Steps to take when exposed to the hepatitis B virus.

VnExpress•12/05/2023

Prompt first aid, blood tests, vaccinations… are necessary steps to protect your health if you suspect you have been exposed to the hepatitis B virus.

According to Doctor Vu Truong Khanh (Head of the Gastroenterology Department, Tam Anh General Hospital , Hanoi ), hepatitis B virus infection progresses silently, with unclear symptoms, leading to a high risk of cross-infection in the community. The hepatitis B virus (HBV) is very long-lasting and persistent, able to survive outside the body for up to 7 days even after blood has dried.

Anyone can be exposed to HBV through contact between damaged skin or mucous membranes (eyes, nose, mouth) and the blood, tissue, or bodily fluids (semen, vaginal secretions) of an infected person via unprotected sexual intercourse, or through the use or injury of unsterilized medical instruments. Sharing razors, toothbrushes, blood glucose testing equipment, or dental treatments, and cosmetic services (nail salons, tattoo parlors, ear piercings, etc.) using unsterilized equipment can also spread the disease.

HBV has an incubation period of about 3-6 months, depending on the individual's health, after which it becomes active and causes acute hepatitis B. If after 6 months the body cannot develop immunity to the virus, the disease will progress to the chronic stage. The disease usually begins with mild fever, loss of appetite, indigestion, bloating, and digestive disorders, lasting from a few weeks to 6 months. After about 7-10 days, jaundice appears, and the fever subsides. However, according to Dr. Khanh, HBV only shows symptoms in about 30-50% of cases. Many people with hepatitis B are asymptomatic but can still transmit the virus to others. When suspected exposure to HBV is present, the doctor suggests quickly taking the following steps:

Provide prompt first aid to the exposed area.

First aid for HBV exposure varies depending on the type of exposure and the means of exposure (mucous membrane, intact skin, or damaged skin).

If the injury is caused by a needle or sharp object, you should immediately wash the affected area with soap under running water; let the blood drain naturally, do not squeeze or press the wound.

If blood or bodily fluids from someone suspected of having HBV come into contact with damaged skin, you should immediately wash the affected area with soap under running water. Absolutely do not scrub, rub, or apply antiseptic to the affected area.

If blood or bodily fluids get into your eyes, do not rub them. Instead, rinse gently but thoroughly under running water or sterile 0.9% saline solution for at least 15 minutes.

If blood or bodily fluids get into your mouth or nose, rinse your mouth thoroughly with water several times; rinse your nose with sterile 0.9% saline solution. Do not brush your teeth or use antiseptic products.

If blood or body fluids splash onto healthy skin, you should wash the affected area with soap under running water, avoiding vigorous scrubbing to prevent further damage.

Blood test

HBV has three antigens: HBsAg, HBeAg, and HBcAg, corresponding to three antibodies: anti-HBs, anti-HBc, and anti-HBe. The presence of these antigens and antibodies is crucial in determining the disease, its type, and its progression. After performing the first aid steps mentioned above, you need a blood test to check for the presence of HBV 1-9 weeks after exposure. Typically, the doctor will look for HBsAg and ALT. You should fast for 4-6 hours before the blood test and have another test after 6 months for evaluation.

Prophylactic treatment with hepatitis B vaccine and immunoglobulin.

Hepatitis B immune globulin (HBIG) is commonly used for prophylactic treatment immediately after exposure to the blood or bodily fluids of someone infected with hepatitis B virus. For example, infants born to HBsAg-positive mothers, healthcare workers exposed to the blood of infected individuals, or after sexual contact with someone infected.

According to Dr. Khanh, a negative HBsAg test result means you are not infected. However, you still need to get the hepatitis B vaccine to prevent infection if the test does not show antibodies (anti-HBs). If you have been vaccinated, you should check your viral antibodies to see if they are still strong enough. If the anti-HBs antibody level is above 10 mIU/mL, it means you have achieved protective immunity and do not need further vaccination or HBIG.

If you are unvaccinated, unsure if you have been vaccinated, or do not have protective immunity, you need to receive a dose of HBIG within the first 24 hours after suspected exposure (200-400 IU), and also get the hepatitis B vaccine at a different injection site. HBIG will no longer be effective in preventing infection if given 14 days after sexual contact with someone infected with hepatitis B virus or 7 days after exposure to HBV through blood or mother-to-child transmission.

You need to receive all three doses of the vaccine within six months of your doctor's scheduled appointment. If you have a history of not responding to the hepatitis B vaccine, you will need an additional dose of HBIG the following month.

Getting vaccinated against hepatitis B helps prevent infection. Photo: VNVC — Getting vaccinated against hepatitis B helps prevent infection. Photo: *VNVC*

Proactive measures to prevent community transmission.

If you suspect you've been exposed to HBV, you should proactively limit direct contact with others, especially if you have open wounds. Both men and women should practice safe sex by using condoms; avoid sharing personal items such as toothbrushes, razors, and nail clippers to prevent transmission. If you are pregnant or planning to become pregnant, you should inform your doctor so that measures can be taken to prevent mother-to-child transmission.

Dr. Khanh stated that pregnant women with hepatitis B virus infection have a high rate of transmitting HBV to their fetuses, which increases progressively from pregnancy to childbirth. The transmission rate rises to 60-70% in the last three months of pregnancy. The risk of newborns contracting the disease is as high as 90% if no protective measures are taken immediately after birth. Approximately 50% of these children may develop chronic hepatitis B, with a risk of cirrhosis in adulthood.

Adhere to the treatment plan.

Adhering to your doctor's treatment plan, including scheduled follow-up appointments, taking medication as prescribed, and maintaining a healthy lifestyle and diet , can control the virus and improve the immune system. Individuals exposed to HBV who do not receive timely and proper treatment may develop acute hepatitis B, and there is a high risk of it becoming chronic if exposure occurs in adulthood, potentially leading to cirrhosis or liver cancer.

Trinh Mai

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