DRHOOK- Hepatitus B: Babies, children, adults all vulnerable

the handsome doctor John Hong

Chopped liver? 

 When we feel undervalued, we sometimes ask, "What am I– chopped liver?" I don't think the liver should be referenced as something undervalued, as it's a vital organ that filters the junk in our blood. (Too bad it doesn't filter the emotional vomit on today's blogs and in those with road rage.) 

The liver does many other things, from working with cholesterol to helping digestion. But what happens if the liver becomes infected?

Hepatitis B virus infects more than 350 million people in the world, mostly in Southeast Asia, China, and sub-Saharan Africa. The most common method of infection is an infected mother passing it to her baby during pregnancy or childbirth.

Adults catch hepatitis B most often by having sex with an infected person or using IV drugs.  

Blood carries the hepatitis B virus (something the book series Twilight should consider), so having a blood transfusion is always a risk, though blood for transfusions is always tested before it's administered.

Sharing things that could have traces of blood, like razors and toothbrushes, can also transfer the virus.

Seventy percent of people acutely infected with hepatitis B virus don't become jaundiced (yellow eyes, skin, and frenulum– that piece of skin under the tongue you're afraid will rip) or have dark, cola-colored urine. Infected babies normally aren't sick at birth. 

The symptoms–- often flu-like– usually occur one to four months after infection. Then, the upper right part of the abdomen starts to hurt (where Mr. Liver lives), accompanied by nausea and loss of appetite. The jaundice usually goes away after one to three months; it's a bad sign if it lasts longer than that. 

Blood tests show high liver enzymes (AST and ALT), and total bilirubin is high in people with jaundice. Fortunately, liver failure is pretty rare from acute hepatitis B, so anti-virals are usually not needed for treatment.

Five percent of infected adults will not eliminate the virus and will have chronic hepatitis B. It's worse, though, for younger victims: 20 to 50 percent of children between ages one and five, and 90 percent of infected babies will have the disease for life. So you can see it's hard to eliminate hepatitis B in areas with high prevalence of chronic hepatitis B, because many babies are born with it and carry it for life. 

And because the majority of folks infected never had acute symptoms, about 50 percent of people with chronic hepatitis B never knew they had the virus! (Isn't life a stinker?) What stinks even more is a small percentage of people who eliminate the hepatitis B after acute infection can have a reactivation of the virus later in life.

People with chronic hepatitis B have an increased risk of cirrhosis and liver cancer. In China, about 50 percent of men and 15 percent of women with the chronic disease will die as a result of it.

Drinking alcohol or long-term use of medicines that stress the liver, like acetaminophen, both increase the risk of liver problems down the road. Having other forms of viral hepatitis– in particular hepatitis C and D– can beat up the liver even more. 

There's so much more to discuss about hepatitis B, but it's necessary to talk to a hepatologist on that. So for now, as far as Ms. Hepatitis B goes, I think it's just better to liver alone.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.