I'm not a physician, and my daughter does NOT have Hep. B, but here is my understanding of the situation.
When people are infected with Hep. B, some will experience a complete recovery and NOT become chronic carriers. However, many will become chronic carriers. You can tell by good lab testing whether a person has become a chronic carrier.
Also, if a baby has a mother who is a chronic carrier, he/she may test positive for Hep. B, even if he/she is actually negative, up to around age two, because of maternal antibodies. If a country, like China, refers a child under two in the special needs program, because of Hep. B, there is at least some chance that further testing, once the child is home, will show that he/she is actually negative.
All chronic carriers can infect any person who has not received effective immunization against Hep. B. Hep. B, however, is transmitted only in blood and other bodily fluids. It is not transmitted by casual contact or through the air. And some bodily fluids are more likely to transmit the disease than others. As an example, contact with saliva carries less risk than contact with blood.
The good news is that most American children are immunized against Hep. B. In fact, some states require immunization for admission to schools, day care centers, etc., unless a family has a religious objection to vaccination. Some day care centers require immunization against Hep. B for their staff, and most health care personnel are also required to be immunized.
As a result, the likelihood that a child who is a carrier will infect someone his/her age is low. However, it is important for a parent to educate family and caregivers about the importance of using "universal precautions" to avoid contact with blood and bodily fluids, and of being immunized.
Children who are carriers also need to be educated as they get older and do more things on their own. As an example, an older child should be taught what to do (or tell a friend's parent to do) if he/she gets a bad cut while playing at a friend's house, and blood gets on the floor. (This includes keeping friends away from the blood, using a dilute bleach solution to clean the floor, etc.)
Before a carrier becomes sexually active, he/she should be taught about the importance of "safe sex", since Hep. B can be transmitted sexually. A female carrier needs to be told that it might be advisable to avoid pregnancy, lest she infect her baby during the birth process, and to consider forming her family by adoption.
Some chronic carriers will not show any symptoms of Hepatitis B, despite being infectious. Their life span may be normal, and there may be no liver damage. They will simply have to be monitored to ensure that no liver problems occur over time. A doctor may advise them not to do things that stress the liver, such as drinking alcohol or taking certain medications, such as acetaminophen.
Some chronic carriers may have liver problems that will arise only when they are in middle age or old age. Hep. B can predispose a person to the risk of liver cancer or cirrhosis of the liver. Again, any Hep. B carrier should be monitored regularly to ensure that no liver involvement is occurring. Many doctors believe that, by the time a baby who is born today reaches middle age, a full cure for Hep. B will be found and complications will not occur.
Some people with Hep. B WILL have liver damage that starts early in life. There is no actual "cure" for Hep. B. However, some of the treatments that exist currently can reduce viral "load" to low levels and minimize the possibility of severe damage to the liver.
Testing of newer, and possibly more effective, treatments is under way. Working with a competent specialist in infectious diseases will be important.
A family adopting a Hep. B positive child will need to have access to excellent medical care resources in his/her community, in case ongoing care is needed.
A family adopting a Hep. B positive child should also have group health insurance, subject to HIPAA protections, that will cover a child with special needs. Any insurance policy that is obtained should allow for the coverage of treatment with the sort of antiviral drugs, such as interferon, that may be necessary in some cases.
A family adopting a Hep. B positive child should be aware that delicate questions about whom to inform will arise. The family will have to strike a balance between protecting others from getting Hep. B and protecting the child's right not to be stigmatized because of his/her condition.
There are several Internet sites where one can learn a great deal about Hep. B. Here are just a few:
1. The Centers for Disease Control (
Centers for Disease Control and Prevention)
2. The Hepatitis B Foundation (
Hepatitis B Foundation)
3. The Hepatitis Foundation International (
Hepatitis Foundation International - Hepatitis Living and Learning Resources, Support and Answers)
Sharon
Sharon