Hepatitis B: The In-Depth Understanding Of A Severe Liver Infection

  • Hepatitis B is a lethal liver infection that can cause both chronic and acute diseases. It is the world’s most severe acute liver infection, 100 times more virulent than the HIV/AIDS virus. 
  • It is considered a primary cause of liver cancer, known as hepatocellular carcinoma(HCC). HCC holds the second position in the list of different types of cancer-causing death in the world. 
  • In 2019, 820,000 people died because of hepatitis B complications every year, says the WHO. 300 million people were found chronically infected with the infection and still, 1.5 million people get newly infected every year.
  • 1 in every 3 people; 2 billion people have been found infected with the hepatitis B virus. All in all, two people die every minute because of hepatitis B worldwide, says Hepatitis B Foundation.
  • Hepatitis B symptoms can be treated completely, but only if the victim had taken the hepatitis B vaccine. However, there’s no cure if you have the condition, says the Mayo Clinic.

Can Hepatitis B Be Transmitted Through Saliva?

Hepatitis B often transmits through sexual or direct contact with an infected person. The virus does not spread through coughing or sneezing, but it is still believed to be found in saliva.

  • The virus can transmit from mother to child at birth(perinatal transmission), or through infected blood(horizontal transmission). The development of the hepatitis B virus is common in infants inherited from the mother or before the age of 5 years.
  • Apart from these modes of infection, hepatitis B transmission routes are infected needles, tattooing, piercing as it involves blood contact. Transmission of body fluids such as saliva, menstrual, vaginal, and seminal fluids are also responsible for inheriting the hepatitis B virus.
  • The virus may also get transmitted through sexual transmission, particularly in unvaccinated people.
  • Additionally, it is recommended not to share personal items like toothbrushes, razors, syringes, or glucose monitors containing microscopic amounts of blood. This amount of blood is enough to transmit infection, says the CDC.

The hepatitis B virus can remain inactive outside the body for at least seven days, and it can cause infection in unvaccinated people. 

On average, the incubation period of the hepatitis B virus is 75 days and may vary from 30 to 180 days. The virus can be detected within 30 to 60 days after getting infected and can cause chronic hepatitis B.

How Does Hepatitis B Affect The Body?

Initially, the Hepatitis B infection may not show symptoms or make you feel acute illness for several weeks. The common possible symptoms of Hepatitis B may start to occur about one to four months after getting infected and can make you feel:

  • Dark urine
  • Joint pain
  • Loss of appetite
  • Extreme fatigue
  • Nausea
  • Jaundice
  • Vomiting
  • Abdominal pain

Even a person with acute hepatitis may develop liver failure, which can lead to death. Not only this, in some cases, the virus may cause a liver infection that can further result in cirrhosis(a scarring of the liver) or liver cancer.

Can A Child Get Hepatitis B?

In the case of infants and children, age plays a vital role in such chronic infections. The chance of developing chronic disease is the most with children less than six years of age.

80%-90% of the infants develop a chronic infection in their first year of life, and 30%-50% of children get infected with chronic infections before the age of six years.

In the case of adults, it is found that 20%-30% of adults have a chronic infection and will develop cirrhosis or liver cancer. On the other hand, less than 5% of infected healthy persons will develop chronic diseases.

WHO and Hepatitis B

In March 2015, WHO attempted to take a step towards hepatitis B prevention and launched guidelines for the prevention, treatment, and care. It includes:-

  • To perform non-invasive diagnosis tests to assess the current stage of the disease.
  • Prioritize treatment according to the most advanced liver disease that is a higher risk of morality
  • Used the nucleus(t)ide analogs with a high barrier to drug resistance for first and second-line treatment, preferably.

WHO is also working to support countries to achieve global hepatitis elimination targets under Sustainable Development Agenda 2030, this includes specific measures, such as:-

  • By raising awareness and mobilizing resources
  • By promoting partnerships
  • To formulate evidence-based policy and data
  • By providing screening, care, and treatment service

Since 2012, WHO has organized an annual World Hepatitis Day campaign with a national government, partners, and civil society to increase awareness and understanding of the hepatitis B virus.

