Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
What is hepatitis B?
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus, and types B and C are most likely to become chronic.
According to the Centers for Disease Control and Prevention (CDC), approximately 296 million people around the world are living with hepatitis B, and there were approximately 1.5 million newly-contracted, chronic hepatitis B cases in 2019.
HBV infection can be acute or chronic
Acute hepatitis B causes symptoms to appear quickly in adults. Infants who contract it at birth rarely develop only acute hepatitis B. Nearly all hepatitis B infections in infants go on to become chronic.
Chronic hepatitis B develops slowly. Symptoms may not be noticeable, unless complications develop.
CAUSES AND RISK FACTORS
Hepatitis B is a viral infection that’s spread through blood or other body fluids, including semen or vaginal fluids.
Among the ways that hepatitis B can be spread are:
* By having unprotected sex with a person who has HBV (without using a condom or other barrier methods).
* By sharing toothbrushes, razors, or nail clippers that have been exposed to blood
* By receiving a tattoo, or by piercing the body with equipment that has not been sterilized.
* By injecting drugs and sharing needles, syringes, or other equipment.
* From a birthing parent to a newborn baby
Although the virus may be found in the saliva, hepatitis B is not spread through kissing, sneezing, coughing, or sharing utensils.
Certain groups are at particularly high risk of HBV infection. Those include:
* Healthcare workers
* People who use injection drugs
* Infants born to birthing parents who have HBV
* Sexual partners of people with HBV
* Individuals receiving dialysis for kidney disease
SYMPTOMS
Symptoms of acute hepatitis B may not be apparent for months. But common symptoms include:
* Fatigue
* Dark urine
* Joint and muscle pain
* Loss of appetite
* Fever
* Abdominal discomfort
* Weakness
* Yellowing of the whites of the eyes (sclera) and skin (jaundice)
Any symptoms of hepatitis B need urgent evaluation. Symptoms of acute hepatitis B are worse in people over the age of 60.
Diagnosis
Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for individuals who:
* Use injection drugs
* Receive kidney dialysis
* Were born in a country where hepatitis B is common
* Household contact or sexual partner of someone with hepatitis B
* Taking medications that suppress the immune system
* Donating blood or organs
* Infant born to a birthing parent with hepatitis B
* Lab test results that show elevated liver enzymes
* Pregnant
* Men who have sex with men
* HIV
Test includes
* Hepatitis B surface antigen test
* Hepatitis B core antibody test
* Hepatitis B surface antibody test
* Liver function tests
TREATMENT
Administration of a first dose of the hepatitis B vaccine and a shot of hepatitis B immunoglobulin, which is a combination of antibodies that provide short-term protection against the virus.
Though both can be given up to a week after exposure, they’re most effective at preventing infection if administered within 48 hours.
If diagnosed with acute hepatitis B, persons may be referred to a specialist, and be advised to get regular blood tests to ensure that they don’t develop chronic hepatitis.
Though many people with acute hepatitis B don’t experience serious symptoms, getting plenty of rest, wearing loose clothing, maintaining a cool environment, or taking over-the-counter pain-killers may be beneficial if symptoms do occur.
Other lifestyle changes may also be required, such as following a healthy, well-rounded diet, and avoiding substances that can harm your liver, such as alcohol, acetaminophen, and certain herbal supplements or medications.
If blood tests show that you still have an active infection after 6 months, your doctor may recommend further treatment, including medications to help control the virus and prevent damage to the liver.
Medications
Some of the medications that may be used to treat chronic hepatitis B include:
* Peginterferon alfa-2a (Pegasys).
* Entecavir (Baraclude).
* Tenofovir (Viread, Vemlidy).
* Adefovir dipivoxil (Hepsera).
* Lamivudine (Epivir).
* Interferon alfa-2b (Intron A).
COMPLICATIONS OF HEPATITIS B
Complications of having chronic hepatitis B include:
* Hepatitis D infection
* Liver scarring (cirrhosis)
* Liver failure
* Liver cancer
* Death
Hepatitis D infection can occur only in people with hepatitis B. Hepatitis D is uncommon in the United States, but can also lead to chronic liver disease.
HEPATITIS B AND PREGNANCY
Hepatitis B can be passed from a birthing parent to a newborn infant. This is because the newborn is exposed to blood and body fluids during delivery.
In fact, it’s estimated that 90 percent of mothers with an acute hepatitis B infection, and 10-20 percent with chronic hepatitis B, will pass the virus to their newborn.
For this reason, birth parents are routinely screened for hepatitis B during each pregnancy.
Additionally, the hepatitis B vaccine and hepatitis B immune globulin are both administered to infants with an HBV-positive birthing parent within 12 hours of birth, to prevent infection.
PREVENTION OF HEPATITIS B
The hepatitis B vaccine is the best way to prevent infection. Vaccination is highly recommended. It takes three vaccines to complete the series. The following groups should take the hepatitis B vaccine:
* Infants, at the time of birth
* Children and adolescents who weren’t vaccinated at birth
* Adults being treated for a sexually transmitted infection
* People living in institutional settings
* People whose work brings them into contact with blood
* HIV-positive individuals
* Men who have sex with men
* People with multiple sexual partners
* Injection drug users
* Family members or sexual partners of those with hepatitis B
* Individuals with chronic diseases
* People travelling to areas with high rates of hepatitis B
In other words, just about everyone should receive the hepatitis B vaccine. It’s a relatively inexpensive and very safe vaccine.
