Health Informations For All: HEPATITIS B

HEPATITIS B

Hepatitis B Overview

Hepatitis is a general term that means inflammation of the liver. The liver can become inflamed as a result of infection, a disorder of the immune system, or exposure to alcohol, certain medications, toxins, or poisons.

Hepatitis B is caused by infection with the hepatitis B virus (HBV). This infection has 2 phases: acute and chronic.
- Acute (new, short-term) hepatitis B occurs shortly after exposure to the virus. A small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.
- Chronic (ongoing, long-term) hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.
- About 90-95% of people who are infected are able to fight off the virus so their infection never becomes chronic. Only about 5-10 percent of adults infected with HBV go on to develop chronic infection.
- HBV infection is one of the most important causes of infectious hepatitis.

People with chronic HBV infection are called chronic carriers. About two-thirds of these people do not themselves get sick or die of the virus, but they can transmit it to other people. The remaining one third develop chronic hepatitis B, a disease of the liver that can be very serious.
- The liver is an essential organ that the body needs to stay alive. Its most important functions are filtering many drugs and toxins out of the blood, storing energy for later use, helping with the absorption of certain nutrients from food, and producing substances that fight infections and control bleeding.
- The liver has an incredible ability to heal itself, but it can only heal itself if nothing is damaging it.
- Liver damage in chronic hepatitis B, if not stopped, continues until the liver becomes hardened and scarlike. This is called cirrhosis, a condition traditionally associated with alcoholism. When this happens, the liver can no longer carry out its normal functions, a condition called liver failure. The only treatment for liver failure is liver transplant.
- Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma.
- Any of these conditions can be fatal. About 15-25 percent of people with chronic hepatitis B die of liver disease.

Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV, of whom, more than 250,000 die from liver-related disease each year.

In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 1.25 million people are chronic carriers, and the disease causes about 5000 deaths each year.

The good news is that infection with HBV is almost always preventable. You can protect yourself and your loved ones from hepatitis B.

Hepatitis B Causes

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood.
- Semen and saliva, which contain small amounts of blood, also carry the virus.
- The virus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

People who are at increased risk of being infected with the hepatitis B virus include the following:
- Men or women who have multiple sex partners, especially if they don't use a condom
- Men who have sex with men
- Men or women who have sex with a person infected with HBV
- People with other sexually transmitted diseases
- People who inject drugs with shared needles
- People who receive transfusions of blood or blood products
- People who undergo dialysis for kidney disease
- Institutionalized mentally handicapped people and their attendants and family members
- Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood
- Infants born to infected mothers

In some cases, the source of transmission is never known.

The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. The rates of progression to chronic hepatitis B are as follows:
- 90% of infants infected at birth
- 30% of children infected at age 1-5 years
- 6% of people infected after age 5 years
- 5-10% of infected adults

You cannot get hepatitis B from the following activities:
- Being sneezed or coughed on
- Hugging
- Handshaking
- Breastfeeding
- Eating food or drinking water
- Casual contact (such as an office or social setting

Hepatitis B Symptoms

Half of all people infected with the hepatitis B virus have no symptoms.

Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to flu. Most people think they have flu and never think about having HBV infection.
- Appetite loss
- Feeling tired (fatigue)
- Nausea and vomiting
- Itching all over the body
- Pain over the liver (on the right side of the abdomen, under the lower rib cage)
- Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
- Urine becomes dark in color (like cola or tea).
- Stools are pale in color (grayish or clay colored).

Many types of acute viral hepatitis have similar symptoms (hepatitis A, hepatitis C).

Fulminant hepatitis is an unusual illness. It is a severe form of acute hepatitis that can be life threatening if not treated right away. The symptoms develop very suddenly.
- Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)
- Sudden collapse with fatigue
- Jaundice
- Swelling of the abdomen

Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice these symptoms:
- Feeling tired or weak
- Feeling confused or having difficulty concentrating
- Headache
- Not urinating
- Irritability

Symptoms of liver failure may include the following:
- Fluid retention causing swelling of the belly (ascites) and sometimes the legs
- Weight gain due to ascites
- Persistent jaundice
- Loss of appetite, weight loss, wasting
- Vomiting with blood in the vomit
- Bleeding from the nose, mouth, or rectum or blood in the stool
- Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

When to Seek Medical Care

Call your health care provider if you have any of the following:

Nausea and vomiting that does not go away in 1-2 days
Yellow skin or eyes
Dark-colored urine (like tea or cola)
Pain in the abdomen

Either of these situations also warrants a call to your health care provider:

You think that you might have been exposed to someone with hepatitis or that you might be at risk for any reason.
You have other medical problems and think that you might have hepatitis.