28 July was chosen as World Hepatitis Day on the birthday of Nobel-prize-winning scientist Dr.Baruch Blooberg, who discovered the hepatitis virus and developed ways of diagnosing and vaccinations. 

Is Hepatitis B Vaccine Good For Life?

Hepatitis B vaccine is mandatory and the only best way to prevent hepatitis B. WHO recommends, all infants should get the hepatitis B vaccine within 24 hours after birth. In 2017, this routine infant immunization against hepatitis B has now increased globally, with 84%.

In 2015, 1.3% of children under five years had a low prevalence of chronic HBV infection in children. The complete course of hepatitis B vaccination is available in the following dosage:-

  • 3 Dose Schedule Of Hepatitis B: The first dose(monovalent) is given at the time of birth, the second and the third dose(monovalent or combined vaccine) is injected simultaneously with the first and third dose of diphtheria, pertussis (whooping cough), and tetanus – (DTP vaccine).
  • 4 Dose Schedule Of Hepatitis: When the three-dose schedule of hepatitis follows a monovalent birth dose, it is called the four-dose schedule of hepatitis given with other routine infant vaccines.

Is Hepatitis B Worse Than HIV?

The hepatitis B infection is considered less fatal than HIV infection. The global prevalence of Hepatitis B Virus(HBV) infection in HIV-infected persons is around 7.4%, and about 1% of the population having HBV infection are also affected by HIV.

Since then, in 2015, WHO has suggested every HIV patients undergo a diagnosis of hepatitis B simultaneously.

WHO has recommended a combined treatment called Tenofovir that includes first-line therapy for HIV infection, which is also against HBV.

What Lab Tests Are Done To Diagnose Hepatitis B?

Laboratory tests are the only way to diagnose hepatitis B infection. Few blood tests are used to diagnose the hepatitis B virus and can help distinguish acute and chronic infection.

The diagnosis procedures look for the presence of an antigen, HBsAg. The presence of HBsAg and immunoglobulin M(IgM) antibody to the core antigen, HBcAg, causes HBV infection. At the initial stage of infection, patients are also seropositive to hepatitis B e antigen(HBeAg). 

It is responsible for enhancing the virus’s replication process, and its presence specifies that the virus highly infects the blood and the body fluids.

The presence of HBsAg for at least six months may cause chronic infection, with or without concurrent HBeAg. It is also responsible for developing chronic liver disease and leading to liver cancer(hepatocellular carcinoma).

Following are the laboratory tests the doctors may ask a patient to undergo:-

  • Blood Test: A blood test detects the hepatitis B virus signs and reports to the doctors whether it’s acute or chronic. It can also determine if you are immune to the condition.
  • Liver Ultrasound: A type of ultrasound called transient elastography shows the amount of liver damage.
  • Liver Biopsy: It is the process of examining the presence of a virus by testing a tissue sample to check for liver damage. It involves removing tissue of the liver by inserting a thin needle through your skin for laboratory tests.

In some cases, doctors may ask healthy people to go for specific tests to ensure their immunity to the virus because the virus can damage the liver without showing any signs and symptoms. 

However, for everybody’s safety, it is recommended to go for hepatitis diagnosis if you fall under the below-mentioned condition:-

  • When a woman is expecting a baby
  • Living with hepatitis B patient
  • Having multiple sexual partners
  • Had sexual intercourse with an infected person
  • A man has sex with men
  • You have a history of STD
  • Your liver enzyme test is negative
  • Receive kidney dialysis
  • Intake of medications to prevent rejection after an organ transplant that suppresses the immune system.
  • Use illegal injected drugs
  • You are born in a region where hepatitis B is imminent such as Asia, the Pacific Islands, Africa, and Eastern Europe.

