Asking for directions and safety measures

Just diagnosed or new to the community
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22

Dear @MDX,

This appears to have the same active compound at the same concentration as Vemlidy, so it would be suitable.

Thomas

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23

Hi @stevenS,

It might be worth bringing up this aspect with your doctor and indeed the WHO guidelines do include a section where there should be considerations for treatment if there are worries about transmission:

There may also be individual circumstances in which, although individuals may not meet any of the four options for treatment eligibility, there are specific individual concerns regarding infectivity, transmission, associated stigma, the risk of oncogenicity and progressive liver fibrosis and a strong individual motivation to consider treatment, despite the lack of direct evidence. In such cases, a patient-centred approach with discussion between individuals and their health-care provider will be key in helping them make informed decisions about whether to begin treatment or not. This should consider the uncertainties resulting from lack of direct evidence for treatment benefit and low risk of transmission for those with HBV DNA <2000 IU/mL, overall lower benefit-to-risk ratio, the financial implications associated with long-term treatment and importance of sustained treatment adherence.

Thomas

24

Hello

@Bansah1 I will do my best, but it will take 3 weeks minimum. Can you tell me some methods to cope during this time? For example, today, I incidentally got an object in my eye, and while attempting to remove it, I did not sanitize my hands (it was stinging, and had to remove it fast), and my movements caused minor internal bleeding of the eye. The eye is still red, and I avoid contact(at least for the day) with my caretaker now.Similar situations are likely to occur in the following weeks.

@ThomasTu, are WHO saying that any carrier below the viral load of 2000 UI/ML (blood) is considered safe for interaction other than birth, blood mixing, or intercourse, or did I misunderstand?
Also, given that for 20+ years now, transmission did not occur.

Thanks again for your patience and help

25

Thank you for your prompt response. I really appreciate it.

26

Hi @StevenS,
Sorry for responding late to your message. There are no bullet answers or solutions aside from vaccination and being boosted which you plan on doing. But there are some things that you can try for sure, please encourage your caregiver to use gloves in certain situations, for example bathing, washing your feet, etc. if that makes you feel more comfortable and less stressful. No gloves needed to help you feed, dress, get around, etc. The other thing probably is to give yourself enough time to complete tasks so you donā€™t have to rush leading to accidents or your hurting yourself. I know time is money, but give yourself the extra time needed so you donā€™t feel rushed. I feel a bit clumsy whenever I am in a rush which is never good, because I make mistakes and forget about things. To avoid that, I try to give myself enough time to avoid going through that. And as always, be gentle around stuff/objects and careful so you donā€™t hurt yourself. We do not want that happening to you. I hope this can help, as you wait to get your shots. Best, Bansah1

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Hi @StevenS, for most interactions, such a low viral load is not considered as a high risk of transmission.

Thomas

28

Hello again

As I suspected new situation occured while waiting the vaccine. I accidentally happened to rub the upper part of my foot to my caretakerā€™s calf(bare foot both). The contact was between 3 to 5 seconds and it felt bruised it still itching . I saw no visible blood on the place of friction just some reddish irritation.

I wanted to ask how deep possible crack would have to be,so to be considered dangerous. Is lymph considered high risk (if present)?

Thanks again for the patience and the answers
Regards

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@StevenS

Hi Steven, if there is no blood, there is no chance of getting infected.
Blessings

30

Hello @Caraline

Thank you for the answer. I am anxious because at first my caretaker was quite reluctant about taking me for vaccine.

The doctor told as the viral load was 48 UI/ml that vaccination is not needed for now.

I am with physical disability, we do not own a car and that makes the situation worse, as we have to travel to a larger town to get to the doctor + I have to purchase the vaccine and wait additional 1-2 weeks for it.

So that is why I am little worried over not so dangerous situation

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31

Hi @StevenS,

Itā€™s right that the transmission likelihood is low in this instance given your low viral load. Just to clarify, vaccination will not help you, but it is for others to protect themselves.

Given this, I would take the view that you have done all you can do in these instance to prevent any transmission (you have told everyone surrounding you and provided ample opportunities for them to protect themselves). It is now up to others to also take the responsibility for their own health.

