@ThomasTu @john.tavis @availlant
As I mentioned, my child’s anti-HBsAg level is 26 mIU/mL. If we give the child a vaccine booster dose, could it cause any harm to their body or health—either now or in the future as they grow up—such as side effects leading to illness or life-threatening complications?
Dear @Rohit ,
The HBV vaccine is quite safe and there would be no cause for concern with another dose. However, the level of anti-HBs in your child is more than sufficient to provide protection against developing HBV infection.
Yep, completely agree with @availlant here!
TT
@ThomasTu @availlant thanks for your suggestion. I appreciate your support guys.
@john.tavis @ThomasTu @availlant @Bansah1
I have a question: As I am a Hepatitis B carrier, and I have relatives visiting my home to whom I haven’t disclosed my status. If, for some reason, I were to get injured and a small amount of blood spilled on the floor-which I could only clean up using water and a cloth in front of the relatives. could this situation lead to the infection spreading to my child or the relatives’ children? (Suppose the children are playing there; after cleaning the blood, I wouldn’t be able to stop the children from playing in that spot while the relatives are present.)
Personally, I feel that since there is no visible blood, the viral load on the floor would be minimal, and it wouldn’t cause an infection in a vaccinated child Who has developed immunity above 10 mIU/ml. Do you all agree with this?
Secondly, since I don’t know whether the relatives’ children are vaccinated or not—let’s assume for a moment that they are unvaccinated—how dangerous would the situation be in that case?
Kindly share your experience and knowledge for all scenarios(for a vaccinated child and for unvaccinated children)
Thanks
Hi @Rohit,
In my opinion, I agree with your assessment. Cleaning the blood off the floor could reduce such risks. Even if there are microscopic viral particles left behind it is of no risk to anyone with strong antibodies or protection against HBV.
Depending on how comfortable you feel maybe you could use the opportunity to have a conversation, recommend, and encourage your relatives to get themselves and their kids vaccinated. Knowing they are vaccinated with a strong protection will definitely provide some peace of mind to you, so you can enjoy having them around more and not fearing or worrying constantly about transmission which can make things feel a bit awkward. Being around family and friends should be a time for us to have fun and relax, but I understand the fear of transmission could hold some patients back.
I hope this is helpful. Best, Bansah1
Hi @Rohit,
As mentioned above, even with the very high exposure risks and fluid exchange during birth, the risk of a transmission event with a HBV DNA level as low as yours is extremely low. In the scenario you describe (particularly with the cleaning in between), the risk is negligible.
Thomas
@ThomasTu @Bansah1 @john.tavis @availlant
Need to ask more questions:
Question 1: what is the minimum concentration of virus in blood( virus dna in IU/ml) required to cause infection to an unvaccinated person(specially child) by any type of exposure?
Question 2: what is the minimum concentration of virus in blood( virus dna in IU/ml) required to cause infection to a vaccinated person(specially child who has developed anti hbs just greater than 10mIU/ml) by any type of exposure?
Question 3: Does protection against Hepatitis B increase with the number of antibodies? Since antibody levels vary from person to person, is someone with 50 mIU/ml more protected than someone with 20 mIU/ml, or is the level of protection the same for everyone once it is above 10 mIU/ml?
Question 4: It is suggested that the minimum antibody level should be at least 10 mIU/ml; against what maximum range or concentration of the virus can this level provide protection? For example, can this antibody level(10mIU/ml) protect against a Hepatitis B viral load of up to 100,000 IU/ml or 50,000 IU/ml(or some other number)?
Hi @Rohit,
The trials to answer some of these questions cannot be done because it is unethical to transfer a specific amount of virus to children.
I am not aware of any instance where a child who was a responder to vaccines went on to get a chronic infection.
As far as I know, any antibody level greater than 10 is equally as protective.
Thomas
Welcome Rohit!
You are already on the right path, if you have questions. I had similar questions and concerns when I found out it had Hepatitis B (I like saying Hep B better. Sounds less serious. Lol).
