Hepatitis B: Causes, Stages, Symptoms, Treatment and Vaccine

Hepatitis B - STDTestGuru
Hepatitis B – STDTestGuru

Hepatitis B – a liver infection caused by the hepatitis B virus (HBV) and this can be prevented easily by a vaccine. It is transmitted when the blood, semen, or other body fluids from a person infected with the virus enter the body of someone who is not infected. It can happen during sex, sharing needles/syringes, or drug-injection equipment, and even from a mother to baby at birth. WHO estimated that 296 million people were living with chronic HBV infection in 2019. Hepatitis B is a major global health problem and affects people of all ages around the world.

What is Hepatitis B?

This infection is short-term in the beginning and, in some people, the virus remains in the body and causes chronic, or lifelong infection. Acute hepatitis B takes place within the first 6 months after someone is exposed to HBV. Some people have no symptoms at all or only mild illness. When acute hepatitis B leads to a life-long infection, it is known as chronic hepatitis B. This can be life-threatening and causes serious health problems, including liver damage, cirrhosis, or liver cancer.

A person is at more risk if they inject drugs, are a sex worker, change partners frequently, are a man who has sex with men, or someone who is in close contact with an infected person. This infection can be prevented by vaccines that are considered to be safe. The vaccine offers 98% to 100% protection against HBV.

Hepatitis B Causes

Caused by the hepatitis B virus (HBV) and it is spread through to blood, semen, and other bodily fluids of an infected person. This infection is highly contagious and the virus can live outside the body for up to seven days.

Hepatitis B virus can spread through:

  • Unprotected sex (oral, vaginal, and anal sex)
  • Direct contact with infected blood or open sore
  • Needles and syringes contaminated with infected blood
  • Sharing items like toothbrushes, razors, jewelry for piercings, nail clippers, or medical equipment (like a glucose monitor)
  • An accidental stick with a needle that was used on an infected person (healthcare workers)
  • Getting a tattoo or piercing with tools that were used on an infected person
  • An infected woman who is pregnant can pass on the infection to their babies

Hepatitis B virus will not spread through sharing eating utensils, food or water, breastfeeding, hugging, kissing, shaking hands or holding hands, sitting next to the infected person, coughing, or sneezing.

Stages of Hepatitis B

Hepatitis B can be both acute and chronic. The risk for chronic infection is linked to age at infection. Nearly 90% of infants with hepatitis B develop chronic infection, and only 2% – 6% of adults become chronically infected.

Acute stage

The acute stage of hepatitis B takes place within the first 6 months after someone is exposed to the virus. Some people have no symptoms or only mild illnesses. When a person is infected, their immune system can clear acute hepatitis B and they will recover completely within a few months. Hospitalization is required when acute hepatitis B causes a more severe illness.

Chronic Stage

When acute hepatitis B leads to a life-long infection it is said to be chronic hepatitis B. This stage will last six months or longer as the immune system can’t fight off the infection. When a person gets infected in their adulthood, they can clear the virus from their bodies without treatment in some cases. Chronic HBV infection can be life-threatening and can cause serious health problems, including liver damage, cirrhosis, or liver cancer. Proper treatment can slow disease progression and reduces the chance of liver cancer and increase the chances of surviving.

Symptoms of Hepatitis B

Mostly, people do not experience any symptoms. However, some may have acute illnesses with symptoms that last several weeks. For children younger than 5 do not have symptoms if they’re infected.

Common symptoms may include:

  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Fever
  • Extreme fatigue
  • Joint pain
  • Loss of appetite
  • Nausea or vomiting
  • Diarrhea
  • Constipation
  • Jaundice

Symptoms of chronic HBV infection do not always show up. But, when they show up, they may be like those of acute infection.

Hepatitis B: Causes and Symptoms
Hepatitis B: Causes and Symptoms

Testing for Hepatitis B

Doctors may conduct a complete physical exam and a blood test is done to check if the liver is inflamed. Following is the test that can help diagnose the infection.