Hope this helps,
Thomas

1 Like
32

Hi there,

You probably misunderstood @ThomasTu . I spoke about my caretaker. He does not have a physical disability - I have.

My point was that, as the doctor says, vaccination is not needed due to his low viral load. My caretaker was reluctant to vaccinate me, and in addition there is transportation and vaccine supplement issues.

So, in other words, I have to wait probably a few more weeks for the vaccine, and during that time, some household minor injuries happen, cuts, nicks, and bruises from my side and the others side

The point is, while I am waiting, may I be calm that minor injuries (from both sides) are considered harmless.

Thanks again

33

Ah, I understand a bit clearer now. If your caretaker had no broken skin in any instance, then there is no risk of transmission from such casual contacts. To address your point, such minor injuries are a negligible risk for transmission with such a low viral load.

Hope this helps,
Thomas

1 Like
34

Hello again,

Today came the results of my caretaker:

The Hep B viral load came from 48 UI/ml to 703 UI/ml
The Hep D viral load came from 3100 UI/ml to undetectable

My questions @ThomasTu are (if possible and if there is time @john.tavis can also comment)

  1. Does the transmission risk change significantly, compared to the previous situation?

  2. Are these 20x times fluctuations in the viral load normal?

  3. Can Hep D reappear?

  4. I have heard that if values of the HbSag are between 100 and 200 UI/ml, there is a chance for the virus to be put in remission - is this true

Thanks

35

Hi @StevenS,

Iā€™ll do my best to answer these questions:

No, this is still a very low level of virus, and the risk of transmission through the contacts involved in caretaking is still negligible.

Yes, they have been reported to happen in this phase of infection

Yes, HDV can reappear. Subsequent blood tests are needed to ensure that they have cleared the HDV infection.

Only in particular circumstances (e.g., in people treated with interferon or investigational therapies).

Hope this helps,
Thomas

36

Hello again

I have few more questions

When I searched for available vaccines for Hep B in my region, it turned out that only Enge.rix b is available with pre-purchase and 1 week waiting period.

When I asked my GP if this vaccine is safe for my condition(cerebral palsy), she could not give me an answer, So I would like to ask if the vaccine is suitable for my condition and if it is notā€¦ which is it?

And also how much time after the booster I have to go for antibodies check?

Thanks in advance

37

Hi @StevenS,

According to this WHO document, cerebral palsy is NOT a contraindication for Hep B vaccination: https://iris.who.int/bitstream/handle/10665/66957/WHO_V-B_01.31_eng.pdf?sequence=1 (pg 12 of the document, pg 19 of the pdf). That is, cerebral palsy should not be a factor in determining if you should take the vaccine or not.

Regarding the antibody check, this is generally done 1-2 months after your booster: I received my vaccine years ago--am I still protected? Ā» Hepatitis B Foundation.

Hope this helps,
Thomas

1 Like
38

Hello

Thanks again @ThomasTu. The booster was applied 3 days ago.

May I ask if I am safe(assuming an optimistic outcome that I am a responder) if an exposure happens before one month passes?

I asked my doctor for HBIg, but she said she had never heard of such a thing, which makes me think that the immunoglobulin prevention method is not available in our town.

She just told me if I do not respond to the booster to repeat the series on 1 month and 6 month after the initial dose?

And if it turns out that I am a non-responder if this means I have to go to a bigger city for HBIg on every 6 months?

Thanks in advance

2 Likes
39

Hi @StevenS,
If you responded well with the earlier shots, I doubt anything will change here. You should respond well again then. That is my perspective on your question and @ThomasTu will respond. Best, Bansah1

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40

Hi @StevenS,

Iā€™m not sure if there is good data on this specific case. I think the closest scenario would be birth dose vaccination. Newborns who are vaccinated upon birth are generally protected against any exposures (including those at birth). Given that newborns are extremely susceptible to chronic HBV infection, this would suggest that there would be little worry in your case.

Hope this helps,
Thomas

1 Like
41

Oh, and if you do not respond to the initial course, then the general prescribed course of action is additional boosters until you do respond. HBIg is generally not given in these circumstances.

Thomas

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