Hepatitis B

What is Hepatitis B?

Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). HBV infection can be of 2 types: acute (short-term) illness and chronic (long-term, 6 months or more) illness. 

What is the burden of Hepatitis B in India?

  • Approximately 4 crores people are living with HBV infection of which 90% are not aware about their infection status.
  • Most people who develop chronic HBV infection do not display any symptoms, till the disease has progressed to an advanced stage like liver damage (cirrhosis) and liver cancer.

How does Hepatitis B infection spreads?

HBV is transmitted through activities that involve contact with HBV infected blood or body fluids including:

  • Unsafe sexual practices
  • Injection of drug that involves sharing needles, syringes, or drug-preparation equipment of infected person.
  • Infected mother to child at the time of delivery
  • Contact with blood or open sores, wounds and ulcers of an infected person
  • Needle stick injury or injury due to sharp instruments
  • Sharing of items such as razors or toothbrushes of an infected person.

Can a person spread Hepatitis B and does not know about it? 

Yes. Majority of people with Hepatitis B infection do not know that they are infected since they do not have any symptoms. The virus quietly stays in the liver and multiplies. However, these people can act as “carrier” and can spread the virus to spouses, household contacts and other population group through above mentioned routes.

What are the ways through which Hepatitis B does not spread?

Hepatitis B infection does not spread through:

  • Food or water
  • By casual contacts like hugging, kissing, holding hands, coughing, sneezing or sharing of utensils,
  • Breastfeeding, unless there is an injury or open wound or ulcer on/near nipple. 

Who is ‘at risk’ for Hepatitis B infection?

  • Infants born to HBV infected mothers
  • Persons with multiple sex partners
  • Men who have sex with men, Female Sex workers, Transgenders
  • Sexual partners of HBV infected person
  • People who inject drugs
  • Family members of HBV infected persons
  • Health care workers who are at risk of occupational exposure to infected blood or body fluids
  • Hemodialysis patients
  • Persons who need repeated blood transfusion

Who should be screened for Hepatitis B infection?

The above-mentioned population ‘at risk’ should be screened for Hepatitis B infection.

In addition to it, following groups of people should also be screened for HBV infection:

  • Persons infected with hepatitis C and HIV
  • Blood and tissue donors
  • Pregnant women
  • Persons with abnormal liver function test
  • Prisoners
  • Persons on immunosuppressive therapy.

What tests are available for screening of a person for Hepatitis B infection?

  • HBV screening test includes 3 seromarkers: HBsAg, Anti-HBs, and Anti-HBc.
  • HBsAg is used to screen people for HBV infection. If found positive further investigations and confirmatory test (HBV-DNA) is advised.

What are the Signs and Symptoms of Hepatitis B infection?

Only some of the newly acquired Hepatitis B infections are symptomatic. Most children under the age of 5 years and newly infected adults are generally without any symptoms. Signs and Symptoms of acute HBV infections include following:

  • Jaundice
  • Dark urine
  • Clay-colored stool
  • Abdominal and Joint pain
  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting

Should general population be screened even if they don’t have any symptoms?

Yes. Most people with Hepatitis B don’t have any symptoms initially, however, liver damage can still occur. Screening for Hepatitis B will help to diagnose the disease at an early stage. This will help the people to access medical treatment and prevent liver damage.

How does getting tested for Hepatitis B help in protecting the person and his/her family members?

  • Early diagnosis of Hepatitis B can help the people to access the medical treatment and can prevent serious liver damage.
  • The person tested positive for Hepatitis B can follow safe practices and undertake necessary precautions to prevent spread of HBV to others.
  • Family members of Hepatitis B patients are at high risk of having the HBV infection. Hence, person with Hepatitis B must encourage their family members to get screened for Hepatitis B.
  • People with Hepatitis B infection must be encouraged to get their family members vaccinated with Hepatitis B vaccine.

Who should get vaccinated?

A safe and potent vaccine is available and can be given to all individuals. However, it is recommended for the following persons should get vaccinated:

  • All infants immediately after birth preferably within 24 hours
  • Unvaccinated children aged <18 years
  • Family members of the Hepatitis B infected person.
  • People at high risk
  • People with hepatitis C and HIV infection
  • People with chronic liver disease
  • Healthcare workers including doctors, nurses, lab technicians and para medical staff.
  • Person who might come in contact with Biomedical waste.
  • Persons seeking protection from HBV infection

What are the recommended doses of hepatitis B vaccine?

  • Infants should be given a birth dose within 24 hours of the delivery, followed by 3 doses at 6,10 and 14 weeks.
  • For children and adults, 3 doses are required. The person can start at any age. The second and third doses are administered at 1 and 6 months, respectively, after the first dose.

If the vaccination schedule is interrupted, does the schedule need to be restarted?

No, if the hepatitis B vaccine schedule is interrupted, the vaccine schedule does not need to be restarted. If the schedule is interrupted after the first dose, the second dose should be administered as soon as possible. The second and third doses should be separated by at least 8 weeks. If only the third dose has been delayed, it should be administered as soon as possible.

What should be done if the person has Hepatitis B?

  • Visit the nearest Health care facility and consult a doctor for advice, at the earliest.
  • Use of alcohol should be avoided, because it can cause additional liver damage.
  • A healthy lifestyle should be adopted, including regular physical activity and avoidance of food rich in fat.

How is Hepatitis B treated?

  • Several antiviral medications are available for Hepatitis B treatment but lifelong follow up is required.

References:

  1. https://www.nhp.gov.in/national-viral-hepatitis-control-program-(nvhcp)_pg
  2. https://www.who.int/news-room/fact sheets/detail/hepatitis-b
  3. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm