liver disease or liver cancer.
Persons diagnosed with Hepatitis B can remain on active duty but are not deployable into combat theaters. AR 40-501 requires a Medical Evaluation Board (MEB) for persons with chronic Hepatitis B when symptoms persist and there is evidence of impaired liver function.
After exposure, it takes approximately 1 to 9 weeks before the blood test is positive for Hepatitis B. Over time, about 15-25% of people with chronic Hepatitis B develop serious liver problems, including liver damage, cirrhosis, liver failure, and liver cancer. Every year, thousands of people in the U.S. and more worldwide die from Hepatitis B-related liver disease.
Cause/Exposure
Hep B is transmitted through contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn. The Hepatitis B virus is 50-100 times more infectious than HIV virus and is easily passed through breaks in the skin or in soft tissue such as the eyes, nose, and mouth. The virus can live on objects for up to 7 days so individuals can also become infected from contact with contaminated objects.
- Spread to a baby during childbirth can happen during a vaginal delivery or a Cesarean section. When babies become infected with Hepatitis B, they have a 90% chance of developing a lifelong, chronic infection that may result in liver damage, disease, or cancer over time. Because pregnant women may not have symptoms, they are routinely tested for Hepatitis B, along with other diseases. All babies receive the Hepatitis B vaccine, regardless of the mother's Hepatitis B status. A baby will get 3 or 4 shots, depending on which brand of vaccine is used. All of the Hepatitis B shots are necessary to help keep your baby from getting the virus. Blood tests after the vaccines will determine if a baby is protected and does not have Hepatitis B. Hepatitis B Immune Globulin (HBIG) is a medicine that gives the baby's body a "boost" or extra help to fight the virus as soon as the baby is born. The HBIG shot is only given to babies of mothers who have Hepatitis B.
- Hepatitis B is NOT spread through breastfeeding, sharing eating utensils, hugging, kissing, holding hands, coughing, or sneezing. Unlike some forms for hepatitis, Hepatitis B is NOT spread through contaminated food or water.
- There is little evidence that Hepatitis B is spread by getting tattoos in licensed, commercial facilities. Whenever tattoos or body piercings are given in an informal setting or with non-sterile instruments, transmission of Hepatitis B and other infectious diseases are possible.
Symptoms
- ACUTE: Not everyone has symptoms with acute Hepatitis B, especially young children. Even people without symptoms can still spread the virus to others and the virus can be detected in their blood. For those with symptoms, they will typically appear within 3 months of exposure and can last from a few weeks to several months.
- CHRONIC: Many people with chronic Hepatitis B do not have symptoms and do not know they are infected. Even people without symptoms can spread the virus to others and the virus can still be detected in their blood. Symptoms of chronic Hepatitis B can take up to 30 years to develop. Damage to the liver can silently occur during this time. When symptoms do appear, they are similar to those of acute Hepatitis B infection and can be a sign of advanced liver disease.
Diagnosis
Hepatitis B is diagnosed with specific blood tests that are not part of blood work typically done during regular physical exams. Typically, a person first gets a screening test that looks for "antibodies" to the Hepatitis B virus (proteins released by the body, into the bloodstream, when a person becomes infected). The antibodies remain in the bloodstream, even if the person clears the virus. If the screening test is positive for Hepatitis B antibodies, different blood tests are needed to determine whether the infection has been cleared or has become a chronic infection. There are many different blood tests available to diagnose Hepatitis B. They can be ordered as an individual test or as a series of tests. Ask your health professional to explain what they hope to learn from the tests and when you will get the results.
Vaccination
The best way to prevent Hepatitis B is by getting vaccinated. For adults, the Hepatitis B vaccine is given as a series of 3 shots over a period of 6 months. The entire series is needed for long term protection. Booster doses are not currently recommended. Vaccination is recommended for certain groups, including:
- All infants at birth
- Healthcare and public safety workers at risk for occupational exposure to blood or bodily fluids
- Military personnel
- Anyone having sex with an infected partner
- People with multiple sex partners
- Anyone with a sexually transmitted infection
- Men who have sexual encounters with other men
- People who inject drugs
- People who live with someone with Hepatitis B
- People with chronic liver disease, end stage renal disease, or HIV infection
- Some travelers, depending on the potential risk in their travel plan
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