The liver, the largest organ inside the belly, could be infected with many pathogens. Infection of the liver by the Hepatitis B Virus (HBV) is known as Hepatitis B. HBV can cause both acute and chronic liver diseases.
The Hepatitis B virus (HBV), is a highly infectious virus, transmitted through blood and genital fluids of infected persons. The virus is transmitted through contact with any of the following body fluids:
- Menstrual fluid
- Vaginal fluid
- Seminal fluids, of an infected person.
Hepatitis B virus can survive outside the body for more than one week and will cause infection if it enters the body of the unvaccinated person.
The incubation period “time from infection to symptoms manifestation” is 2 months (varies from one to six months)
Hepatitis B is spread in one of several ways:
- From an infected mother to child at birth (commonest transmission)
- Unprotected Sex, especially unvaccinated men with multiple sex partners
- Infected blood after injury, scratch or bites.
- Health care providers and emergency responders.
- Sexually active individuals (those with more than 1 partner in the past six months).
- Illicit drug users (injecting, pill-popping)
- Sexual partners or those living in close household contact with an infected person.
- Pregnant women.
- Kidney dialysis patients and those in early kidney failure
- Inmates and Prison staff
- Staff and residents of facilities for developmentally disabled persons.
The Hepatitis B virus is not spread through:
- food or water (unlike Hepatitis A)
- Sharing eating utensils
- A cough or sneezing
- Hugging and holding hands
SYMPTOMS, Acute Hepatitis
The incubation period ranges from 1-6 months, the average is 2 months. Acute means short-lived and hepatitis will go away on its own.
Most infected persons do not exhibit any symptoms. Others exhibit the following symptoms
- Bodily aches
- Abdominal pain, nausea and vomiting
- (It is the Jaundice which draws attention to a possible HBV infection). Jaundice occurs when the injured liver, fails to remove bilirubin from the body
- Acute liver failure, (occasionally)
Acute hepatitis resolves with the clearance of HBsAg within 6 months
HOW TO KNOW YOUR HEPATITIS B STATUS.
From a simple blood test, one could know if they are,
- Infected (positive HBsAg)
- Protected (positive HBsAb)
- At Risk (negative HBsAg, HBsAb). Never got an infection or vaccination. Requires vaccination
Chronic infection is characterized by the persistence of HBsAg for at least 6 months.
The age at which one gets infected with HBV determines chronicity of the infection
90% of children infected during their first year of life, develop chronic HBV infection.
The rate decreases with age at infection.
Less than 5% of adults who get infected, develop chronic HBV infection.
The persistence of HBsAg is the primary marker for the risk of developing chronic liver disease and liver cancer. Most young people in Ghana acquired the infection from their childbirth and early childhood. The prevalence of chronic HBV is higher in rural areas.
COMPLICATIONS OF CHRONIC HBV
Most people with chronic Hepatitis B have no symptoms and feel well. They may already have liver damage and they are infectious. Left untreated, 1 in 4 people with chronic Hepatitis B develop liver problems including cirrhosis and liver cancer.
If you would like to be vigorous in your old age, avoid getting HBV infection.
Some of the HBV related complications include:
- Liver scarring (Fibrosis) due to recurrent viral injury.
- Liver cirrhosis, that is extensive liver fibrosis
- Cancer of liver cells (Hepatocellular carcinoma)
- Liver failure
- Chronic kidney disease (glomerulonephritis)
HEPATITIS B RELATED DEATHS
HBV related deaths include deaths from liver cancer, cirrhosis and liver failure.
In Ghana, the annual mortality rate of 1.7/100,000. This means close to 500 people die every year from HBV related deaths in Ghana. This rate is one of highest in the world.
The Acute infection goes away on its own, and may not require treatment. However, severe cases may require hospitalization and antiviral medication.
Chronic HBV infection:
Take care of yourself first. Eat a healthy diet, full of fruits and vegetables Exercise regularly and get adequate sleep
Take care of your liver:
- Do not drink Alcohol
- Do not take paracetamol
Get tested for HIV, Hepatitis A &C and get vaccinated for Hepatitis A
PROTECTING OTHERS FROM HBV.
Safer sex: No condom no sex
Encourage all sexual partners to get tested to know their status, in order not to infect others
Do not share personal items: razor blades, toothbrush, needles and syringes, all of which may be contaminated with infected blood
Antiviral medications may help fight the virus and slow the viral ability to damage the liver.
Indication for Antiviral Treatment
Those with acute liver failure
Chronic HBV infection + elevated transaminases, and Viral DNA count greater than 1000 iu/ml
Those receiving immuno-suppressant medication
The goal of antiviral therapy is to reduce the amount of the virus in your body and to reduce the risk of liver cancer and liver failure.
Antiviral treatment is lifelong.
Antivirals suppress HBV. Oral tablets are taken once daily
- Tenofovir or
Interferon alfa –2b. Injections, for young people who do not want indefinite antiviral oral medications
This option is for those with a severely damaged liver.
PREVENTION OF HBV infection
Hepatitis B vaccine has been the backbone of hepatitis B prevention.
The vaccine is given in a 3-shot series at 1, 2 and 6 months. Get all 3 shots for effective protection.
The complete vaccine series induces immunity in more than 95% of those vaccinated.
Protection lasts for 20 years or more.
Who Needs HBV vaccine?
All kids younger than 18 years old, who have not had the vaccine
All those in the high risk, group.
Vaccination against HBV is the best way to decrease the disease prevalence.
By Dr Alex K Sarkodie