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Few numbers. Hepatitis B is curable in 90% of cases. But 10% of people after treatment remain carriers of the virus – their blood can be infected for months, years, and sometimes for life. Why they still have the virus is not known for certain.
70% of carriers develop chronic persistent hepatitis B. They look healthy, the liver does not bother them, or it makes itself felt, but very rarely. The remaining 30% of carriers constantly suffer from liver diseases. They may eventually develop cirrhosis and then, 30 to 40 years later, liver cancer.
There is currently no treatment for carriers. The risk of becoming a chronic carrier is inversely proportional to the age of the infected person. For example, infants become carriers 90-95% of the time, while adults only become carriers 3-10%.
Viral hepatitis is an infectious disease that primarily affects the liver. The provocateur of this infection is the hepatitis B virus (HBV), which enters the body through blood, saliva or semen, and then reaches the liver with the bloodstream.
There are several defense mechanisms in the body to fight disease. White blood cells, which protect the body from infections, attack and destroy infected liver cells. In addition, our immune system produces antibodies that circulate in the blood to destroy the virus and protect against subsequent infection.
The incubation period (the time between initial exposure to the virus and the onset of illness) for hepatitis B is 60 to 150 days. Symptoms appear on average 90 days after infection.
The blood is the main source of the hepatitis B virus. It can also be found in other tissues and body fluids, but at lower concentrations.
The hepatitis B virus can be transmitted in several ways.
Through the blood. This can happen in the following cases:
- skin punctures with infected needles, lancets, scalpels or other sharp objects;
- direct contact with open sores of an infected person;
- splashes of infected blood on the skin with small scratches, abrasions, burns, or even minor rashes;
- splashes of blood on the mucous membranes of the mouth, nose or eyes;
- using someone else’s toothbrushes or razors.
Contact with blood-contaminated surfaces can also lead to disease, but to a lesser extent.
By the way, the virus can remain stable in dried blood for up to 7 days at 25 °C.
Hand contact with blood-contaminated surfaces, such as laboratory tables, test tubes, or laboratory instruments, can transmit the virus to the skin or mucous membranes.
Through saliva. The saliva of people with hepatitis B may contain the virus, but at very low concentrations compared to blood. Nevertheless, infection is possible, for example, through bites.
But it is impossible to get infected through dishes or mouthpieces (smoking or musical instruments) – such cases have not been registered.
Through semen or vaginal secretion. Hepatitis B is found in semen and vaginal secretions. The virus can be transmitted during unprotected intercourse and from mother to child during childbirth.
Feces, nasal discharge, sputum, sweat, tears, urine, and vomit are not involved in the spread of hepatitis B. If they are not contaminated with blood, the risk of contracting hepatitis B from these fluids is very low.
Synovial fluid (joint lubricant), amniotic fluid, cerebrospinal fluid, and peritoneal fluid (found in the abdomen) may contain hepatitis B virus, but the risk of transmission is unknown.
Hepatitis B is not spread through sneezing, coughing, shaking hands, hugging, kissing, breastfeeding, sharing cutlery, water or food.
The main symptoms of hepatitis B include:
- dark urine;
- clay-colored stools (grey-white);
- jaundice;
- heat;
- joint pain;
- abdominal pain;
- fatigue;
- lack of appetite;
- nausea, vomiting.
Symptoms may vary depending on the person’s age. Many people may not show symptoms (asymptomatic).
A very small proportion of patients develop a critical form of the disease called fulminant hepatitis B. This condition occurs as a result of a sudden malfunction of the liver.
As already mentioned, in 90% of cases, viral hepatitis B is curable. And if immunoglobulin is introduced into the body within 12 hours after contact with the carrier, the development of the disease can be prevented.
Diagnostics
There are tests (blood tests) to identify the hepatitis B virus – they show if there is an infection in the tissues or blood. The amount of antigen of each type shows how advanced the disease is and how infectious the person is.
There are other tests to determine the body’s response to a viral infection or the body’s response to vaccination against a virus – in this case, they measure the amount of antibodies present in the blood.
Modern treatments
Currently, there is no specific treatment for patients with acute hepatitis B. Acute infection is usually short-lived and often clears up on its own due to the forces of the immune system. Your healthcare provider may recommend rest and appropriate food and drink to help your body fight infection.
Hospitalization may be required for patients who suffer from severe vomiting and cannot maintain adequate nutritional levels. It may also be required to prevent the development of complications.
Although a chronic infection cannot be cured, there are two standard treatments that can help control the virus and prevent further damage to the liver:
- liver transplantation – it may be recommended in cases where the liver is seriously damaged;
- antiviral drugs, such as Interferon – it is prescribed for a short period of time to suppress the virus.
“Antiviral therapy for chronic hepatitis B is carried out in the presence of certain indications,” says infectious disease specialist, hepatologist Tatyana Kovaleva. – The specialist evaluates the level of viral load, changes in liver enzymes, the degree of liver damage according to the results of ultrasound examination (ultrasound) of the abdominal organs and liver elastography (fibroscan) and then makes a decision.
“Despite the success of modern therapy, it is currently impossible to completely eliminate the hepatitis B virus from liver cells, since the DNA of the virus is able to integrate into the genetic apparatus of liver cells,” continues Dr. Tatyana Kovaleva. “Therefore, even with complete clinical recovery and the absence of hepatitis B virus in the blood, it remains in the liver cells for life. With a pronounced decrease in immunity (the use of immunosuppressive therapy, hormones, cytostatics, etc.), the hepatitis B virus can become active, which will require a new prescription of antiviral therapy.
The most reliable prevention is vaccination. Since 2000, it has been carried out for all children, starting from birth. And more recently for adults. Vaccines provide safe and reliable protection – tests show that 90 to 95% of vaccinations in healthy people lead to the development of resistance to hepatitis B.
Hepatitis B vaccination is safe. Side effects are usually minor, most often soreness at the injection site.
Contraindication to vaccination – allergy to any of the ingredients of the vaccine.
Popular questions and answers
Questions related to hepatitis B were answered by infectious disease specialist, hepatologist Tatyana Kovaleva.
In most adults, acute hepatitis B is asymptomatic without any clinical manifestations and ends in self-recovery. Only in 5-10% of adult patients the disease becomes chronic and continues for many years. This condition is called “chronic carriage of the virus” or “chronic hepatitis B”.
Because infection with the hepatitis B virus often does not cause jaundice, many patients are unaware that they have the disease. Often chronic hepatitis B is diagnosed during a routine examination, including during pregnancy. If chronic hepatitis B is detected in a pregnant woman, she can pass the infection on to her baby. Currently, it is recommended to control the level of viral load during pregnancy; if high rates are detected, a pregnant woman is prescribed prophylactic antiviral therapy. If the child was not vaccinated after birth, then the risk of infection from the mother with the hepatitis B virus can reach 90% or more. In childhood, the risk of the disease becoming chronic is 30-98%.
If chronic hepatitis B is detected, constant monitoring by a specialist is necessary.
Many patients with chronic hepatitis B may not have any symptoms for a long period of time. However, after a few years without antiviral therapy, severe manifestations of hepatitis – cirrhosis of the liver or liver cancer (hepatocellular carcinoma) may develop. Weight loss, increased fatigue, the appearance of yellowness of the skin and sclera may indicate the progression of the disease.