I am cautious with my family. Get them vaccinated. I m lucky where I have 3 boys and they would never kiss me. lol. I personally don’t share food and drinks with my kids. With drinks, since it’s going down, no real concerns for me. My lips aren’t cracked or bleeding. Food, I don’t share from the same plate, meaning we don’t eat from the same plate. But that’s because it’s just how it’s always been.
Exercise, eat right, clean up and cover up cuts, and for me…I read have a good amount of vitamin D in my body, so I been doing that. Your kPa reading on the fibroscan could be higher than it really is. 5 years ago my reading was 7.4kpa and two months ago it was 9.8kpa. I was really stressed and thinking the worst. My doctor had me to a MRI and it came back at 4.3kpa. She told me the MRI reading are more accurate. Also my every 6 months US were always good.
Best of luck. Stay positive and healthy.
I agree with Thomas. In the HIV world, there is the concept of U=U, which means that people with undetectable viral load on medication cannot transmit HIV. We don’t yet have enough evidence to conclude the same thing for hepatitis B, but I suspect that we can conclude something similar. If it would make you feel better, you could look into antiviral therapy so that you can get your viral load down to undetectable. I have never heard of anyone catching HBV from someone with undetectable viral load. I suppose it could still happen if you get a blood transfusion from an infected person, just because the volume of blood is so massive in that case, but I have never heard of it happening from accidental exposure to small amounts of blood, or even a somewhat larger amount of blood during childbirth.
@NeptuneJ hello dear, thanks for taking interest and thanks for your opinion.
I want to tell you something: I have no fear regarding myself… my only fear is for my child. I am 36 years old and have already lived half my life—and lived it exactly the way I wanted to. I know I can live a full life even with Hep B; I just need to overcome this fear concerning my family and child, which is why I ask so many questions.
@Rohit
That’s the biggest fear we have-passing on the virus to family members, or anyone.
We can only do our best.
It’s great you are aware you have the virus and know how to protect others. They are vaccinated so chances are pretty much nonexistent.
Do not let the fear invade your life.
@ThomasTu @john.tavis @availlant @Bansah1 thank you very much Mr. Thomas. You are always a kind and helping person.
I have a few more questions, as I am looking for an expert and experienced perspective from you. My questions concern the fluctuations in the Hepatitis B virus DNA levels.
Question 1: In my case, my viral load was 800 IU/mL, but recently it tested as “not detected.” I am not taking any medication. My question is: can the virus levels rise or fall on their own? And can the count shoot up to the millions at any time?
Question 2: You previously mentioned that the viral load in saliva, tears, and sweat is 10 to 100 times lower than in blood, which is why these fluids do not transmit the virus. However, if the virus fluctuates and the load reaches millions or tens of millions, the viral DNA count in saliva could also rise to thousands or hundreds of thousands. Would saliva be considered infectious in that scenario? For instance, if there are 1 million viral DNA copies in the blood, then based on your statement, there would be 10,000 to 100,000 copies per mL in saliva—a level high enough to potentially transmit the infection. Please clarify this point.
Question 3: If I were to start taking medication, is there still a possibility that the viral load in the blood could rise at some point? Or does taking medication mean that the virus will remain “not detected” for the rest of my life? Please provide detailed answers to these three questions; I would be very grateful.
Question 4: I am concerned about fluctuations because it is important to know the extent of potential fluctuations at any given time. If there were a massive fluctuation (in the range of hundreds of thousands) at some point during the six-month testing period—and I was unaware of it—could saliva then pose a risk?
Please shed some light on this matter.
Kindly provide the answers corresponding to the question numbers.
@ThomasTu @john.tavis @availlant @Bansah1
These are some important questions for me, so please answer them specifically as asked.
These are perhaps the most crucial questions for me, and once I have the answers, I might finally be able to breathe a sigh of relief.
Thanks guys for all your hard work.
Dear @Rohit
We have answered some of these questions in the past.
