World Hepatitis day- Management and treatment of Hepatitis b Virus

HEPATITIS B VIRUS

Hepatitis B Virus is an Infection which results to the Inflammation of the Liver cells. 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 can withstand outside the body for 7 days

 

TYPES

Acute Hepatitis– Is insidious in onset and last lesser than 6 Months. Here the Liver cells are meant to recover at this stage if the immune system was able to fight the virus. Most of the Adult (90%) with Hepatitis B virus fall under this category.

Chronic Hepatitis– Is when the infection last longer than six months. This is because of the inability of the immune system to fight the infection thereby leading to complications.50% of iInfants and under-5 children are liable to have this type of hepatitis.

 

CAUSATIVE ORGANISM

It is caused by Hepatitis b virus. About one-third of people worldwide have been infected with HBV once in their life.

RISK FACTORS

Because the Hepatitis B virus (HBV) is transmitted from person to person by bodily fluids such as blood, semen, saliva etc, you are at risk if you:

  • Have unprotected sex;
  • Have multiple sexual partners;
  • Are a homosexual or engage in Anal sex
  • Are Blood donor or recipient;
  • Share needles and sharps with others;
  • Engage in illicit drug;
  • Are Health practitioner or have an accidental needle stick;
  • Are an Infant born to an Infected mother;
  • Travel to places where HBV is endemic.
  • Are a Prisoner.
  • Have previously be diagnosed of Sexual transmitted disease
  • HIV /AID patients. About 1% of people living with hepatitis B are also infected with HIV

 

However, it cannot be contacted with holding hands, hugging, superficial kiss, sharing cooking utensils etc.

MODE OF TRANSMISSION

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.

 

 

CLINICAL MANIFESTATIONS

This is unique to individuals as some may be asymptomatic. Symptoms range from mild to severe which appear between 1 -4 months.

  • Tenderness of the liver (Hepatomegally)
  • Enlargement of the spleen (Spleenomegally)
  • Abdominal pain at the right upper quadrant
  • Jandice (Yellowing of the scelera part of the eye, nails and body)
  • Pruritus or Itching
  • Dark colored Urine
  • Clay colored stool
  • Diarrhea or constipation
  • Nausea and vomiting
  • Anorexia
  • Flatulence
  • Weight loss
  • Fever
  • Irritability
  • Fatigue
  • Haematuria
  • Malaena

COMPLICATIONS

  • Fulminant Hepatic failure
  • Post hepatitis syndrome
  • Aplastic anemia
  • Cirrhosis (scarring) of the Liver
  • Liver cancer (hepato-carcinoma)
  • Death

DIAGNOSIS

  • Physical Examination- Here the Doctor makes some subjective findings as well as examines the patient objectively.
  • Blood test will reveal HbSAg serum antigen- antibody reaction, increased level of SGOT and SGPT (also known as AST and ALT respectively), increased serum bilirubin and Increase of prothrombin time.
  • Urine test will reveal an increase level of urobilinogen at the initial stage after which bilirubin may appear.
  • Abdominal Ultrasound- To detect the extent of liver damage
  • Liver biopsy

PREVENTION

To prevent you from being infected with Hepatitis B, It is advocated that:

  • All Individuals who are at risk should be vaccinated
  • Standard precautions should be observed by Healthcare worker caring for a suspected or confirmed hepatitis Patient.
  • Avoiding multiple Sexual partners.
  • Making use of condom with water base lubricant during sex.
  • Avoiding unprotected oral or anal sex.
  • Lifestyle modifications like avoidance of illicit drug use, risky sex, body piercing and tatooing.
  • Wash your hands thoroughly with soap and water after any potential exposure to blood
  • Avoid direct contact with blood and bodily fluids
  • Clean up blood spills with a fresh diluted bleach solution (mix 1 part bleach with 9 parts water)
  • Cover all cuts carefully.
  • Avoid sharing sharps such as razor, clippers, shaving bic, tooth brush etc
  • Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture.

VACCINATION

The hepatitis B vaccine is also known as the first “anti-cancer” vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide. This is recommended for all:

  • New born babies
  • Children and Adolescent who are yet to be vaccinated
  • Homosexual men, Heterosexual men who engage in anal sex or have multiple sexual partners
  • All Healthcare workers
  • Those at risk of Hepatitis.
  • Those with HIV and Hepatitis C Infection
  • Travelers travelling to Hepatitis endemic areas.
  • Blood Donors or Organ Donors.

N.B– Common side effects of HBV vaccine include soreness and inflammation at the injection site. The vaccine has been in used since 1986 and there have not been evidence of getting infected with HBV infection.

Nevertheless, the vaccine does not protect someone who has already been exposed to the infection though someone who is exposed in lesser than 24 hours can also benefit from the vaccine this is known as Prophylaxis.

HEPATIS VACCINATION SCHEDULE

DOSE TIME AND DURATION
1st Dose At birth, > 12hrs post Exposure, 1st contact
2nd Dose 4weeks or 28 days after the 1st  dose
3rd Dose 2 months after 2nd dose for adults or when the infant is 24 week old

You do not need to restart the hepatitis B vaccine series if you miss any of the doses. For example, when you break the vaccine series, you will have to get the second dose when you can and make sure to get the third dose at least two months later. Or, if you get the first two doses of vaccine and miss the third dose, then just schedule the last shot when you can.

 

MANAGEMENT

Acute HBV infection are short lived and it is expected that patient recover after sometimes. Self Care is recommended. This includes but not limited to:

  • Rest and Sleep
  • Adequate fluid Intake
  • avoidance of alcohol
  • Eaten more of fruits, vegetables and other foods that aid in boasting immune system and 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

During Chronic Infections, hospital Admission is recommended for observation as well as to avoid complications. The goals of treatment are to minimize infectivity, normalize liver inflammation, and decrease symptoms. Treatment Includes:

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

IMMUNE MODULATORS(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: entecavir, tenofovir , lamivudine, adefovir, telbivudinehave 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.

LIVER TRANSPLANT – This is the last resort after all other measures have failed. It is the process of replacing the damaged liver with a healthy one which is usually from a donor (deceased or alive).

 

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
  • Increasing screening, care and treatment services.

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

With  2020 theme, “FIND THE MISSING MILLION”. According to World Hepatitis day Organization,”290 million people worldwide are living with viral hepatitis unaware.Without finding the undiagnosed and linking them to care, millions will continue to suffer and lives will be lost”.

 

 

 

2 Comments

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