Hepatitis B

1) Key facts

• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.

• The virus is transmitted through contact with the blood or other body fluids of an infected person - not through casual contact.

• About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B.

• About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection.

• The hepatitis B virus is 50 to 100 times more infectious than HIV.

• Hepatitis B virus is an important occupational hazard for health workers.

• Hepatitis B is preventable with a safe and effective vaccine.
   

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2) Hepatitis B Causes

• The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood.

• Semen and saliva, which contain small amounts of blood, also carry the virus.

• The virus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

• People who are at increased risk of being infected with the hepatitis B virus include the following:

• Men or women who have multiple sex partners, especially if they don't use a condom

• Men who have sex with men

• Men or women who have sex with a person infected with HBV

• People with other sexually transmitted diseases

• People who inject drugs with shared needles

• People who receive transfusions of blood or blood products

• People who undergo dialysis for kidney disease

• Institutionalized mentally handicapped people and their attendants and family members

• Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood

• Infants born to infected mothers

• In some cases, the source of transmission is never known.

• The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. The rates of progression to chronic hepatitis B are as follows:

• 90% of infants infected at birth

• 30% of children infected at age 1-5 years

• 6% of people infected after age 5 years

• 5-10% of infected adults

• You cannot get hepatitis B from the following activities:

• Being sneezed or coughed on

• Hugging

• Handshaking

• Breastfeeding

• Eating food or drinking water

• Casual contact (such as an office or social setting).

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3) Hepatitis B Symptoms

• Half of all people infected with the hepatitis B virus have no symptoms.

• Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to flu. Most people think they have flu and never think about having HBV infection.

• Appetite loss

• Feeling tired (fatigue)

• Nausea and vomiting

• Itching all over the body

• Pain over the liver (on the right side of the abdomen, under the lower rib cage)

• Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color

• Urine becomes dark in color (like cola or tea).

• Stools are pale in color (grayish or clay colored).

• Many types of acute viral hepatitis have similar symptoms (hepatitis A, hepatitis C).

• Fulminant hepatitis is an unusual illness. It is a severe form of acute hepatitis that can be life threatening if not treated right away. The symptoms develop very suddenly.

• Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)

• Sudden collapse with fatigue

• Jaundice

• Swelling of the abdomen

• Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice these symptoms:

• Feeling tired or weak

• Feeling confused or having difficulty concentrating

• Headache

• Not urinating

• Irritability

• Symptoms of liver failure may include the following:

• Fluid retention causing swelling of the belly (ascites) and sometimes the legs

• Weight gain due to ascites

• Persistent jaundice

• Loss of appetite, weight loss, wasting

• Vomiting with blood in the vomit

• Bleeding from the nose, mouth, or rectum or blood in the stool

• Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

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4) Where is hepatitis B most common ?

Hepatitis B is endemic in China and other parts of Asia. Most people in the region become infected with HBV during childhood. In these regions, 8% to 10% of the adult population are chronically infected. Liver cancer caused by HBV is among the first three causes of death from cancer in men, and a major cause of cancer in women. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and Indian sub-continent, an estimated 2% to 5% of the general population is chronically infected. Less than 1% of the population in western Europe and North American is chronically infected.
 

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5) Hepatitis B Transmission

Hepatitis B virus is transmitted between people by contact with the blood or other body fluids (i.e. semen and vaginal fluid) of an infected person. Modes of transmission are the same for the human immunodeficiency virus (HIV), but HBV is 50 to 100 times more infectious Unlike HIV, HBV can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Common modes of transmission in developing countries are:

• perinatal (from mother to baby at birth)

• early childhood infections (inapparent infection through close interpersonal contact with infected household contacts)

• unsafe injections practices

• blood transfusions

• sexual contact

In many developed countries (e.g. those in western Europe and North America), patterns of transmission are different than those mentioned above. Today, the majority of infections in these countries are transmitted during young adulthood by sexual activity and injecting drug use. HBV is a major infectious occupational hazard of health workers.

HBV is not spread by contaminated food or water, and cannot be spread casually in the workplace.

The virus incubation period is 90 days on average, but can vary from about 30 to 180 days. HBV may be detected 30 to 60 days after infection and persist for widely variable periods of time.

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6) Treatment

There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Chronic hepatitis B can be treated with drugs, including interferon and anti-viral agents, which can help some patients. Treatment can cost thousands of dollars per year and is not available to most patients in developing countries.

Liver cancer is almost always fatal, and often develops in people at an age when they are most productive and have family responsibilities. In developing countries, most people with liver cancer die within months of diagnosis. In higher income countries, surgery and chemotherapy can prolong life for up to a few years in some patients.

Patients with cirrhosis are sometimes given liver transplants, with varying success.

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7) Prevention

• There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB ). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months.

• This vaccine has successfully prevented infection in people exposed to the virus.

• The vaccine is recommended for all children younger than 19 years. It can be given as part of their normal vaccination series.

• The following groups should be vaccinated for hepatitis B:

• All children younger than 18 years, including newborns--especially those born to mothers who are infected with HBV

• All health care and public safety workers who may be exposed to blood

• People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors

• People who require hemodialysis for kidney disease

• Travelers to countries where HBV infection is common - This includes most areas of Africa, Southeast Asia, China and central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America.

• People who are in prison

• People who live in residential facilities for developmentally disabled persons

• People who inject illegal drugs

• People with chronic liver disease such as hepatitis C

• People who have multiple sex partners or have ever had a sexually transmitted disease

• Men who have sex with men

• Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B.

• These include close contacts of people with HBV infection, health care workers who are exposed to HBV-contaminated blood, and infants born to mothers infected with HBV.

• It also includes people who have finished only part of the 3-shot vaccination series.

• Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80-90 percent of cases.

• Other ways to protect yourself from HBV infection:

• If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B.

• If you inject drugs, don't share needles or other equipment.

• Don't share anything that might have blood on it, such as a razor or toothbrush.

• Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or piercer does not sterilize needles and equipment, use disposable gloves, or wash hands properly.

• Health care workers should follow standard precautions and handle needles and sharps safely.

• If you are pregnant or think you might be pregnant, tell your health care provider if you have any of the risk factors for HBV infection.

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8) Self-Care at Home

•  The goals of self-care are to relieve symptoms and prevent worsening of the disease.

• Drink plenty of fluids to prevent dehydration. Water is fine; broth, sports drinks, Jello, frozen ice treats (such as Popsicles), and fruit juices are even better because they provide calories.

• Avoid medicines and substances that can cause harm to the liver, such as acetaminophen (Tylenol).

• Avoid drinking alcohol until your health care provider OKs it. If your infection becomes chronic, you should avoid alcohol for the rest of your life.

• Avoid using drugs, even legal drugs, without consulting your doctor. Hepatitis can change the way drugs affect you. If you take prescription medications, continue taking them unless your health care provider has told you to stop. Do not start any new medication (prescription or nonprescription), herbs, or supplements without first talking to your health care provider.

• Try to eat enough for adequate nutrition. Eat foods that appeal to you, but try to maintain a balanced diet. Many people with hepatitis have the greatest urge to eat early in the day.

• Take it easy. Your activity level should match your energy level.

• Avoid prolonged, vigorous exercise until symptoms start to improve.

• Call your health care provider for advice if your condition worsens or new symptoms appear.

Avoid any activity that may spread the infection to other people.

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