Hepatitis B Infection

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What is hepatitis B infection? – This is an infection of the liver caused by hepatitis B virus.  The virus attacks the liver cells with the aim of destroying them. This destruction may happen rapidly (acute) or gradually (chronic). The acute infection tends to be short and severe; and may lead to death in few days / weeks or progress to become chronic; while the chronic infection tends to be milder at the beginning but may ultimately lead to death much later from liver cirrhosis or cancer.

How is hepatitis B transmitted?

Hepatitis B virus can be transmitted from person to person through contacts with blood or other body fluids. Thus, it can be transmitted through:

  1. Blood transfusion 
  2. Sexual intercourse – through semen and vaginal fluid
  3. Sharing of sharp objects such as blades, needles, clippers and other sharp hair-making instruments, manicure and pedicure instruments etc
  4. Mother to child transmission during childbirth

In what ways can hepatitis not be transmitted?

Hepatitis is not transmitted through kissing, sharing of household utensils, sweating, hugging, handshake, breastfeeding, food or water. However, if there is any form of bruises, cracks or injury on the nipple that leads to bleeding, this may increase the chances of transmission of the virus to the baby through breastfeeding. So, in such women, breastfeeding should be discontinued on the affected breast.  

How does hepatitis B infection present?

Majority of infected persons do not present with any symptom after infection. Those who have symptoms may present with:

  1. High fever
  2. Yellowness of the eyes (jaundice)
  3. Feeling easily tired (easy fatigability)
  4. Nausea and vomiting
  5. Abdominal pain
  6. Passing dark urine

How does hepatitis B infection progress?

There are three main pattern of progression of hepatitis B infection:

1. Remission: The immune system of the majority of people who contract hepatitis B may successfully fight the infection before it is able to do any significant damage to their liver. In this case, the infection may resolve without the infected persons having symptoms while some will resolve after the initial symptoms, as listed above. This set of people become hepatitis B carrier.

They may not suffer any significant health challenge due to hepatitis B virus infection but they cannot donate blood for transfusion to others as they can successfully transmit the infection to others through blood transfusion.

2. Rapid progression to death: A proportion (about 1%) of those infected and who subsequently develop severe symptoms may die within a short time of the infection (about one week or more). In this case, the body’s immune response is unable to successfully fight the virus.

People in this category develop severe symptoms of the infection following multiple organ damage, which subsequently leads to shutting down of the body system within a very short time. This ultimately culminates in the death of the affected persons within a very short time. This type is called fuminant hepatitis. 

3. Chronicity: In the third category, the immune response is able to suppress the virus to certain level but not completely. Therefore, the activities of the virus (multiplication, growth and destruction of liver cells) go on albeit slowly. The affected persons may not be aware of the infection as this may not elicit any symptom or may have recovered from the initial symptoms following infection with the virus.

This results in chronic hepatitis B infection. In this people, liver damage goes on little by little until the damage is too much for the body to cope with. Unfortunately, the infected person may not be aware of this damage, which ultimately results in liver cirrhosis (shrunken scarred liver) or liver cancer (hepatocellular carcinoma). Childhood infection of hepatitis B virus tends to progress this way due to the immaturity of the immune system to fight the infection at that time.

How is hepatitis B infection diagnosed?

Since other infections can present with similar symptoms with hepatitis B, it may not be possible to diagnose hepatitis B from just history and examination. Diagnosis involves laboratory testing of blood samples, which can also be used to differentiate acute from chronic infection.

Liver functions are also checked to ascertain the extent of damage the virus has caused to the liver. Ultrasound may be helpful to assess the state of the liver at the point of diagnosis as well as monitor the progression of liver disease. 

How is hepatitis B infection treated?

Treatment of hepatitis B infection depends on the mode of presentation. Patients who present with acute symptoms are stabilized by treating the immediate symptoms such as:

  1. Analgesic and anti-pyretic for pain and fever
  2. Intravenous fluid if they cannot take anything by mouth
  3. Liberal fluid intake if they can take food and water by mouth
  4. Adequate food intake

For chronic hepatitis B infection, antiviral drugs, which come in tablet form, may be given (for those who meet the criteria) to reduce viral load and slow down the rate of liver damage. This treatment may also improve long term survival. Other treatment modalities include surgery to remove the affected part of the liver, chemotherapy to destroy cancer cells and liver transplant for those who have developed liver cirrhosis or cancer.

Can hepatitis B be cured?

No. There is no cure for hepatitis B viral infection. The treatment of chronic hepatitis B is for life.

How can hepatitis B infection be prevented?

Hepatitis B infection is better prevented than treated. The following measures can be taken to prevent the infection:

  1. Avoid sharing sharp objects: needles, blades etc
  2. Wash hands properly after coming in contact with blood or other body fluids
  3. Proper screening of blood before transfusion
  4. Routine testing for hepatitis B in pregnancy in order to prevent mother-to-child transmission in those who test positive
  5. Targeted testing of high risk groups such as commercial sex workers, family members of infected persons, HIV infected persons, health-care workers etc
  6. Immunization of people at risk after testing negative for the virus
  7. Hepatitis B immunization for children at birth
  8. Hepatitis B immunoglobulin injection after delivery for children of infected mothers
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