If you are unable to reach your health care provider or have any of the following, go immediately to a hospital emergency department.

Vomiting and cannot keep down any fluids
Severe pain or high fever
Confusion, delirium, or difficulty awakening

Self-Care at Home

The goals of self-care are to relieve symptoms and prevent worsening of the disease.

Drink plenty of fluids to prevent dehydration. Water is fine; broth, sports drinks, Jello, frozen ice treats (such as Popsicles), and fruit juices are even better because they provide calories.
Avoid medicines and substances that can cause harm to the liver, such as acetaminophen (Tylenol).
Avoid drinking alcohol until your health care provider OKs it. If your infection becomes chronic, you should avoid alcohol for the rest of your life.
Avoid using drugs, even legal drugs, without consulting your doctor. Hepatitis can change the way drugs affect you. If you take prescription medications, continue taking them unless your health care provider has told you to stop. Do not start any new medication (prescription or nonprescription), herbs, or supplements without first talking to your health care provider.
Try to eat enough for adequate nutrition. Eat foods that appeal to you, but try to maintain a balanced diet. Many people with hepatitis have the greatest urge to eat early in the day.
Take it easy. Your activity level should match your energy level.
Avoid prolonged, vigorous exercise until symptoms start to improve.
Call your health care provider for advice if your condition worsens or new symptoms appear.

Avoid any activity that may spread the infection to other people.

Medical Treatment

Acute hepatitis B infection

The most severe effect of acute hepatitis B is dehydration from vomiting and diarrhea.

If you are dehydrated, your doctor may prescribe IV fluid to help you feel better.

If you are experiencing significant nausea and vomiting, you will receive medicines to control these symptoms.

People whose symptoms are well controlled can be cared for at home.

If dehydration or other symptoms are severe or if you are extremely confused or difficult to arouse, you may need to stay in the hospital.

There is no treatment that can prevent acute HBV infection from becoming chronic.

Chronic hepatitis B infection

The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the blood and liver. Regularly measuring the amount of HBV DNA in the blood gives a good idea of how fast the virus is multiplying. The treatments now in use are antiviral drugs, which stop the virus from multiplying.

Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals with the disease.

Although there are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug Administration (FDA), research is ongoing. This means that dosages and treatment recommendations are subject to change.

Research is ongoing to find medications that work better with fewer side effects.

Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to chronic hepatitis B.

Decisions to start medications for treatment of hepatitis B are made by you and your health care provider, often in consultation with a specialist in diseases of the digestive system (gastroenterologist) or liver (hepatologist).

The decision is based on results of liver function tests, HBV DNA tests, and, frequently, liver biopsies after a complete history and physical examination.

Depending on the results of these tests, you may decide to start therapy or to delay it until later.

Treatment is usually started when blood tests indicate that liver functions are deteriorating and the amount of replicating HBV is rising. The interval between diagnosis and starting treatment can be a year or two or several years. Many people may never require medication.

If you have chronic hepatitis B infection and think you might be pregnant, let your health care provider know right away. If you are pregnant and think you have been exposed to hepatitis B, let your health care provider know right away.

Prevention

There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months.

This vaccine has successfully prevented infection in people exposed to the virus.
The vaccine is recommended for all children younger than 19 years. It can be given as part of their normal vaccination series.

The following groups should be vaccinated for hepatitis B:

All children younger than 18 years, including newborns--especially those born to mothers who are infected with HBV
All health care and public safety workers who may be exposed to blood
People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors
People who require hemodialysis for kidney disease
Travelers to countries where HBV infection is common - This includes most areas of Africa, Southeast Asia, China and central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America.
People who are in prison
People who live in residential facilities for developmentally disabled persons
People who inject illegal drugs
People with chronic liver disease such as hepatitis C
People who have multiple sex partners or have ever had a sexually transmitted disease
Men who have sex with men

Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B.

These include close contacts of people with HBV infection, health care workers who are exposed to HBV-contaminated blood, and infants born to mothers infected with HBV.
It also includes people who have finished only part of the 3-shot vaccination series.
Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80–90 percent of cases.

Other ways to protect yourself from HBV infection:

If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B.
If you inject drugs, don't share needles or other equipment.
Don't share anything that might have blood on it, such as a razor or toothbrush.
Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or piercer does not sterilize needles and equipment, use disposable gloves, or wash hands properly.
Health care workers should follow standard precautions and handle needles and sharps safely.
If you are pregnant or think you might be pregnant, tell your health care provider if you have any of the risk factors for HBV infection.

If you want more information about hepatitis B, you can visit full information in : http://www.emedicinehealth.com/hepatitis_b/page13_em.htm#Prevention