By Dr. Vidyasagar Ramappa, Consultant – Gastroenterology, Columbia Asia Referral Hospital Yeshwanthpur (A unit of Manipal Hospitals)
Hepatitis B is a liver infection caused by a virus with potentially serious consequences, that affects people of all age groups around the world. This infection can result in inflammation of the liver that can lead to serious illness and liver damage that includes cirrhosis, liver cancer and even death.
Though there are various types of hepatitis which can create different health problems, due to the severity of Hepatitis B, WHO is looking to eliminate it by 2030. Globally, one person dies every 30 seconds from hepatitis related illness. World Hepatitis Day is observed each year on 28 July to create awareness about this disease. WHO has created a theme for this year called “Hepatitis can’t wait”, indicating its urgency to eliminate the disease.
Most of the time Hepatitis goes unnoticed until it causes irreversible damage to the liver. 90% of the people suffering from viral hepatitis do not know that they have the disease. This shows the dearth of awareness among people regarding this disease.
Once the hepatitis B virus enters the body it travels through the blood to the liver. In the liver, it latches on to the liver cells and multiplies. The patient may not have any problems at the initial phase. Multiplication of the virus triggers the body’s immune system in response to the virus and this host immune response causes inflammation and liver disease.
Types of Hepatitis B
Typically, there are two types of hepatitis B infection: acute and chronic.
Hepatitis B infection is considered to be ‘acute’ in the initial 6 months. Many people are able to get rid of it and recover at this stage. If hepatitis B virus tests (HBsAg) are positive even after 6 months, it is then considered a ‘chronic’ (long term) hepatitis B infection, which may last a lifespan. This may lead to inflammation and the serious liver cirrhosis and liver cancer.
Symptoms of acute hepatitis B
Acute hepatitis B infection usually begins with jaundice occurring about 12 weeks after initial infection. Listed below are some of the associated symptoms which are non-specific
- Nausea and vomiting
- Lack of appetite
- Fatigue
- Abdominal pain
- Muscle and joint pain
- Jaundice
Symptoms of chronic hepatitis B
Many people suffering from chronic hepatitis B do not experience any symptoms of infection and remain unaffected. But they can still pass on the virus to others. Some develop serious liver problems. However, some may experience symptoms that are similar to other forms of viral hepatitis.
- Nausea and vomiting
- Lack of appetite
- Tiredness and irritability
- Pain in the upper, right side of abdomen (liver area)
- Joint aches and pains
How does one get the infection?
Hepatitis B can spread from person to person in certain ways. People can get the infection through exposure to blood and other body fluids of an infected person. The most common ways to get hepatitis B include:
- Having unprotected sex with an infected individual.
- Sharing needles from an infected individual for drug use, tattoos or piercing.
- Sharing everyday items that may contain body fluids including razors, jewellery, nail cutters etc.
- During medical treatment of an infected individual via contaminated / non sterile equipment / instruments
- Being bitten by an infected person
- From an infected mother to the new born at the time of delivery
We must also know that Hepatitis B does not spread by kissing, coughing or sneezing, hugging, shaking or holding hands, eating food that someone with the infection has prepared or by breastfeeding.
How is hepatitis B diagnosed and assessed?
A simple blood test can detect if an individual is infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If an individual is found to be infected (if the person is HBsAg-positive) then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver.
Hepatitis B Prevention
- Vaccination
The hepatitis B vaccine (if you haven’t already been infected) is one of the best ways to control the disease. It is safe, effective and commonly available.
- Post-exposure prevention
If you are not immunised and have been exposed to the virus, you should see a doctor immediately. You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
- Preventing infection in newborns, babies
All pregnant women are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. (The transmission of the virus to the baby is thought to occur mainly during childbirth and not during the pregnancy.) With this treatment there is a good chance of preventing infection developing in the baby.
To avoid hepatitis B infection from spreading from self (infected) to others (non-infected):
- Never share personal care items like toothbrushes or razors.
- Safe-sex practices
- Get tattoos or piercings only at places that ensures safe practice and has standard hygiene protocols.
- Ensure to use clean single use disposable needles for injections
Treatment
If you are aware or suspect that you have been exposed to the virus, consult your doctor and seek advice. In case of acute hepatitis B infection, you may not need medical treatment. Doctor may suggest to get ample rest, plenty of fluids and a healthy diet to fight off the infection. It is mandatory to stay away from alcohol as it can damage your liver. Consult your doctor before taking any other medications, herbal treatments, or supplements as some of them can be harmful when the liver is inflamed.
If the infection is active for more than 6 months, you are considered as a chronic hepatitis B patient and your doctor may prescribe antiviral medications to treat it. These treatments are to stop the hepatitis B virus from multiplying. This decreases the risk of severe liver disease from developing later in life. Additionally, it helps the liver to repair some of the damage. Nevertheless, it is very rare that any of these medications will get rid of the hepatitis B virus itself from your liver. Treatment with medicines is usually continued for many years.
The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and there are some newer medicines that are in the pipeline that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.