The World Health Organization (WHO) has set a goal to eradicate viral hepatitis by the year 2030. WHO plans to achieve this by universal vaccinations against hepatitis B infection and through increasing awareness on the disease in communities.
Hepatitis B virus is one of the most common infectious agents that affects the liver and may result in shrinking of the liver (Cirrhosis) and liver cancer. Hepatitis B infection is a vaccine-preventable disease. Inasmuch as it is a disease that can be prevented by taking full dose of the vaccine, every year, millions of people die due to hepatitis B related diseases because of the lack of awareness on preventive measures and poor access to early treatment.
Where is hepatitis B found
Hepatitis B virus is found in body fluids such as blood, saliva, semen, urine and sweat. Hepatitis B virus in body fluids may remain on surfaces or objects for a long time and then get into another person when there is contact between the infected object and broken skin.
The virus is transmitted through contact with infected body fluid if there is a break in the skin. It may also be transmitted by sexual intercourse or insemination with the sperm of an infected male. This is the reason sperm banks have to screen sperm donors for hepatitis B before they can donate.
Hepatitis B may be transmitted through the use of a sharp object that has been used by an infected individual. For instance, if a hepatitis B positive individual used a blade or nail cutter and gets a cut on his/her skin in the process, if another person who is not infected used the same instrument, he/she may contract the disease.
Vertical transmission of hepatitis B refers to transmission from an infected mother to the child during pregnancy or delivery. This can be prevented by the administration of hepatitis B immunoglobulin and the vaccine to the child within seventy-two hours of birth.
Hepatitis B is more common in developing countries because of misconceptions about vaccinations resulting in refusal to accept vaccines, lack of access to vaccinations in some places and some cultural practices that encourage sharing of unsterilized sharp objects such as pins, needles and razor blades.
Which people who are at higher risk of getting infected with Hepatitis B virus?
- People that work in healthcare settings such as medical doctors, nurses, medical laboratory scientists, health assistants etc.
- People who abuse intravenous drugs because they tend to share needles among each other particularly when they are under the influence of the illicit drugs.
- Commercial sex workers
- People with kidney failure receiving dialysis
- People living with HIV or hepatitis C infection. Infection with any of these two increases risk of co-infection with hepatitis B virus.
- People who have blood problems that may need frequent blood transfusions. Example people with sickle cell disease and leukaemia.
- Homosexuals (Men who have sex with men) are at higher risk than heterosexual men.
- People whose spouses or partners are hepatitis B positive and have not been vaccinated.
What happens when you get infected with Hepatitis B virus?
When one gets infected with the virus, the immune system tries to fight off the virus by sending out cells to fight and producing certain chemicals which help to destroy the virus and prevent it from gaining root in your body. If your body wins this fight, it will produce certain proteins called antibodies which show that you have built immunity against the virus. In this case, Hepatitis B goes away on its own without the individual needing medications. This process may occur without any serious signs or symptoms. This is usually the case in about 90 percent of healthy people that have been exposed to hepatitis B virus.
In a smaller set of healthy individuals, the body loses the fight and the virus therefore incorporates itself into your body cells and begins to multiply itself. It goes to other organs through the blood stream including the liver and kidney. Hepatitis B virus is called a hepatotrophic virus because it often affects the liver more than it affects any other organ.
It may cause an acute hepatitis which is swelling of the liver associated with fever, tummy pain, body weakness, bleeding from different body orifices and may even lead to coma and death. Acute hepatitis may become fatal if not identified and treated promptly. After recovery from acute hepatitis, the body may have been able to surmount the infection and gotten rid of the virus.
It may continue to multiply and overwhelms your immune cells such that they stop fighting or the immune cells continue to fight to get rid of it. When your immune cells continue to fight, it may reduce the multiplication of the virus but does not kill it off completely.
On the other hand, the virus may multiply rapidly without any opposition if the immune system stops trying to destroy it. This is called the immune-tolerant phase of the infection. At this stage, treatment needs to commence immediately to stop the multiplication of the virus and avoid complications such as liver cancer.
What is Chronic Hepatitis B infection?
If the body does not surmount the infection in the first 6 months of the infection, the individual is said to have Chronic Hepatitis B. This is confirmed by the presence of specific proteins called antigens and/or antibodies.
Living with chronic hepatitis B infection increases the risk of death from hepatitis B related cancers and liver disease.
When do you need to be treated for hepatitis B infection?
The decision of your doctor to commence treatment or not depends on the results of the tests that s/he will request after you get result that shows “hepatitis B surface antigen (HbsAg) reactive”.
These tests include hepatitis B viral profile consisting of tests for antigens and antibodies that show if the virus is currently actively multiplying or not, if you are highly infectious or not and if it is a new infection less than 6 months or a chronic infection.
Liver function test is another blood test that shows if your liver function has been affected by the infection. If this is the case, then treatment may commence immediately.
Hepatitis B viral load shows the amount of the virus in the system. Treatment guidelines recommend levels at which treatment must commence and when treatment may be withheld while still monitoring the person every 3 to 6 months.
Hepatitis B virus vaccine
Hepatitis B virus vaccine was introduced into the National Program on immunization in Nigeria in 2005. Since then, any child that comes to a healthcare facility for routine vaccination gets hepatitis B virus vaccine free of charge.
There are two types of hepatitis B vaccine, the most recent type which is the 2-dose vaccine was licenced for use in adults in 2017.
Energix-B (alumadjuvant) vaccine: Is the 3-dose vaccine which is given at month zero, one and six. Four weeks after the first dose, you should take the second dose and the 5 months after the second dose which is 6 months after the first, you take the 3rd dose.
Teplisav B (Cytosine Phosphoguanine adjuvant-CpG) vaccine: Is given at contact and then 4 weeks later. People are more likely to get complete doses of this vaccine than the Energix-B vaccine for obvious reasons.
In conclusion, hepatitis B infection is a vaccine preventable disease. Infection with the virus can be easily missed as most people do not have profound symptoms when infected. Therefore, you should check your status routinely especially if you are at risk of contracting the disease by virtue of your occupation or health condition or habits. If your results show you are not infected, go ahead and get the vaccine immediately. Ensure you complete the doses.
Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.