Hepatitis B: Causes, Symptoms & Management Of The Disease

The above slogan is the theme for “World Hepatitis Day” this year, observed on 28th July in memory of the birthday of Nobel Laureate Prof. Samuels Blumberg who discovered the Hepatitis B virus. World Hepatitis Day, observed on July 28 every year, aims to raise global awareness of Hepatitis B and Hepatitis C and encourage prevention, diagnosis and treatment.

Today we shall discuss in detail about the prevalence, pathophysiology & preventive aspects of Hepatitis B infection.

Prevalence of Hepatitis B:

Hepatitis B is the most common liver infection in the world. It is caused by the hepatitis B virus (HBV), which can attack and injure the liver.

HBV is transmitted through blood and infected body fluids. This can occur through direct blood-to-blood contact, unprotected sex, unsterile needles, and from an infected woman to her newborn during pregnancy or delivery.

Two billion people around the world (almost one out of three persons) have been infected with hepatitis B. Of these, 400 million are chronically infected.
Each year, there are 10-30 million new infections worldwide.
Each year, there are one million deaths worldwide due to hepatitis B.
In the U.S., there are approximately 1.25 million people who are chronically infected with hepatitis B, and there are almost 100,000 new infections each year.
Hepatitis B is a silent disease, which means that someone can be infected for years, even decades, without having any symptoms.

Most healthy adults who are infected with hepatitis B will recover without problems. Unfortunately, this is not true for infants and children. The younger a person is when they are first infected with the virus, the greater their risk of developing a chronic infection.

If an adult is infected – 10% will develop chronic infections
If a child is infected – up to 50% will develop chronic infections
If an infant is infected – 90% will develop chronic infection

Hepatitis B panel:

The hepatitis B blood panel is made up of multiple tests, but you only need to give one blood sample. This test can be done easily in your doctor’s office or local health clinic.

Hepatitis B Surface Antigen (HBsAg):

If this test is positive, then the hepatitis B virus is present in the blood. This means that you have a hepatitis B infection. In people who recover, this protein usually disappears after 4 to 6 months. Its continued presence suggests that chronic infection has developed

Hepatitis B Surface Antibody (HBsAb or anti-HBs):

If this test is positive, then you are immune to (or protected against) hepatitis B.

Hepatitis B e antigen (abbreviated HBeAg):

HBeAg is a protein whose presence indicates that the hepatitis B virus is continuing to make copies of itself (replicating). Its presence usually indicates a high level of circulating virus and a high chance of transmission of infection.

Hepatitis B Core Antibody (HBcAb or anti-HBc):

If this test is positive, then you may have been exposed to the hepatitis B virus, but it does not confirm a current infection.

Acute Hepatitis B:

A hepatitis B infection is considered to be “acute” from the time of exposure until 6 months afterwards. This is the typical amount of time it takes for a healthy adult to successfully clear hepatitis B infection and develop the protective antibodies. During an acute infection, a person is contagious and able to pass the virus on to others.

90% of healthy adults are able to “recover” by getting rid of the virus, which is confirmed by a blood test. Once a person has recovered, they are no longer contagious and are immune to future hepatitis B infections.

Chronic Hepatitis B:

Six months after you test positive for hepatitis B, you should be tested again. If you are still positive for hepatitis B, then you have a chronic infection. This means that your body was not able to get rid of the virus and it still remains in your liver and blood. Chronic hepatitis B can increase your risks for developing more serious liver disease later in life, such as cirrhosis or even liver cancer. It is also important to learn how to avoid spreading the virus to your loved ones, and to take good care of yourself so you can enjoy a long and healthy life.

How to protect your loved ones?

The first step is to have household family members and sexual partners tested, and vaccinated if they are not infected.
Hepatitis B can be spread through direct blood contact, unprotected sex, and contact with infected bodily fluids, so until you know that your family members are protected:
- avoid unprotected sex
- don’t share razors, needles, nail clippers, tooth brushes or earrings
- make sure you keep all cuts and open sores covered
- clean all blood spills with a fresh solution of bleach and water(1 part bleach to 9 parts water).
Hepatitis B is NOT spread through casual contact such as hugging, coughing, sneezing, or eating food prepared by someone who is infected.

So, even while your family members or sexual partners are completing the vaccine series, enjoy your loved ones. This is a time when you need them the most.

Pregnancy and Chronic Hepatitis B:

If you are chronically infected with hepatitis B and pregnant, or thinking about becoming pregnant, there are some things you need to know.

The virus CAN be transmitted to your baby during pregnancy or delivery.

Fact: 90% of babies born to hepatitis B infected moms will become infected with hepatitis B unless properly vaccinated at birth.

Fact: The good news is that you CAN prevent the hepatitis B virus from infecting your baby.

Protecting your newborn:

Your baby must be given two shots in the delivery room. Within the first 12 hours of life the first dose of hepatitis B vaccine and one dose of hepatitis B immune globulin (HBIG) should be given.
Make sure you tell your obstetrician and your baby’s future pediatrician that you have hepatitis B before you give birth so the doctors will have these two shots available in the delivery room.
Your baby will need additional doses of hepatitis B vaccine at one and six months of age to provide complete protection.
The baby can be tested any time after 12 months of age to make sure they have developed immunity to the hepatitis B virus.
Make sure you regularly follow-up with your liver specialist throughout your pregnancy.

If the hepatitis B vaccine and HBIG are given correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection. It is very important to make sure you protect your child as soon as he/she is born!

Hepatitis B and Breastfeeding:

Women with hepatitis B are encouraged to breastfeed their babies since the benefits of breastfeeding outweigh the very small potential risk of transmitting the virus through breast milk. Since all newborns should receive the hepatitis B vaccine at birth, this further reduces any small risk of transmission.

According to the leading hepatitis B experts at the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), it is safe for an infected mother to breastfeed her infant.

Why is Hepatitis B dangerous?

Hepatitis B is dangerous because it is a “silent infection” that can infect people without them knowing it. Most people who are infected with hepatitis B are unaware of their infection and can unknowingly pass the virus to others through their blood and infected bodily fluids. For those who become chronically infected, there is an increased risk of developing the serious liver disease later in life. The virus can quietly and continuously attack the liver over many years without being detected. Dr. Srivatsan Gurumurthy will explain Myths and Facts about Hepatitis in next blog.

Here is the message from the WHO Director-General on the occassion of World Hepatitis Day.