Hepatitis B: Transmission Risks and Vaccine Efficacy

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I have been infected with hepatitis B for over 2 years.
My surface antigen is still positive, and last week my E antigen test was negative.
Does this mean I am completely non-infectious to others? If I receive the hepatitis B vaccine now, can it produce hepatitis B surface antibodies? If I develop hepatitis B surface antibodies, does that mean I am completely cured?

you xie yi huo, 20~29 year old female. Ask Date: 2004/04/28

Dr. Li Xuanshu reply Gastroenterology and Hepatology

Hello! Your test results show that the e antigen is negative, which indicates that the viral activity is low and the infectiousness is relatively low, making it less likely to transmit to others.
You are already a hepatitis B patient, and receiving the vaccine will be ineffective as it will not produce surface antibodies.
In Taiwan, once you are a carrier, the likelihood of being a lifelong carrier is quite high.

Dear friend, thank you for your inquiry.
Here are the answers to your questions:
1.
A positive hepatitis B surface antigen for more than six months indicates that you are a chronic carrier, which applies to your situation.
If a chronic carrier maintains normal liver enzyme levels (GOT, GPT, etc.), they are referred to as a healthy carrier, meaning there is no liver inflammation, thus reducing the risk of complications such as cirrhosis.
If liver enzyme levels are elevated, it generally indicates chronic hepatitis B, unless the elevation is due to other causes such as fatty liver or drug-induced hepatitis.
2.
A negative e antigen typically means that the amount of hepatitis B virus in the blood is reduced; however, it does not guarantee that you cannot transmit the virus to others.
Some patients may experience natural mutations of the hepatitis B virus that do not produce e antigen, meaning that even with a negative e antigen, there could still be a significant viral load in the blood, thus maintaining infectiousness.
3.
If you are already a chronic hepatitis B carrier, receiving the hepatitis B vaccine will not be effective, and you will not produce hepatitis B surface antibodies.
It is recommended that you follow the guidance of a hepatologist based on your liver enzyme levels and undergo regular blood tests to monitor liver enzymes and alpha-fetoprotein, as well as periodic abdominal ultrasound examinations.
If liver inflammation is severe, with GPT levels exceeding five times the normal upper limit and elevated hepatitis B virus (HBV DNA) levels, it is advisable to consult a hepatologist to evaluate the need for antiviral treatment.
Currently, there are two types of medications: interferon (which requires injections and has significant side effects) and entecavir (which is convenient for oral use but has issues with drug resistance).
Recently, a new oral antiviral medication, Adefovir, has been released, which may significantly help with the drug resistance issues associated with entecavir.
The purpose of sharing all this information is to encourage you not to lose hope.
New medications are continually being developed, and as long as you regularly follow up with a hepatologist for monitoring and advice, it will certainly benefit your health.
Wishing you all the best,
Dr.
Li Hsuan-Shu
Department of Internal Medicine, National Taiwan University Hospital

Reply Date: 2004/04/28

More Info

Hepatitis B is a viral infection that affects the liver and can lead to chronic disease and increases the risk of liver cirrhosis and liver cancer. Understanding the implications of being infected with Hepatitis B, especially regarding transmission risks and vaccine efficacy, is crucial for both the infected individual and their close contacts.

From your description, you have been infected with Hepatitis B for over two years, and your surface antigen (HBsAg) remains positive, while your E antigen (HBeAg) is negative. This indicates that you are likely in a chronic phase of the infection, but the negative E antigen suggests that you may have a lower level of viral replication, which can reduce the risk of transmission to others. However, it is important to note that being HBsAg positive means that you are still infectious, and there is a possibility of transmitting the virus through blood and bodily fluids, even if the risk is lower with a negative E antigen.

Regarding vaccination, it is important to clarify that the Hepatitis B vaccine is designed to prevent infection in individuals who have not been exposed to the virus. If you are already infected, receiving the vaccine will not be effective in generating an immune response or producing antibodies (Anti-HBs). The vaccine works by introducing a harmless piece of the virus (the surface antigen) to stimulate the immune system to produce antibodies against Hepatitis B. Since you are already infected, your immune system is not going to respond to the vaccine in the same way it would in an uninfected person.

The presence of Anti-HBs antibodies would indicate that you have cleared the virus or have been successfully vaccinated against it. However, in your case, since you are HBsAg positive, it is unlikely that you will develop Anti-HBs antibodies from vaccination. Instead, your focus should be on monitoring your liver health through regular check-ups with a healthcare provider, who may recommend liver function tests and imaging studies to assess the state of your liver.

In terms of treatment, if you are experiencing any symptoms or if your liver function tests indicate liver damage, your healthcare provider may discuss antiviral treatments that can help manage the infection and reduce the risk of liver complications. Current antiviral therapies include medications like tenofovir and entecavir, which can effectively suppress the virus and help protect your liver.

In summary, while your negative E antigen may suggest a lower risk of transmission, you are still infectious due to your positive HBsAg status. Vaccination against Hepatitis B will not be beneficial for you at this stage. Instead, focus on regular monitoring and potential treatment options with your healthcare provider to manage your condition effectively. It is also essential to educate your close contacts about the risks of transmission and the importance of vaccination for those who are not infected.

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