Hepatitis A Immunisation
October 25, 2017
Hepatitis B Immunisation
October 25, 2017
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​Hepatitis B

The liver is in the upper right part of the tummy (abdomen). It performs various functions:

1.It makes proteins that are essential for blood to clot(clotting factors).

2.It helps to process fats and proteins from digested food.

3.It stores glycogen, a chemical made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.

4It makes bile which passes from the liver to the gut and helps to digest fats.

5.It helps to remove or process alcohol, poisons and toxins from the body.

6.It processes many medicines which one may take.

Grasping hepatitis and hepatitis B

Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different germs (viruses) can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus.

Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage the liver.

Prevalence of hepatitis B

The exact number of people infected is not known but it is very common worldwide and hepatitis B is the most common cause of hepatitis. For example, in parts of Asia and Africa more than 1 person in 10 has chronic hepatitis B infection.

How can you get hepatitis B?

Hepatitis B is a very infectious disease. It has various means of communication:

From person to person (horizontal transmission)

Blood and other bodily fluids, such as semen and vaginal secretions, contain the virus in infected people. The main ways in which people become infected include the following:

Having unprotected sex with an infected person.

Even having oral sex can transmit hepatitis B. Many people with hepatitis B are not aware that they are infected and can pass on the virus during sex.

From mother to baby (vertical transmission)

Worldwide, the most common way the germ (virus) is passed on is from an infected mother to her baby. This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus Ideally every pregnant woman should be tested for Hepatitis B.

From infected blood.

It only needs a tiny amount of infected blood to come into contact with a cut or wound on the body to allow the virus to enter one’s bloodstream, multiply and cause infection. For example:

Sharing needles and/or any injecting equipment (for example, spoons, filters, water for injection) to inject drugs. Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others.

Some people who had a blood transfusion or another blood product several years ago were infected with hepatitis B. Now, all blood donated is checked for the hepatitis B virus and for certain other infections.

From needle stick accidents where the needle was used on an infected person.

A bite from an infected person, or if their blood spills on to a wound on one’s skin, or on to one’s eyes or into one’s mouth

There is a small risk of contracting the virus from sharing toothbrushes, razors, and other such items which may be contaminated with blood. The virus can actually live outside the body for more than one week.

From using equipment which is not sterile for dental work, medical procedures, tattooing, body piercing, etc.

However it is also important to remember that the virus is not passed on during normal social contact such as holding hands, hugging, kissing or sharing cups or crockery.

Manifestations and progression of hepatitis B

It is helpful to think of two phases of infection with the hepatitis B virus.

A short-term (acute) phase when one is first infected

A persistent (chronic) phase when the virus remains long-term in some cases.

Acute infection

Symptoms of acute hepatitis may develop shortly after one first becomes infected with the virus (within 1-6 months, which is the incubation period). Symptoms include: feeling sick (nausea), being sick (vomiting), tummy (abdominal) pains, high temperature (fever) and feeling generally unwell. One may look yellow (become jaundiced). This is due to a build-up of the chemical bilirubin which is made in the liver and spills into the blood in some liver conditions. With jaundice due to hepatitis one’s urine goes dark and stools (faeces) may go pale.)

Symptoms of acute hepatitis B infection usually go after a few weeks, as the immune system either clears the virus or brings it under control. Rarely, an acute severe (fulminant) hepatitis develops which is life-threatening.

However, in about half of cases, no symptoms, or only mild flu-like symptoms, develop in the acute phase. One may not even be aware that one has been infected with hepatitis B. In particular, babies who are infected from their mothers during childbirth usually have no symptoms at first.

Following the initial acute phase:

In more than 9 in 10 cases in adults, the virus is cleared from the body by the immune system within 3-6 months. In this situation the person is no longer infectious and is immune to further infection.

In up to 1 in 10 cases in adults, the virus remains long-term (chronic hepatitis B infection). This may occur whether or not one has symptoms in the acute phase.

In more than 9 in 10 babies infected from their mothers, the virus remains long-term.

So, in other words, there is a good chance of full recovery and clearing the virus for adults who become infected with hepatitis B. However, this is not so for newborn babies who become infected.

