Communication Skills: Explaining Hepatitis B

Possible OSCE scenario: "This patient has recently found out that he has Hepatitis B. Please discuss this with him and answer any questions he may have."

• Wash your hands
• Introduce yourself and ask the patient's name
• Ask permission to discuss his recent diagnosis with him
• Remind him that you will keep the content of their discussion confidential

• Hepatitis B is a viral infection which affects the liver
• In most people (9/10) it is self-limiting, and will have resolved by itself within 6 months of acquiring it
• In 1/10 people, the infection is not cleared by the body and becomes a long term infection. 2/3 of these people remain well without symptoms, 1/3 have symptoms (such as those below)
• In long term carriers of the infection, there is an increased risk of cirrhosis of the liver and of liver cancer

• It can be contracted through a number of different modes, including:
  • unprotected sex with an infected individual
  • use of intravenous drugs
  • transfusions with infected blood products
  • mother-to-baby transmission
  • some people may not know where they have contracted it from

• 1-6 months ago (if the serology results show acute infection)

• A patient may have no symptoms at all, or may suffer from symptoms such as;
  • jaundice
  • right upper quadrant abdominal pain
  • nausea and vomiting
  • malaise
  • fever
  • arthralgia and myalgia

• Conservative management
  • regular follow up with your doctor with blood tests, to check your progress
  • normally this is the only necessary management in the first 6 months of the condition
  • Hepatitis A vaccination may be given to protect you from co-infection
  • avoid drinking alcohol and keep well hydrated
  • avoid certain medications which may affect your liver - see your doctor to confirm which ones
  • avoid transmission of the virus yourself, by:
    • having protected sex
    • not donating of blood
    • not sharing products that may contain traces of blood, e.g.: razors, toothbrushes, needles
    • screening household contacts and sexual partners, and vaccinating them against Hepatitis B
• Medical management
  • Is used if the infection is still present after the first 6 months
  • IFN 2a (weekly injection) and Lamivudine work together to help clear the virus. The side effects of both include:
    • Flu-like symptoms such as fever, chills, headache, muscle ache, and fatigue
    • Nausea and loss of appetite are also common
  • We can discuss this in further detail if the situation arises, although we expect you will get better from this infection within the first 6 months without the need for this treatment

• Ask if there are any further questions
• Thank the patient for talking to you
• Provide with a leaflet and arrange follow up

Pregnancy and Hepatitis B:

• 10-20% women positive for Hepatitis B transmit it to their child in the absence of treatment. If positive for the Hepatitis B 'e' (envelope) antigen, the transmission rate can be up to 90%
• Chronic infection occurs in 90% of infected neonates and 30% of children aged under 5 - much higher than rates for adults (10%)
• The baby of an infected mother should receive the Hepatitis B vaccine after labour, and Immunoglobulin if the mother is Hepatitis B 'e' antigen positive
• Breast feeding does not carry a risk of transmission
• If a seronegative mother comes in contact (e.g.: has sexual intercourse) with a person who has Hepatitis B then give mother a course of the vaccine, and Immunoglobulin (if person has acute Hepatitis B)

A note on Hepatitis C:

• In acute infection, generally people are asymptomatic
• 85% of patients develop a chronic infection. 1/3^rd of these chronic carriers have no symptoms, 2/3^rd have symptoms, and 30% develop cirrhosis over the next 20-30 years
• There is a need to check Liver Function Tests, the ?-fetoprotein level (screening for liver carcinoma), carry out an ultrasound of the liver (for cirrhosis/cancer) and possibly biopsy the liver on diagnosis to discover the extent of damage
• Incubation of the virus is 6-12 weeks
• Treatment is usually with Pegylated IFN 2a or 2b, and Ribavirin - the main side effects of these are nausea, headache and depression

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