Hepatitis B

Hepatitis B is the inflammation of the liver caused by a virus known as Hepatitis B Virus (HBV). It is the world’s most common liver disorder, especially among the Asian population, and it is the leading cause for liver cirrhosis and liver cancer. More than 450 million people worldwide are infected with chronic HBV.

The infection has two phases:

  • Acute Hepatitis B lasts only a short period of time and patients usually recover completely. There is no strain of the HBV in the blood.
  • Chronic Hepatitis B is a life-long infection with HBV

HBV can survive for at least seven days outside the body.
 

How can I be infected?

HBV is transmitted through direct contact or exposure to blood, bodily fluid and donated organ from an infected person. HBV is commonly transmitted through:

  • Unprotected sex
  • Syringes
  • Contaminated tattooing, body piercing needles
  • Blood transfusion
  • Non-sterilised acupuncture needles
  • Non-sterilised dental/medical tools
  • Open wounds and sores

The most common form of transmission in Asia is from an infected mother to her baby during childbirth. Infected newborns have a 90% chance of developing chronic infection.
 

There are also those who are at greater risk of being infected with HBV because of their ethnic background, occupation or lifestyle choices:

  • Healthcare providers and emergency responders
  • Those with sexually-transmitted disease (STD)
  • Sexually promiscuous individuals
  • Drug users
  • Those living with an infected person
  • Recipients of blood transfusion before 1970
  • Those suffering from chronic liver disease
  • Kidney dialysis patients
  • Immigrants and children of immigrants from endemic countries such as Asia, Pacific Islands, South America, the Middle East, Eastern Europe

 

Symptoms

Hepatitis B is known as the “silent” infection because it often does not show any symptom. Most people feel healthy and do not know that they have been infected and unknowingly pass the virus to others. In other instances, the symptoms are very mild and may be mistaken for flu. Loss of appetite, fatigue, joint or muscle pain and nausea may be evident. It can be followed by tenderness in the right upper abdomen, dark-coloured urine, clay-coloured stool and jaundice. Symptoms may develop within 30 to 180 days (incubation period) of exposure to the virus.

Chronic Hepatitis B patients rarely show any symptom at the early stage. When symptoms appear, they are usually due to liver damage caused by the infection:

  • Ascites (accumulation of fluid in the abdomen)
  • Confusion, difficulty in concentrating
  • Dehydration
  • Persistent jaundice
  • Vomitting blood

 

Diagnosis

A blood test is required to diagnose Hepatitis B infection. It would also help to determine whether a patient is a carrier or having acute or chronic Hepatitis B.

If one is suspected to have chronic infection, regular additional tests will be required:

  • Liver biopsy – to determine the degree of inflammation and scarring of the liver
  • Ultrasound – to determine the condition of the liver

Blood-test

 

Complications

A rare complication of acute Hepatitis B infection is fulminant hepatitis, a severe life-threatening condition.

Chronic infection can lead to liver cirrhosis, liver cancer, liver failure and death.

Cirrhotic-liver

Treatment

Currently, there is no cure for Hepatitis B infection but there are treatments available to suppress or eradicate the virus and prevent the progress of liver damage.

In acute Hepatitis B infection, supportive measures to counteract with visible symptoms are prescribed. Patients recover completely within six months and develop life-long immunity.

Chronic Hepatitis B can now be treated with specific antiviral medications which suppress the virus. Regular laboratory and diagnostic tests and review with one’s doctor are necessary in order to monitor the level of virus in the blood and to detect cirrhosis or liver cancer as early as possible

If one is infected with HBV and plan to get pregnant, her doctor will arrange to protect the baby with Hepatitis B Immuno Globulin (HBIG) and vaccinate the newborn within 12 hours of birth.

 

Prevention

  • Hepatitis B vaccination or a combined Hepatitis A and Hepatitis B vaccination
  • Hepatitis B Immuno Globulin (HBIG) – if one is unvaccinated and has been exposed to the virus
  • Practise safe sex
  • Do not share needles, personal grooming items (e.g. toothbrush, razor) or cutting tools with an infected person
  • Avoid direct contact with blood and bodily fluids
  • Use new and sterilised needles are used for body piercing, tattoos and acupuncture

 

Prognosis

The prognosis of acute Hepatitis B is good, the recovery is complete and the patients develop life-long immunity against HBV.

Patients with chronic Hepatitis B infection need to be reviewed by a liver specialist regularly so as to arrest any development of cirrhosis and liver cancer. Abstaining from alcohol can prevent further aggravation to the infected liver. A healthy balanced diet has been shown to improve the outcome of chronic Hepatitis B infection.