May 24, 2022
Hepatitis B is present in roughly 3% of general population, i.e. 3 out of 100 persons we see daily. Most (95%) of the infected persons are not aware that they are infected. It can cause chronic (long term, usually life long) infection and can put the person to risk of death from cirrhosis or cancer. It is usually detected incidentally during routine health check up for any reason, workup for cause of deranged blood test (liver function test), cirrhosis (scarring) of liver or liver cancer.
Hepatitis B is infection of liver caused by hepatitis B virus (HBV) which causes liver cell injury and can lead to acute infection, chronic infection (i.e. hepatitis B surface antigen HBsAg is positive for more than 6 months), cirrhosis (scarring) of liver and liver cancer.
Hepatitis B infection occurs by contact with body fluids of infected person e.g. blood, semen, vagina fluid, menstrual fluid or saliva. This is usually acquired from infected mother to child during delivery, by having sex without condom with infected person, sharing infected needle/syringe used for drug injection, getting tattoo or piercing from infected needle and sharing razor, nail clipper or toothbrushes. All blood available in blood banks is routinely screened for hepatitis B along with other infectious organism (hepatitis C, HIV, etc.)
If HBV infection occur at birth from infected mother or in childhood (<5yr age) from infected person, it usually persists for many years in form of chronic hepatitis B (i.e. 90% and 30% respectively). These patients usually remain symptom free till patients develop advanced disease like cirrhosis or cancer. Infection in adult age usually last for short duration (acute hepatitis B) but can last for many years (chronic hepatitis B in 5%). Acute hepatitis B can present with symptoms like fever, bodyache, tiredness, weakness, abdominal (tummy) pain, nausea, vomiting, decrease appetite, dark color urine or yellow color eyes (jaundice). Jaundice usually appears once other symptoms starts to disappear. These patients usually clear virus in 1-6 months but it can persist for long in form of chronic hepatitis B (if HBsAg is positive after 6month) in 5%. If person present in advanced disease then he/she can have jaundice, abdominal distension, blood vomiting, black or red color stool, altered sensorium, decrease appetite, weight loss, etc.
Hepatitis B is usually diagnosed if HBsAg blood test is positive. If it is positive, then you need further testing by HBV markers to detect whether you have acute or chronic infection and active or inactive infection. You also need certain test to know extent of liver damage like liver function test, prothrombin time, ultrasound, endoscopy, fibroscan or liver biopsy.
Hepatitis B vaccine is fairly safe method to get protection against hepatitis B. Usually three doses of hepatitis B vaccine (0, 1, 6 moths) gives long lasting immunity (atleast 20 years or probably lifelong) against hepatitis B with efficacy of 95% in preventing infection. Hepatitis B vaccination is available in national immunization schedule also. First dose of hepatitis B vaccine should be given to all newborn at birth. World health organization (WHO) recommends vaccination of all non-vaccinated children, adolescents or adults. WHO has chosen a strategy to eliminate hepatitis B from world by 2030 by vaccinating all non-infected people, test all (with HBsAg test) and treat those who are eligible for treatment. WHO celebrates 28th July every year as World Hepatitis Day to increase awareness of viral hepatitis (hepatitis B and C). All blood donations are routinely screened for hepatitis B along with other infections prior to transfusion to ensure safety and avoid accidental transmission.
All HBsAg positive persons are potential source of transmission. Most of infected persons are not aware of their infection so best way to prevent yourself getting infection is hepatitis B vaccination. If your Anti-HBs titre is >10 mIU/ml that means you have immunity. If you get exposed to any body fluid of infected person, contact doctor immediately. You may require certain medicines to prevent you from getting infection. Even if you have received HBV vaccination properly do contact doctor for checking your immunity status.
Medications are available like oral antivirals (Entecavir, Tenofovir, etc) or injectable (Pegylated-interferon) which suppress the replication of virus and improves the long term survival but medications do not cure person from hepatitis B virus. These oral medications need to be taken for many years. Medications needs to be started after proper testing and justification of need of medication because all infected persons do not medication but they do need repeated testing and follow up.
Hepatitis B infection cannot get from touching, handshaking, hugging, sharing food or utensils, using same toilet or cough. Hepatitis B usually do not cause symptoms and most of person with hepatitis b infection are not aware of having infection. If you are infected with hepatitis B infection does not mean that you need medication for that.
DR VISHAL KHURANA
MBBS, MD (Medicine), DM (Medical Gastroenterology), MNAMS
Senior Consultant- Gastroenterology