  • Blood tests – Blood tests will detect signs of HBV and helps the doctor to know whether it’s acute or chronic. The blood test also determines if a person is immune to the condition.
  • Liver ultrasound – Transient elastography helps to show the amount of liver damage.
  • Liver biopsy – The doctor might remove a small sample of the liver for testing to check for liver damage.

When a person has symptoms and high levels of liver enzymes, they will be tested for:

  • Hepatitis B surface antigen & antibody (HBsAg) – They show up in your blood between 1 and 10 weeks after exposure. Antigens are proteins on the HBV and antibodies are proteins made by immune cells.
  • Hepatitis B surface antibody (anti-HBs) – When HBsAg disappears these show up. And these antibody makes a person immune to hepatitis B.

Who should get screened for hepatitis B?

  • People who born in regions/countries where hepatitis B is common
  • Men who have sex with men
  • People who had sex with someone who has hepatitis B
  • HIV-positive people
  • A person who injects drugs
  • People who live with hepatitis B infected person
  • All pregnant women

Is hepatitis B curable?

Currently no cure for HBV, but getting vaccinated can prevent initial infection. Chronic infections can be treated with antiviral medications. If chronic HBV infection causes permanent liver damage, then undergoing a liver transplant will help to improve long-term survival.

Treatment

Doctors may usually recommend rest, adequate nutrition, and fluids for people with mild symptoms. Hospitalization is required when acute hepatitis B causes a more severe illness.

If left untreated, chronic HBV infection can cause cirrhosis, which can cause the liver to stop working properly. The infected person may need a liver transplant when the infection has severely damaged the liver. Only a small number of people with cirrhosis develop liver cancer, and these complications can lead to death.  Proper treatments will help to relieve some of the symptoms.

People diagnosed with hepatitis B should get vaccinated against hepatitis A. And they must be tested for hepatitis C and must avoid drinking alcohol, should follow a healthy diet, and stay physically active, especially in patients who are overweight. An infected person needs to check with a health professional before taking any prescription pills, nutritional or herbal supplements.

Medication

Most of the time people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. Treatment for chronic HBV infection may include oral antivirals and immune modulators.

Approved drugs for adults

Currently, there are 7 approved drugs in the US for adults living with chronic HBV infection. This includes 5 antiviral drugs and 2 immune modulator drugs called interferon.

Oral Antivirals:

  • Tenofovir disoproxil (Viread) – The pill is taken once a day, for at least one year or longer. This is a first-line treatment.
  • Tenofovir alafenamide (Vemlidy) – The pill is taken once a day for 6 to 12 months.
  • Entecavir (Baraclude) – This pill is taken once a day for at least one year or longer.
  • Telbivudine (Tyzeka or Sebivo) – This pill is taken once a day for at least one year or longer. This is a second-line treatment.
  • Adefovir Dipivoxil (Hepsera) – This pill is taken once a day for at least one year or longer. The patients must have their kidney function monitored regularly.

Common side effects of the antivirals include nausea, diarrhea, headache, stomach pain, weakness, sleeping problem, fever, and skin rash. Not everyone should be treated, so it’s essential to consult a doctor to check whether you are a good candidate for treatment.

Immune Modulators:

  • Pegylated Interferon (Pegasys) – This is given by injection once a week usually for 6 months to 1 year. The side effects include flu-like symptoms and depression.
  • Interferon Alpha (Intron A) – This is given by injection several times a week usually for 6 months to 1 year. And this treatment can be longer. The side effects include flu-like symptoms, depression, and headaches (rarely used).

Approved drugs for children

Chronic HBV infection is mild and does not have visible signs or symptoms in children and teens. Only in rare cases, they may require immediate medical intervention and treatment. Not everyone should be treated, so it’s essential to consult a pediatric liver specialist and decide whether he or she is a good candidate for treatment. Currently, there are 5 approved drugs in the US for children living with this infection.

