Hepatitis B
Last updated March 21, 2008
Hepatitis B is an issue in adoptions, especially from Asian and African countries, as the disease is endemic to those populations - some countries with as much as 20-30% of the general population being carriers or exhibiting disease symptoms.
Hep B is generally very manageable in the small number of people who exhibit the disease pathology (the most severe being cirrhosis and liver cancer) - most of those infected have no noticeable problems from the infection, and live normal lives. Hepatitis B Virus (HBV) infection can take 6+ months to show up in lab tests, so even an infant that tests negative multiple times in VN or back home can later test positive. It is important to have your child tested for Hepatitis B 6 months after arriving home to be sure if they are infected or not. There are also several types of tests for HBV, not all doctors test for all the antigens/antibodies. HBV is what is known as a “good” or “efficient” infector, meaning that it doesn’t take very much of the virus to initiate an infection in the body.
A small percentage of infants clear the infection naturally; most (~90%) become chronically infected for life. In adults and older children it is the opposite, and 90-95% of those infected clear the infection naturally. In the US, most people are vaccinated as infants, and the likelihood of infection is even lower if the virus is not actively replicating in the person who is the infector. Vaccines don’t work for everyone, but they do for the vast majority of people, on the order of 90-98%+ for HBV, and the immunity generally lasts about 20 years - though immune memory for HBV has been shown to vary from 10 years to lifetime - research is still ongoing in the vaccination arena.
For me, Hep B isn’t that scary at all (I’m not saying it’s fun or with no risk!); sure there are bad outcomes (there are about 4500 deaths a year in the US that are HBV related), and infected individuals should be tested regularly to make sure the virus isn’t actively replicating and affecting the liver (there are medications to stop the virus from replicating). The likelihood of HBV changing how you or your child live your lives is rather small. Universal precautions, such as avoiding contact with blood, should be followed - but that is really no different than with any person. Teens and adults need to know that HBV can be spread through sex, so condoms should be used. HBV can also be transmitted from mother to child during birth - probably the most common method of transmission outside of the US and Europe - but, steps can be taken immediately after birth to prevent the child from becoming infected.
As mentioned, HBV is endemic to Asia and Africa, and as much as 20-30% of the population is chronically infected, compared to about 1/2 a percent of the US population.
Most of this comes from my virology class notes from when I was in college, and some more recent research I’ve read while I was waiting to go to VN to get Parker. There’s enough research on HBV to fill several hundred encyclopedia volumes, so if you want practical information from someone in the field, I would highly suggest contacting a liver specialist in your area and talking to them.most should be well versed in the various hepatitis variants. Or, if you want more technical info, contact your local university’s microbiology department and ask if there’s someone willing to speak with you about HBV.
Everyone certainly has a right to specify what they will and will not accept in a child to be adopted, but remember that no human comes with any kind of guarantees, regardless of where they were born or whom they were born to. I have seen estimates from multiple sources that about 3-8% of children who are brought to the US from Asia end up being HBV positive even though this was not known at the time of the adoption.
Some great resources on Hep B are:
http://www.pkids.org/dis_hep_phr.php
http://www.cdc.gov/ncidod/diseases/hepatitis/b/
http://www.hepb.org/
http://www.who.int/mediacentre/factsheets/fs204/en/