Hepatitis B: Symptoms, Transmission,Treatment And Prevention

Published by Dr Gigi on August 27, 2019

Hepatitis B virus infection

What is Hepatitis B?

Hepatitis B is a contagious and potentially fatal liver infection caused by hepatitis B virus (HBV).

It is transmitted through contact with blood and body fluids of an infected person.

The disease can be prevented by vaccination

In some individuals, the disease can become chronic- lasting more than 6 months. The disease progresses slowly in people with the chronic form and may result in liver cirrhosis and/or cancer.

In a small percentage of individuals with HBV, it may coexist with HIV/AIDS (human immune virus/acquired immune deficiency).

Anyone with HBV can not donate body organs, blood, or any blood product such as plasma.

Alcoholism worsens the outcome and course of the disease.

What is the Prevalence of Hepatitis B?

Many people are carriers of this disease and would transmit it to others even when they don’t show symptoms themselves. More than 2 billion people are estimated to have had the disease worldwide, including ongoing and resolved infections.1,2 300 million people are currently living with hepatitis B all over the world and 1 million people die every year.3,4 It is estimated that 15% of people in Subsaharan Africa (including Nigeria and Ghana). A recent study to establish the endemicity of hepatitis B reported that about 12% (>24 million people) of the Nigerian population have hepatitis B. According to WHO, there is high prevalence of HBV in Africa, it is estimated that about 6.1% of the adult population are infected by the virus.5

90% of infants infected at birth and 20-50% of children infected after the 1st year, but before 5 years of age, will go on to have chronic HBV disease.5

5-10% of adults and children over 5 years with HBV will end up with chronic infection.6

How Is Hepatitis B Virus Transmitted?

The virus is transmitted through exposure to infected blood and body fluids including saliva, vaginal and seminal fluids, and menstrual fluids. Use of sharp objects contaminated with the blood of someone with HBV will expose others to contracting the disease. The virus can survive outside of the human body for about 7 days and can potentially infect people.

• Unprotected sex: An individual can get HBV infection through unprotected sex with an infected person. Exposure to blood, saliva, vaginal secretions or semen of an infected person can infect someone else.

• Mother to child: Pregnant women infected with HBV can pass it to their newborns at birth. To prevent these babies from being infected, they should be vaccinated within 12 hours after birth.7,8

• Needle-stick injury: Healthcare workers are at risk of  accidentally sticking themselves with needle or sharp objects exposed to the blood of anyone infected with HBV.9

• Exposure to sharp objects contaminated with HBV: It can be contracted by sharing razor, needles, shaver or any other sharp instrument with someone with HBV.

• Tattooing and piercing: Sharp objects used in tattoos and piercings can transmit HBV if exposed to the blood of someone with the disease.

Signs and Symptoms

You may not experience any symptom initially till about 1 to 6 months after infection. A small fraction of people with HBV will not show symptoms at all and will only find out through routine blood tests. The common symptoms include:

• Yellow skin and eyes (jaundice)

• Abdominal pain

• Nausea and vomiting

• Dark urine

• Fever

• Light colored feaces

• Long term fatigue

About 5-10% of adults will develop chronic infection (infection lasting for more than 6 months). These individuals are at increased risk of liver scarring (cirrhosis) and liver cancer.

HBV infection is different for children because about 95% of them will experience chronic infection.

Diagnosis

Physical appearance can not differentiate hepatitis from HBV from other forms of hepatitis, therefore laboratory test are necessary to confirm infection. 

• Liver function test (LFT): This test does not show if an individual has HBV but only gives a picture of how well the liver is working.

• Hepatitis B surface antigen and antibody (HBsAg/HBsAb) tests: HBsAg are proteins found on the virus, and signals the presence of infection. The antibody is produced by the body in response to HBsAg. If your HBs antigen test is positive then you have hepatitis b infection. Individuals with Hbs antibody and no antigen, without the history of vaccination are said to have resolved the disease.

Who is at risk?

• People with multiple sex partners.

• Sex workers and their patrons.

• Unvaccinated men having sex with other men.

• Illicit drug users.

Prevention

1. Vaccination: All newborn babies, healthcare workers, people who work in close proximity with children and everyone that may have been exposed to HBV should be vaccinated as soon as possible.14

2. Sharp objects should be single use only. If they must be reused, they have to be cleaned and sterilized with an autoclave. 

3. Keep to one sexual partner relationships.

Complications and Outcome

1. Liver cancer

2. Liver cirrhosis (scarring of the liver)

3. Human Immunodeficiency Virus co-infection: About 2.7 (1%) million people living HBV also have HIV. This is why everyone with HIV should be screened and treated for HBV.15

In some cases the infection will resolve completely if:

• you no longer have symptoms of acute infection

• your liver function tests are normal

• you have hepatitis B antibody

In some individuals, having HBV infection for more than 6 months signifies chronic infection. The individual is considered a carrier if they have no symptoms but test positive for active infection.

A carrier is capable of infecting other people through sharing needles and sharp objects, blood or organ donation, unprotected sex, blood or body fluid contact.

Majority of carriers go on to develop chronic disease.

Treatment

There is no cure for hepatitis B. If you think you have been exposed to HBV, you need to see a doctor. You will be given HB vaccine and an antibody shot that will fight off the infection.

You will also need to stay away from medicines such as (acetaminophen/paracetamol), herbal supplements and alcohol as they may cause further damage to the liver.

If the infection persists beyond 6 months, your doctor may prescribe some antiviral information. 

Who Should Be Tested For Hepatitis B

Get tested if:

• You live in close proximity with someone who has been diagnosed with hepatitis B.

• You are a family member, caregiver or very close friend of anyone who has been diagnosed with hepatitis B.  

• Sexual partners of hepatitis B carriers.

Note: Take precautions that other people’s blood and body fluids may be infected with hepatitis B or other blood borne disease until a test says otherwise.