Chronic infection

Of those people who develop chronic hepatitis B infection:

Up to 2 in 3 people remain well. One can have the virus in the body but develop no damage or problems to the liver or other organs. This is called being a carrier and is sometimes called chronic inactive hepatitis B. One may not know that one is infected and is a carrier. However, even if one has no symptoms, still the virus can be passed on to others. About 1 in 5 carriers eventually clear the virus from their body naturally, but this may be after several years.

Some people develop persistent liver inflammation (sometimes called chronic active hepatitis B). Symptoms include muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice and depression. Symptoms vary in severity and some people have liver inflammation without having any symptoms.

Some people develop cirrhosis. Cirrhosis is like a scarring of the liver, which can cause serious problems and liver failure when it is severe. Cirrhosis usually takes many years to develop after a person has been infected with hepatitis B.

A small number of people who develop cirrhosis then develop liver cancer after a further period of time.

Identification and reckoning of hepatitis B

A simple blood test can detect if one is infected with the hepatitis B germ (virus). This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If one is found to be infected (if one is HBsAg-positive), then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver.

For example:

A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly which indicates that it is more likely to cause liver damage).

Blood tests called liver function tests. These measure the activity of chemicals (enzymes) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working.

An ultrasound scan of the liver.

A small sample (biopsy) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and scarring of the liver (cirrhosis). A blood test can also be performed to show if one has immunity to hepatitis B.

Other tests may be done if cirrhosis or other complications develop.

There are other specialised blood tests being developed which assess the development and severity of cirrhosis.

Prevention of hepatitis B

Immunisation

A vaccine is available to protect against hepatitis B. This should be offered to anyone who is at increased risk of being infected with the hepatitis B germ (virus). For example, sexual and household contacts of someone infected with hepatitis B.

Post-exposure prevention

If one is not immunised and has been exposed to the virus a doctor should be seen immediately. For example, if one is a healthcare worker and one had a needle-stick injury. An injection of antibodies called immunoglobulin can be given as well as starting a course of immunisation is recommended. This may prevent infection from developing.

Preventing infection in newborn babies at risk

All pregnant women should be 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.

Preventing communication of virus to others while staying infected-

If one has a current hepatitis B infection one should:

Avoid having sex with anyone (especially any sex without using a condom) until they have been fully immunised and have been checked to see that the immunisation has worked by a blood test.

Not share any injecting equipment such as needles, syringes, etc. Not donate blood or semen or carry a donor card.

Not share razors, toothbrushes, etc, that may be contaminated with blood. Cover any cuts or wounds with a dressing.

Make sure that, if any of one’s blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.

Therapies for hepatitis B

Treatment for the short-term (acute) phase

No treatment can clear the germ (virus) from the body. If one develops symptoms when first infected, treatment aims to help ease symptoms until they go – for example, drinking plenty of water to avoid lack of fluid in the body (dehydration). Rarely, a severe hepatitis develops which may need hospital care. No treatment can prevent acute hepatitis B from becoming persistent or chronic.

Treatment for chronic infection

Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and scarring of the liver (cirrhosis). People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:

Interferon. This medicine is similar to a substance produced in the body, which is also called interferon. It works to fight infections by boosting the immune system. Interferon is usually given as an injection each week.

Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include Entecavir, Adefovir, Tenofovir & Lamivudine. A combination of antiviral medicines is sometimes used.

Treatment with medicines is usually continued for many years.

Side-effects with these medicines can occur. One will be monitored regularly while one is taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.

The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and the information above is very general. There are some newer medicines that have been introduced in the last few years 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.

Liver transplant

For some people with advanced scarring of the liver (cirrhosis), liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting (chronic) hepatitis B infection.

Diet and alcohol

Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If one already has liver inflammation, alcohol increases the risk and speed of developing scarring of the liver (cirrhosis).

CONCLUSION:

The hepatitis B virus can cause a short-term but acute infection, which may or may not cause symptoms. Following an acute infection, a minority of infected adults develop a persistent infection called chronic hepatitis B. Many people with chronic hepatitis B remain well, but can still pass on the virus to others. Some develop serious liver problems. The virus is mainly passed on by sexual contact, sharing needles to inject drugs, and from mother to baby.