Hepatitis B(serum Hepatitis); Types, mode of transmission, signs and symptoms,prevention and management.

HEPATITIS B

Also known as SERUM HEPATITIS and also one of the leading viral hepatitis. It is a systematic, viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical and cellular changes.

It has been known to be the fastest spreading virus in the world today. It is gradually claiming lives due to its long incubation period. It is 100 times more transmissible than HIV/AIDS virus with about 2 million fatalities is recorded each year across the globe and it is one of the leading Occupational Hazards for Health Practitioners.

It is found in semen, blood, vagina fluids, and can be contacted through needle sharing, use of sharps, blood donors. It clears up within two to three months. If not cleared ,It developed to  Chronic after 6 months. It can withstand outside the body for 7 days

TYPES

ACUTE HEPATITIS: This starts from the period of exposure till 6 months. Normally, the illness is expected to go on its own if the individual develop a strong immune response as it is the major determinant of the outcome in acute hepatitis B. However, these patients also are more likely to develop more severe liver injury and symptoms due to the strong immune response that is trying to eliminate the virus. On the other hand, a weaker immune response results in less liver injury and fewer symptoms but a higher risk of developing chronic hepatitis B. People who recover and eliminate the virus will develop life-long immunity, that is, protection from subsequent infection from hepatitis B.

CHRONIC HEPATITIS: This is when the infection last longer than 6 months .Patients with chronic hepatitis B develops symptoms in proportion to the degree of abnormalities of the Liver cells. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from mild, moderate and severe liver disease.

Most individuals with chronic hepatitis B remain symptom free for many years or decades. During this time, the patient’s liver function tests usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or symptoms, putting them at risk for developing cirrhosis.

 

MODE OF TRANSMISSION

Unlike hepatitis A, which is transmitted primarily by the fecal–oral route, hepatitis B is transmitted primarily through:

  • blood
  • Saliva
  • Semen
  • Vaginal secretions
  • Mucous membranes
  • Breaks in the skin.
  • Unprotected sex
  • Mothers to their babies through placenta or umbilical vein at the time of birth HBV has a long incubation period.

It replicates in the liver and remains in the serum for relatively long periods, allowing

transmission of the virus.

 

RISK FACTORS

  • Frequent exposure to blood, blood products and other body fluid.
  • HEALTH Care Workers E.g, Surgeons, Doctors, Nurses, Lab Scientist and other peoples who are exposed to needle pricks.
  • Hemodialysis Patients and their Health workers
  • Homosexuals and Bisexual men.
  • Multiple Sexual partners
  • Recent history of sexually Transmitted Disease
  • Frequent Blood Donors and recipients
  • Injection Drug Users
  • People with chronic Liver disease
  • HiV /AID patients. About 1% of people living with hepatitis B are also infected with Hiv

INCUBATION PERIOD

Symptoms may set in with 25 to 180 days from the day of Exposure.

 

SIGNS AND SYMPTOMS

  • Nausea and Vomiting
  • Jaundice- This is yellowing of the eyes and Skin
  • Abdominal Pain in the upper and lower abdominal quadrant due to inflamed liver.
  • Anorexia- Loss of Appetite
  • Joint pain
  • Spleenomegally (enlargement of the spleen)
  • Hepatomegally(enlargement of the Liver)
  • Rashes
  • Puiritis
  • Abnormal coloration of the stool and urine
  • Bleeding problem if it have become a fulminant hepatitis.
  • Coma as a result of Liver failure.

 

 

DIAGNOSIS

  • Physical Examination- Here the Doctor makes some subjective findings as well as examines the patient objectively.
  • Blood test- This is done to rule out other differential diagnosis.
  • Liver function Test
  • Live Biopsy

EPIDEMIOLOGY AND PROGNOSIS

It is a global occurrence commonly found in Asia part of the world, transmitted mostly from mothers to their child before the age of 5 years. 5% of cases develop into chronic hepatitis. Over 257 Million are estimated to be a carrier of Hepatitis B while about 887 thousand deaths are said to occur as a result of its complication. Children who are infected with hepatitis are most likely to develop chronic hepatitis.

Some patients may develop acute Liver failure from acute hepatitis and can lead to death.

COMPLICATIONS

  • Liver cirrhosis. This is known as scarring of the Liver
  • Liver Cancer known medically as hepato-carcinoma.
  • Liver Failure
  • Death

PREVENTION

  • Vaccination-It is given as 3 doses; at birth, a months and 6 months from each last dose this also applies to those who have not been vaccinated before. This has been made available since 1982 which gives the child immunity and as well prevent the infection from developing to chronic disease.
  • Practicing safer sex through the use of condom in vagina, oral sex, and anal sex,a voiding multiple sexual partner.(search for safe sex to read more here).
  • WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. The low incidence of chronic HBV infection in children under 5 years of age at present can be attributed to the widespread use of hepatitis B vaccine. Worldwide, in 2015, the estimated prevalence of HBV infection in this age group was about 1.3%, compared with about 4.7% in the pre-vaccination era. The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate:
  • The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is probably for a life time. Thus, WHO does not recommend booster vaccination for persons who have completed the 3 dose vaccination schedule.

MANAGEMENT

 

Self Care: This includes but not limited to:

  • Bed rest
  • avoidance of alcohol
  • Eaten more of fruits, vegetables and other foods that aid in regeneration of the Liver cells.
  • Abstinence from sexual Intercourse and other mode of transmission.
  • Strict adherence to Doctor’s appointment, nurses’ instructions, and drug schedule.

MEDICAL MANAGEMENT

The goals of treatment are to minimize infectivity, normalize liver inflammation, and decrease symptoms.

ALPHA INTERFERONS: This is single modality of therapy mainly used in treating of chronic hepatitis. This regimen of 5 million units daily or 10 million units three times weekly for 4 to 6 months results in remission of disease in approximately one-third of patients (Befeler & Di Bisceglie,2000). The long-term benefits of this treatment are being assessed. Interferon must be administered by injection and has significant side effects, including fever, chills, anorexia, nausea, vomiting, fatigue, sleep disturbances etc. Late side effects are more serious and may necessitate dosage reduction or discontinuation. These include bone marrow suppression, thyroid dysfunction, alopecia, and bacterial infections.This wears away within few weeks.

DRUGS: Two antiviral agents (lamivudine [Epvir] and adefovir [Hepsera])oral nucleoside analogs, have been approved for use in chronic hepatitis B . Measures to control the dyspeptic symptoms and general malaise include the use of antacids and antiemetic, but all medications should be avoided if vomiting occurs. If vomiting persists, the patient may require hospitalization and fluid therapy.

 

DIET RESTRICTION: Diet high in protein should be restricted because of the liver inability to metabolize it.

Liver transplant– This is sought as a last resort after all other measures failed.

WHO response

In March 2015, WHO launched its first “Guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection”. The recommendations:

  • promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment;
  • prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and
  • recommend the preferred use of the nucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged between 2–11 years) for first- and second-line treatment.

These guidelines also recommend lifelong treatment in those with cirrhosis; and regular monitoring for disease progression, toxicity of drugs and early detection of liver cancer.

In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2020”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.

To support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030, WHO is working in the following areas:

  • raising awareness, promoting partnerships and mobilizing resources;
  • formulating evidence-based policy and data for action;
  • preventing transmission; and
  • scaling up screening, care and treatment services.

WHO also organizes World Hepatitis Day on July 28 every year to increase awareness and understanding of viral hepatitis.

 

 

 

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