Oral Antivirals and Immune Modulators

  • Entecavir (Baraclude) – This pill is taken once a day for at least one year or longer. This first-line treatment is for children 2 years and older.
  • Tenofovir disoproxil (Viread) – The pill is taken once a day for at least one year or longer. This first-line treatment is for children 12 years and older.
  • Peginterferon alfa-2a (Pegasys) – This is an injection given once weekly for 6 months to 1 year. May include flu-like symptoms. And the children must closely be monitored by a liver specialist with regular visits and blood tests.
  • Lamivudine (Epivir-HBV, Zeffix, Heptodin) – The pill is taken once a day for at least one year or more. This is a second-line treatment.
  • Interferon-alpha (Intron A) – This is an injection usually given three times a week for 6 months to 1 year. Children generally experience flu-like symptoms and must be closely monitored by a liver specialist with regular visits and blood tests (usually not prescribed).

Hepatitis B Prevention

  • Get the hepatitis B vaccine
  • Practice safe sex
  • Wear gloves while cleaning up after others, especially if it’s bandages, tampons, and linens
  • Prefer getting tattoos or piercings only at shops that employ safe hygiene practices
  • Should avoid share razors, toothbrushes, nail care tools, or pierced earrings
  • Do not share chewing gum
  • Don’t pre-chew food for a baby

Complication

  • Hepatitis D can only occur in people with hepatitis B
  • Cirrhosis
  • Liver cancer
  • Liver failure
  • Kidney disease
  • Blood vessel problems

Hepatitis B Vaccine

The vaccine is typically given as three or four injections over six months. It’s essential to complete the series of shots to be fully protected. Hepatitis B vaccine is considered to be totally safe for most people. Like all other medicines, people may have some mild side effects like soreness, change in skin color, swelling, or itching around where you get the shot, or a slight fever. They usually go away pretty quickly.

Who should get the hepatitis B vaccine?

  • All infants, at the time of birth
  • Children & adolescents who weren’t vaccinated at birth
  • Adults being treated for a STIs
  • All healthcare workers
  • HIV-positive individuals
  • People with chronic liver disease
  • People who are in jail or prison
  • Men who have sex with men
  • People with multiple sexual partners
  • A person who injects drugs
  • Family members of those with HBV infection
  • International travelers to countries where HBV is common

Hepatitis B and Hepatitis C

Among patients with chronic HBV infection, the rates of HCV co-infection vary from 9% to 30%. Hepatitis B virus and hepatitis C virus share a similar mode of transmission. The majority of those coinfected with HCV and HBV acquired these viruses through intravenous drug use, exposure to dirty needles, unsterilized medical equipment, and unscreened blood products. HBV and HCV co-infection can lead to severe liver disease and an increased risk for progression to liver cancer. As there is no vaccine against hepatitis C, people with hepatitis C should be vaccinated against hepatitis B to prevent co-infection.

Hepatitis B and HIV

Both share a similar mode of transmission. The most common routes of transmission of the HBV among those infected with HIV is through sexual activity or injection drug use. Tenofovir, incorporated in the treatment combinations recommended as first-line therapy for HIV infection, is also active against HBV. An infected person needs to undergo antiretroviral treatment as prescribed, as it’s the best way to stay healthy with HIV and hepatitis B co-infection.

Hepatitis B during pregnancy

Babies born to an infected mother have a 90% chance of developing chronic HBV infection if they are not properly treated at birth. It is necessary for all pregnant women must be tested for HBV. The first-line antiviral therapy with tenofovir (TDF/Viread) is recommended starting from week 28 of pregnancy until delivery. And may continue for 3 months postpartum. However, pregnant women diagnosed with this infection must be referred for follow-up care with a physician who is skilled at managing this infection. Babies born to infected women should receive a birth dose of the vaccine within 24 hours of delivery.

Hepatitis B Statistics
Hepatitis B Statistics

Facts about Hepatitis B

  • As per WHO, 296 million people were living with chronic HBV infection in 2019.
  • Hepatitis B vaccine offers 98% to 100% protection against the infection.
  • Around 1% of persons living with HBV are infected with HIV.
  • According to CDC, 862,000 people were living with HBV infection in 2016.
  • About 1,649 U.S. death certificates had recorded HBV as an underlying or contributing cause of death in 2018.

Other topics you might be interested in:-