To your specific questions:
HBV DNA levels can fluctuate naturally in the body as a person’s immune and health status fluctuates due to other things happening in the body. Going from 800 to not detected is a good sign because it means your body is keeping the virus at low levels. Shooting up to the millions can occur, but it is usually associated with something that suppresses the immune system or stopping drug treatment.
Transfer of saliva, tears, and sweat is not a recognized transmission route. We’ve discussed this extensively.
The current therapies employing Entecavir and Tenofovir can usually, but not always, suppress HBV loads down to undetectable levels. However, they rarely cure the infection and HBV typically comes back when treatment is stopped. In a minority of cases, the rebound in viral replication can be quite high, so physicians like to monitor HBV levels in the post-treatment window so they can restart therapy if the rebound becomes dangerous.
What goes on in the bloodstream has little impact on viral load in saliva, tears, and sweat. As we have repeatedly discussed, these are not modes of transmission for HBV.
John.
@john.tavis i got all your point.
Only two points i need to discuss again. These are the last questions regarding saliva/sweat/tears. Sorry for bothering you again and again. @ThomasTu @john.tavis
Question 1: So, based on this, can we assume and understand that regardless of the viral load in the blood(even if it runs into the millions)the saliva/sweat/tears remains non-infectious?
Question 2: If medication is started, does the possibility remain that the viral load could still increase while taking the medicine? And if it can increase, could it reach levels in the thousands or millions? Or does the viral load never rise when taking the medication?
Please help to answers these only. So that i can finally release my pressure. Hope you would understand.
Hi @Rohit
Yes. Remember, just being able to detect HBV DNA in these fluids by ultrasensitive detection methods most definitely does not mean that infectious virus is present. The studies you are looking at almost certainly used PCR or quantitative PCR to detect HBV DNA. Even fragmented, non-infectious DNA is detected by those assays, and they are so sensitive that they can (with a lot of work) be optimized to detect down to a single DNA molecule.
This is possible but is quite rare. The causes of large rises in HBV levels while on therapy are usually either not taking the drugs as prescribed (for whatever reason, such as forgetting or the pharmacy being out of stock and delaying a refill), but it usually takes an extended period (weeks) off-drug for the rise in HBV levels to be substantial. The other, and much more rare cause of large rises in HBV levels in a person taking nucleoside analogs is evolution of drug resistance by HBV in a person. That was very common with the older drugs such as lamivudine or adefovir, but is extraordinarily rare with proper use of the new drugs. Entecavir has this very “high barrier to resistance” in people who have never developed resistance to the older drugs. Tenofovir is even harder to develop resistance against. That I’m aware of (and I pay attention to this), there have been only a small handful of people who have ever developed true resistance to tenofovir.
Under normal conditions (ie, taking the drug diligently as prescribed as most people do), HBV DNA usually but not always is suppressed below the limit of detection by standard clinical assays and stays there (but it can often be detected by ultrasensitive research assays). HBV levels in the blood stay very low even in the minority of people who still have detectable virus; in this case, the levels can vary a bit over time, but they bounce around at very low levels.
I hope this sets your mind at ease.
John.
Thanks. Such a response makes patients feel better and more hopeful of living more 20yrs. I had counted my self living on earth for just 2 to 3 yrs from now.
@john.tavis thanku very much for your kind response. Now i am pretty confident.
@john.tavis @ThomasTu Following your reassuring answers, I gather that regardless of the viral load in the blood, the virus is not transmitted to a healthy person through saliva—this is because the concentration in saliva is neither high enough nor is the entire content necessarily infectious.
However, for an immunosuppressed individual who has been vaccinated against Hepatitis B, could exposure to the very small amounts of the virus found in saliva, tears, or sweat lead to a chronic Hepatitis B infection? Furthermore, could contact with a very small quantity of blood (even if the viral load is below 2000 IU/mL) cause a chronic Hepatitis B infection in an immunosuppressed patient?
I ask this because my uncle has cancer; he is vaccinated against Hepatitis B—though I do not know his anti-HBs level (hopefully, it is above the 10 mIU/mL threshold)—and he is currently undergoing treatment. I assist in his care, which means I spend some time with him almost every day.
Thanks