Also Read: Top 06 Tips For A Healthy Liver

Can Hepatitis B Be Cured Or Treated?

Based on the severity of the condition, the doctor will ask you for the following possible treatments:-

People getting exposed to the hepatitis B virus and having doubts about their vaccination should consult their doctor immediately. Sometimes the doctor may give you an immunoglobulin injection, an antibody that provides short-term protection from getting sick with hepatitis B. 

It should be given within twelve hours of exposure to the virus. It is also recommended to get the hepatitis B vaccine simultaneously if never received it.

Acute Hepatitis B Infection

There is no specific treatment for acute infection; your doctor may recommend you rest, proper nutrition, and plenty of fluids to charge your body to fight against the disease.

Care aims to obtain comfort and adequate nutrition balance; only such stage of infection is considered mild that will go away on its own.

Another most essential avoidance of unnecessary drugs such as acetaminophen/paracetamol and medications to treat vomiting is required.

Chronic Hepatitis B Infection

The chronic stage of the infection can be treated with the help of medication, including oral antiviral agents. Treatments for such cases slow the progression of cirrhosis reduce the risk of liver cancer and improve long-term survival. 

Treatment reduces the risk of liver disease prevents you from infecting others, it includes:-

  • Antiviral medications: These medicines fight against the virus and reduce the rate of damaging the liver, which includes:-
  • entecavir (Baraclude)
  • tenofovir (Viread)
  • lamivudine (Epivir)
  • adefovir (Hepsera) 
  • telbivudine (Tyzeka) 
  • Interferon infections: Interferon alfa-2a( Intron A) is an artificial substance that is produced by the blood to fight against the disease. It is usually for young people who want to avoid long-term medication, such as if a woman might want to be pregnant within a few years after completing the course of the drug.

These medicines are strictly avoided during pregnancy, as they might show some side effects such as nausea, vomiting, difficulty in breathing, and depression.

  • Liver transplant: In the case of severe liver damage, a liver transplant may occur. The transplantation process involves the replacement of an infected liver with a healthy liver. In most cases, the replaced liver comes from deceased donors, though only a few numbers of livers come from living donors.

The cost of the treatment causes a significant disease burden both physically and economically. In low-income areas, most people die within months of diagnosis, and options are limited.

In high-income regions, the life of an infected person may extend up to a few years. Therefore, liver transplantation is mostly performed in high-income areas.

What Is The Prevention Of Hepatitis B?

People living in low or intermediate endemicity should get vaccinations to prevent hepatitis B. Additionally, preventing the following things can help reduce the risk of developing hepatitis B symptoms:-

  • Lifestyle like prisoners
  • Abuse use of drugs
  • Sexual contacts of people with chronic HBV infection
  • Having multiple sex partners
  • Healthcare workers and people working in the blood department.
  • People living with chronic diseases require a frequent blood transfusion, other blood products, or went through solid organ transplantation.
  • Travelers who have not completed their HBV series should get the vaccine before leaving for endemic areas.

Vaccination played a significant role in terms of safety and effectiveness. In many countries, chronic infection has decreased from (8-15)% to less than 1% among immunized children.

Implementation of blood safety strategies assures the screening of all donated blood and its component used for transfusion to prevent accidental transmission of HBV. This has decreased the unsafe injections from 39% in 2000 to 5% in 2010 globally.

However, some other measures help prevent the hepatitis virus, such as safer sexual intercourse, minimizing the number of sex practice partners, and using barrier protective measures(condoms).

Also Read: Cirrhosis: Causes, Symptoms, Diagnosis and Treatment

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Janet Fudge

Janet Fudge writes on general health topics for CheapMedicineShop.com. She holds a post-graduate diploma in Public Health with a major in epidemiology. During the outbreak of COVID-19, Janet actively volunteered in vaccination drives throughout the state of Iowa. She lives in Iowa with her husband and two children.